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Dubale AT, Tareke AA, Butta FW, Shibabaw AA, Eniyew EB, Ahmed MH, Kassie SY, Demsash AW, Chereka AA, Dube GN, Walle AD, Kitil GW. Healthcare professionals' willingness to utilize a mobile health application for adverse drug reaction reporting in a limited resource setting: An input for digital health, 2023. Eur J Obstet Gynecol Reprod Biol X 2024; 23:100324. [PMID: 39050924 PMCID: PMC11268114 DOI: 10.1016/j.eurox.2024.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/15/2024] [Accepted: 06/27/2024] [Indexed: 07/27/2024] Open
Abstract
Background Adverse drug reactions (ADRs) are a significant public health concern, particularly in limited resource settings where underreporting is prevalent due to various challenges. Mobile health applications (mHealth apps) offer a promising solution to enhance pharmacovigilance by facilitating easier and more efficient ADR reporting. However, despite the increasing availability and use of mHealth apps, there is a lack of evidence on healthcare professionals' willingness to adopt them for ADR reporting in resource-constrained environments. Therefore, this study aimed to assess the willingness of healthcare professionals in Ethiopia to utilize mobile health applications for adverse drug reaction reporting and identify associated factors. Methods We carried out a cross-sectional study involving 422 healthcare professionals working in institutional settings. We gathered data through a pretested questionnaire that participants completed themselves. We inputted the data using Epi Data V.4.6 and analyzed it using SPSS V.26. Our analysis involved conducting multivariable logistic regression to identify the factors influencing the likelihood of healthcare professionals using mobile applications to report adverse drug reactions. Results The study involved 389 healthcare professionals. Approximately 301 (77.4 %) of them expressed willingness to utilize mobile applications for reporting adverse drug reactions. The willingness to utilize mobile applications was significantly associated with the type of mobile phone (smart: AOR 3.56; 95 % CI 2.15-5.67), basic computer training (AOR 4.43; 95 % CI 2.27-8.64), mobile health-related training (AOR 1.96; 95 % CI 1.01-3.79), attitude (AOR 4.01; 95 % CI 2.19-7.35), perceived ease of use (AOR 2.91; 95 % CI 1.59-5.23), and perceived usefulness (AOR 2.10; 95 % CI 1.15-3.85). Conclusions Overall, there was a high proportion of healthcare professionals willing to use mobile devices for reporting drug adverse reactions. Their willingness correlated with factors such as the type of mobile phone, perceived ease of use, attitude, training, and perceived usefulness of mobile applications. With the increasing use of smartphones, motivation among healthcare professionals is rising. Basic computer and mHealth-related training are crucial for enhancing the acceptability of such applications and should be incorporated into future implementations. Taking these factors into account could offer insights into the design and implementation of mobile applications for adverse drug reactions in Ethiopia.
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Affiliation(s)
- Abiy Tasew Dubale
- Department of Health Informatics, College of Health Science, Mattu University, Mattu, Ethiopia
| | - Abiyu Abadi Tareke
- Deparment of Monitoring and Evaluation, West Gondar Zonal Health Department, Gondar, Ethiopia
| | - Fikadu Wake Butta
- Department of Health Informatics, College of Health Science, Mattu University, Mattu, Ethiopia
| | - Adamu Ambachew Shibabaw
- Department of Health Informatics, College of Health Science, Mattu University, Mattu, Ethiopia
- Department of Midwifery, College of Health Science, Mattu University, Mattu, Ethiopia
- Department of Health Informatics, College of Health Science, Wallo University, Wallo, Ethiopia
- Deparment of Monitoring and Evaluation, West Gondar Zonal Health Department, Gondar, Ethiopia
- Department of Health Informatics, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Ermias Bekele Eniyew
- Department of Health Informatics, College of Health Science, Wallo University, Wallo, Ethiopia
| | | | - Sisay Yitayih Kassie
- Department of Health Informatics, College of Health Science, Mattu University, Mattu, Ethiopia
| | | | - Alex Ayenew Chereka
- Department of Health Informatics, College of Health Science, Mattu University, Mattu, Ethiopia
| | - Geleta Nenko Dube
- Department of Health Informatics, College of Health Science, Mattu University, Mattu, Ethiopia
| | - Agmasie Damtew Walle
- Department of Health Informatics, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Gemeda Wakgari Kitil
- Department of Midwifery, College of Health Science, Mattu University, Mattu, Ethiopia
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Siira E, Tyskbo D, Nygren J. Healthcare leaders' experiences of implementing artificial intelligence for medical history-taking and triage in Swedish primary care: an interview study. BMC PRIMARY CARE 2024; 25:268. [PMID: 39048973 PMCID: PMC11267767 DOI: 10.1186/s12875-024-02516-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Artificial intelligence (AI) holds significant promise for enhancing the efficiency and safety of medical history-taking and triage within primary care. However, there remains a dearth of knowledge concerning the practical implementation of AI systems for these purposes, particularly in the context of healthcare leadership. This study explores the experiences of healthcare leaders regarding the barriers to implementing an AI application for automating medical history-taking and triage in Swedish primary care, as well as the actions they took to overcome these barriers. Furthermore, the study seeks to provide insights that can inform the development of AI implementation strategies for healthcare. METHODS We adopted an inductive qualitative approach, conducting semi-structured interviews with 13 healthcare leaders representing seven primary care units across three regions in Sweden. The collected data were subsequently analysed utilizing thematic analysis. Our study adhered to the Consolidated Criteria for Reporting Qualitative Research to ensure transparent and comprehensive reporting. RESULTS The study identified implementation barriers encountered by healthcare leaders across three domains: (1) healthcare professionals, (2) organization, and (3) technology. The first domain involved professional scepticism and resistance, the second involved adapting traditional units for digital care, and the third inadequacies in AI application functionality and system integration. To navigate around these barriers, the leaders took steps to (1) address inexperience and fear and reduce professional scepticism, (2) align implementation with digital maturity and guide patients towards digital care, and (3) refine and improve the AI application and adapt to the current state of AI application development. CONCLUSION The study provides valuable empirical insights into the implementation of AI for automating medical history-taking and triage in primary care as experienced by healthcare leaders. It identifies the barriers to this implementation and how healthcare leaders aligned their actions to overcome them. While progress was evident in overcoming professional-related and organizational-related barriers, unresolved technical complexities highlight the importance of AI implementation strategies that consider how leaders handle AI implementation in situ based on practical wisdom and tacit understanding. This underscores the necessity of a holistic approach for the successful implementation of AI in healthcare.
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Affiliation(s)
- Elin Siira
- School of Health and Welfare, Halmstad University, Box 823, Halmstad, 301 18, Sweden
| | - Daniel Tyskbo
- School of Health and Welfare, Halmstad University, Box 823, Halmstad, 301 18, Sweden
| | - Jens Nygren
- School of Health and Welfare, Halmstad University, Box 823, Halmstad, 301 18, Sweden.
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de Carvalho RR, Carvalho F, de Oliveira EB, Souza da Silva R, Rados DV, Mattiello R, Gonçalves MR, Umpierre RN, Giugliani C. Doubts about the diagnosis and treatment of syphilis in pregnancy among primary care professionals in a telehealth service. PLoS One 2024; 19:e0306192. [PMID: 38941327 PMCID: PMC11213312 DOI: 10.1371/journal.pone.0306192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 06/11/2024] [Indexed: 06/30/2024] Open
Abstract
This cross-sectional study aims to describe doubts regarding the diagnosis and treatment of syphilis in pregnancy among primary care professionals in a telehealth service. All teleconsultations (TCs) offered through TelessaúdeRS-UFRGS to primary health care (PHC) services in the state of Rio Grande do Sul between 2018 and 2021 involving syphilis in pregnancy were included. A total of 356 (TCs) were analyzed. The main doubts about syphilis during pregnancy raised by primary care professionals were related to the need for retreatment (35%), diagnostic definition (23%) and initial treatment (16%). In addition, 95% of TCs were suitable for diagnosing and treating syphilis based on the 2020 Brazilian Ministry of Health guideline. This study suggests that TCs can identify failures in the diagnosis and treatment of public health problems and support decision making in PHC involving syphilis in pregnancy.
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Affiliation(s)
- Renata Rosa de Carvalho
- Núcleo de Telessaúde do Rio Grande do Sul (TelessaúdeRS-UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Post Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Fabiana Carvalho
- Núcleo de Telessaúde do Rio Grande do Sul (TelessaúdeRS-UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Post Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Elise Botteselle de Oliveira
- Núcleo de Telessaúde do Rio Grande do Sul (TelessaúdeRS-UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rodolfo Souza da Silva
- Núcleo de Telessaúde do Rio Grande do Sul (TelessaúdeRS-UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Dimitris Varvaki Rados
- Núcleo de Telessaúde do Rio Grande do Sul (TelessaúdeRS-UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rita Mattiello
- Núcleo de Telessaúde do Rio Grande do Sul (TelessaúdeRS-UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Post Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Social Medicine Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcelo Rodrigues Gonçalves
- Núcleo de Telessaúde do Rio Grande do Sul (TelessaúdeRS-UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Post Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Social Medicine Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Roberto Nunes Umpierre
- Núcleo de Telessaúde do Rio Grande do Sul (TelessaúdeRS-UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Social Medicine Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Camila Giugliani
- Post Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Social Medicine Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Chu G, Silva C, Adams K, Chacko B, Attia J, Nathan N, Wilson R. Exploring the factors affecting home dialysis patients' participation in telehealth-assisted home visits: A mixed-methods study. J Ren Care 2024; 50:128-137. [PMID: 37434485 DOI: 10.1111/jorc.12475] [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] [Received: 03/27/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Technology, such as telehealth, is increasingly used to support home dialysis patients. The challenges patients and carers face when home dialysis nursing visits are provided via telehealth have yet to be explored. OBJECTIVES To explore patients' and carers' perspectives as they transition to telehealth-assisted home visits and identify the factors influencing their engagement in this modality. DESIGN A mixed-methods approach, guideed by the behaviour change wheel using the capability, opportunity, motivation-behaviour model to explore individual's perceptions of telehealth. PARTCIPANTS Home dialysis patients and their carers. MEASURUEMENTS Suveys and qualitative interviews. METHODS A mixed-methods approach was undertaken, combining surveys and qualitative interviews. It was guided by the Behaviour Change Wheel using the Capability, Opportunity, Motivation- Behaviour model to explore individuals' perceptions of telehealth. RESULTS Thirty-four surveys and 21 interviews were completed. Of 34 survey participants, 24 (70%) preferred face-to-face home visits and 23 (68%) had previously engaged in telehealth. The main perceived barrier identified in the surveys was knowledge of telehealth, but participants believed there were opportunities for them to use telehealth. Interview results revealed that the convenience and flexibility of telehealth were perceived as the main advantages of telehealth. However, challenges such as the ability to conduct virtual assessments and to communicate effectively between clinicians and patients were identified. Patients from non-English speaking backgrounds and those with disabilities were particularly vulnerable because of the many barriers they faced. These challenges may further entrench the negative view regarding technology, as discussed by interview participants. CONCLUSION This study suggested that a blended model combining telehealth and face-to-face services would allow patient choice and is important to facilitate equity of care, particularly for those patients who were unwilling or had difficulty adopting technology.
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Affiliation(s)
- Ginger Chu
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Carla Silva
- Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Kelly Adams
- Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Bobby Chacko
- Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Nicole Nathan
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| | - Rhonda Wilson
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
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Wiley K, Johnson J, Coleman C, Olson C, Chuo J, McSwain D. Translating Value Across Telehealth Stakeholders: A Rapid Review of Telehealth Measurement Evidence and a New Policy Framework to Guide Telehealth Researchers. Telemed J E Health 2024; 30:1559-1573. [PMID: 38563764 DOI: 10.1089/tmj.2023.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Introduction: The surge in virtual care during the pandemic was accompanied by an increase in telehealth data of interest to policy stakeholders and other health care decision makers. However, these data often require substantial preprocessing and targeted analyses to be usable. By deliberately evaluating telehealth services with stakeholder perspectives in mind, telehealth researchers can more effectively inform clinical and policy decision making. Objective: To examine existing literature on telehealth measurement and evaluation and develop a new policy-oriented framework to guide telehealth researchers. Materials and Methods: A systematic rapid review of literature on telehealth measurement and evaluation was conducted by two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The findings were analyzed and applied to the Supporting Pediatric Research on Outcomes and Utilization of Telehealth Evaluation and Measurement (STEM) Framework through the lens of key health care delivery decision makers to create a STEM Policy Framework Results: An initial search yielded 2,324 peer-reviewed articles and gray literatyre from 2012 to 2022, of which 56 met inclusion criteria. These measured and evaluated telehealth access (41.5%), quality (32.1%), cost (15.1%), experience (5.7%), and utilization (5.7%), consistent with the STEM Framework domains, but there was no universal approach. The STEM Policy Framework focuses this literature by describing data measures for each domain from the perspectives of five stakeholders. Conclusions: Literature describing measurement and evaluation approaches for telehealth is limited and not standardized, with few considering policy stakeholder perspectives. With this proposed STEM Policy Framework, we aim to improve this body of literature and support researchers seeking to inform telehealth policy through their work.
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Affiliation(s)
- Kevin Wiley
- Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jada Johnson
- Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christina Coleman
- Department of Pediatrics, UNC School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christina Olson
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - John Chuo
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David McSwain
- Department of Pediatrics, UNC School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Usher K, Williams J, Jackson D. The potential of virtual healthcare technologies to reduce healthcare services' carbon footprint. Front Public Health 2024; 12:1394095. [PMID: 38818441 PMCID: PMC11137209 DOI: 10.3389/fpubh.2024.1394095] [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: 03/01/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
The COVID-19 pandemic demonstrated the potential to reduce our carbon footprint especially by reducing travel. We aim to describe healthcare and health education services' contribution to the global climate emergency and identify the need for increased use of virtual health service delivery and undergraduate/postgraduate education to help reduce the impact of health service and health education delivery on the environment. Health care services, as one of the largest contributors to carbon emissions, must take steps to rapidly reduce their carbon footprint. Health services have unfortunately paid little attention to this issue until recently. Virtual healthcare and education have a valuable role in transition to a net carbon-zero outcome. Given the increasing use of and satisfaction with virtual health services such as telehealth, and the increase in virtual education opportunities, it is important that a concerted effort is undertaken to increase their use across health services and education in the future.
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Affiliation(s)
- Kim Usher
- Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
- New England Virtual Health Network (NEViHN), Armidale, NSW, Australia
| | - Jen Williams
- Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
- New England Virtual Health Network (NEViHN), Armidale, NSW, Australia
| | - Debra Jackson
- School of Nursing, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Vaidya V, Patil V, Oswal J, Narula A, Khare Y, Patil P, Deshpande R, Lunge S, Dasgupta S, Dahiphale R, Kulkarni R, Mahajan A, Chelluri S, Teli A. Healthcare in the Modern Era: Launching a Telemedicine-Based OPD Consultation in Rural Pune (Process, Results, and Challenges). Cureus 2024; 16:e60310. [PMID: 38883020 PMCID: PMC11177277 DOI: 10.7759/cureus.60310] [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: 05/14/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Telemedicine serves as a means of overcoming geographical barriers and increasing access to specialist care. This study focuses on the impact of telemedicine on the early diagnosis and treatment of patients, as well as its effect on patient satisfaction. In addition, the study examines the obstacles and facilitators that influence the implementation of telemedicine. Objectives The primary objectives of this study are to assess the effectiveness of telemedicine in facilitating early diagnosis and treatment for patients in need of specialist consultations, to evaluate patient satisfaction with specialist care delivered through telemedicine, and to identify the factors that influence the successful implementation of telemedicine in rural healthcare centers. Methodology An exploratory feasibility study was carried out at two rural health training centers (RHTCs) over a one-year period, enrolling 400 patients requiring specialist consultations. The study involved establishing a telemedicine center, implementing teleconsultations, and collecting data through patient interviews and self-administered questionnaires. Results A majority of teleconsultations, over 79%, were deemed valuable by medical officers, resulting in improved management, better counseling, and earlier diagnoses. More than 76% of patients found telemedicine to be acceptable due to the reduction in travel time and cost. The most common health concerns among patients were diabetes, hypertension, and skin disorders. The study also revealed several challenges, including limited specialist personnel, waiting times, prescription limitations, and connectivity issues. Discussion Telemedicine has proven to be a valuable tool for rural healthcare delivery, providing patients with access to specialist consultations and improving patient outcomes. Both patients and medical officers reported positive experiences with telemedicine. The findings of this study align with existing literature, which highlights the benefits of telemedicine in managing chronic diseases and increasing patient satisfaction. However, it is crucial to address challenges, such as personnel limitations and connectivity issues, to optimize telemedicine's effectiveness. Conclusion Telemedicine offers great potential for enhancing access to specialist care and achieving universal healthcare in rural areas. Despite its limitations, telemedicine demonstrates promising outcomes and warrants further development and optimization to ensure its successful implementation in rural healthcare centers.
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Affiliation(s)
- Varsha Vaidya
- Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, IND
| | - Vaibhav Patil
- Cardiology, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, IND
| | - Jitendra Oswal
- Pediatric Rheumatology, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, IND
| | - Arvinder Narula
- Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, IND
| | - Yogesh Khare
- Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, IND
| | - Prajakta Patil
- Internal Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, IND
| | - Ruma Deshpande
- Pediatric Endocrinology, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, IND
| | - Snehal Lunge
- Dermatology, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, IND
| | - Sukanya Dasgupta
- Internal Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, IND
| | - Ramdas Dahiphale
- Pediatrics, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, IND
| | - Rohit Kulkarni
- Orthopaedics, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, IND
| | - Amit Mahajan
- Orthopaedics and Trauma, Bharati Hospital, Pune, IND
| | - Srinivasa Chelluri
- Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, IND
| | - Advait Teli
- Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, IND
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Ali M, Sullivan G. Racial Differences in Expanded Telemedicine Use During COVID-19: A Literature Review. Telemed J E Health 2024; 30:1394-1400. [PMID: 38064549 DOI: 10.1089/tmj.2023.0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
Background: The COVID-19 pandemic prompted the widespread adoption of telemedicine to deliver health care services while minimizing in-person contact. However, concerns persist regarding equitable access to telemedicine, especially for vulnerable populations. This study examines the utilization patterns of telemedicine by race in the United States, considering different modalities, medical specialties, and geographic regions. Methods: A comprehensive review of 26 articles published between January 2020 and August 2022 was conducted to analyze racial disparities in telemedicine use during the pandemic. Data from electronic health records and self-reported race were compiled for analysis. Variations based on geography, clinical care types, telemedicine modalities (audio or video), and study design were explored. Results: The findings indicate the presence of racial disparities in telemedicine utilization, with minority groups exhibiting lower usage rates compared with Whites. The location of outpatient clinics and clinical care types did not significantly influence telemedicine use by race. Among studies comparing telemedicine modalities, African Americans were more likely to choose audio/phone visits over video visits. Studies employing a pre-post design were less likely to identify disparities in telemedicine use by race. Conclusions: This study consistently demonstrates increasing racial disparities in telemedicine use. Future research should focus on identifying contributing factors and developing strategies to address these disparities. Policymakers should consider implementing initiatives promoting equitable access to telemedicine, including financial assistance, improved broadband infrastructure, and digital literacy programs. By addressing these barriers, telemedicine can play a crucial role in reducing health care disparities and improving access to care for all Americans.
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Affiliation(s)
- Mohab Ali
- Center for Health services Research, Psychiatric Research Institute University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Greer Sullivan
- Center for Health services Research, Psychiatric Research Institute University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Bostan S, Yesildag AY, Balci F. Family Physicians' Perspectives on the Pros, Cons, and Application Areas of Telemedicine: A Qualitative Study. Telemed J E Health 2024; 30:1450-1458. [PMID: 38294897 DOI: 10.1089/tmj.2023.0574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Background: There is evidence that telemedicine can be used safely, easily, and cost-effectively in primary health care services. This study aims to determine family physicians' opinions regarding the potential advantages, disadvantages, and usage areas of telemedicine in primary health care services. Methods: This study was designed with a qualitative case study. The Standards for Reporting Qualitative Research (SRQR) checklist was followed throughout the research process. Interviews were conducted with family physicians working in a provincial center using snowball sampling in the study. MaxQDA 20 software was used for analysis process, and themes and subthemes were identified through a deductive-reflective thematic analysis method. The family physicians who participated in the study are between 29 and 56. In addition, family medicine specialists, general practitioners, and academic department heads were included in the study. Family physicians are evenly distributed in terms of gender and professional experience. Results: All interviewed family physicians stated that they had not received professional or technical training in delivering telemedicine. It was observed that family physicians had different perspectives on telemedicine in primary care. The data obtained in the study were analyzed under the main themes of the advantages, disadvantages, and services that can be provided in primary telemedicine. Physicians have different views on telemedicine, including negative, undecided, and positive opinions. Conclusion: It is understood that many services could be delivered remotely if the scope, procedures, and processes of the services to be provided are determined with guidelines. It is recommended that family physicians receive professional and technical training in telemedicine.
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Affiliation(s)
- Sedat Bostan
- Health Management Department, Karadeniz Technical University, Trabzon, Turkey
| | - Ahmet Y Yesildag
- Health Management Department, Karadeniz Technical University, Trabzon, Turkey
- Health Sciences Institute, Ankara University, Ankara, Turkey
| | - Fatma Balci
- Health Management Department, Karadeniz Technical University, Trabzon, Turkey
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Farford BA, Bulbarelli EM, Ricketts I, Nath S, Ahuja AS, Keith J. Accuracy of Telehealth Visits for Acute Care Needs in Family Medicine. Cureus 2024; 16:e59569. [PMID: 38832206 PMCID: PMC11144591 DOI: 10.7759/cureus.59569] [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: 05/02/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction As primary care practices transition to a post-pandemic system of healthcare, it is important to recognize the benefits of offering telehealth services. Little research is available on the effectiveness of telehealth visits for managing acute illnesses or conditions in primary care practice. Methods Using the reporting functionality in the Epic™ electronic health record (EHR) (Epic Systems Corporation, Verona), a report was generated to identify all telehealth visit encounters that were completed in a family medicine clinic from March 1, 2020, to June 30, 2020. The report identified patients who had an acute complaint and required an in-office visit within 60 days of the telehealth encounter. If the patient required a face-to-face visit, that was not directed by the provider, the chart was reviewed to determine whether the diagnosis changed. The primary outcome was returning for a face-to-face visit within 30 days of the telehealth visit for the same acute need. Results The cohort included 349 telehealth visits for 303 patients. For patients who had more than one telehealth visit, only the first one was included in the analysis. Among the 303 patients, 50 (16.5%) returned for a face-to-face visit within 30 days of the telehealth visit (95% confidence interval: 12.5%-21.2%), and 71 (23.6%) returned for a telehealth visit within 60 days (95% confidence interval: 18.9%-28.8%). Furthermore, 19 of the 50 patients (38%) that returned for a face-to-face visit did not have a change in diagnosis, and, in some instances, the diagnosis made on the telehealth visit was only slightly different from the face-to-face visit. Discussion and conclusion Telehealth, specifically two-way, synchronous, interactive patient-provider communication through audio and video equipment, for acute care needs in a primary care practice helps reduce the need for in-person visits and can address patient complaints without the need for in-person follow-up.
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Affiliation(s)
| | | | | | - Sahil Nath
- Family Medicine, Mayo Clinic, Jacksonville, USA
| | - Abhimanyu S Ahuja
- Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Josh Keith
- Family Medicine, Mayo Clinic, Jacksonville, USA
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11
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Wray CM, Ferguson JM, Greene L, Griffin A, Van Campen J, O'Shea AM, Slightam C, Zulman DM. Overcoming Obstacles: Barriers to Virtual Care Use Among Video-Enabled Tablet Recipients in the Veterans Health Administration. J Gen Intern Med 2024; 39:549-556. [PMID: 37914909 PMCID: PMC10973323 DOI: 10.1007/s11606-023-08468-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION The Veterans Health Administration (VHA) distributes video-enabled tablets to individuals with barriers to accessing care. Data suggests that many tablets are under-used. We surveyed Veterans who received a tablet to identify barriers that are associated with lower use, and evaluated the impact of a telephone-based orientation call on reported barriers and future video use. METHODS We used a national survey to assess for the presence of 13 barriers to accessing video-based care, and then calculated the prevalence of the barriers stratified by video care utilization in the 6 months after survey administration. We used multivariable modeling to examine the association between each barrier and video-based care use and evaluated whether a telephone-based orientation modified this association. RESULTS The most prevalent patient-reported barriers to video-based care were not knowing how to schedule a visit, prior video care being rescheduled/canceled, and past problems using video care. Following adjustment, individuals who reported vision or hearing difficulties and those who reported that video care does not provide high-quality care had a 19% and 12% lower probability of future video care use, respectively. Individuals who reported no interest in video care, or did not know how to schedule a video care visit, had an 11% and 10% lower probability of being a video care user, respectively. A telephone-based orientation following device receipt did not improve the probability of being a video care user. DISCUSSION Barriers to engaging in virtual care persist despite access to video-enabled devices. Targeted interventions beyond telephone-based orientation are needed to facilitate adoption and engagement in video visits.
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Affiliation(s)
- Charlie M Wray
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Section of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| | | | - Liberty Greene
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| | - Ashley Griffin
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| | - James Van Campen
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| | - Amy Mj O'Shea
- The Center for Access and Delivery Research and Evaluation (CADRE, Iowa City VA Healthcare System, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Cindie Slightam
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| | - Donna M Zulman
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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12
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Morgan JW, Salmon MK, Ambady M, Piazza KM, Rhodes CM, Eneanya ND, Shea JA, Grande D. Factors Informing High-Risk Primary Care Patient Choice around Telehealth Use: a Framework. J Gen Intern Med 2024; 39:540-548. [PMID: 37940757 PMCID: PMC10973282 DOI: 10.1007/s11606-023-08491-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND While telehealth's presence in post-pandemic primary care appears assured, its exact role remains unknown. Value-based care's expansion has heightened interest in telehealth's potential to improve uptake of preventive and chronic disease care, especially among high-risk primary care populations. Despite this, the pandemic underscored patients' diverse preferences around using telehealth. Understanding the factors underlying this population's preferences can inform future telehealth strategies. OBJECTIVE To describe the factors informing high-risk primary care patient choice of whether to pursue primary care via telehealth, in-office or to defer care altogether. DESIGN Qualitative, cross-sectional study utilizing semi-structured telephone interviews of a convenience sample of 29 primary care patients between July 13 and September 30, 2020. PARTICIPANTS Primary care patients at high risk of poor health outcomes and/or acute care utilization who were offered a follow-up primary care visit via audiovisual, audio-only or in-office modalities. APPROACH Responses were analyzed via grounded theory, using a constant comparison method to refine emerging categories, distinguish codes, and synthesize evolving themes. KEY RESULTS Of the 29 participants, 16 (55.2%) were female and 19 (65.5%) were Black; the mean age (SD) was 64.6 (11.1). Participants identified four themes influencing their choice of visit type: perceived utility (encapsulating clinical and non-clinical utility), underlying costs (in terms of time, money, effort, and safety), modifiers (e.g., participants' clinical situation, choice availability, decision phenotype), and drivers (inclusive of their background experiences and digital environment). The relationship of these themes is depicted in a novel framework of patient choice around telehealth use. CONCLUSIONS While visit utility and cost considerations are foundational to participants' decisions around whether to pursue care via telehealth, underappreciated modifiers and drivers often magnify or mitigate these considerations. Policymakers, payers, and health systems can leverage these factors to anticipate and enhance equitable high-value telehealth use in primary care settings among high-risk individuals.
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Affiliation(s)
- John W Morgan
- Leonard Davis Institute at the University of Pennsylvania, Philadelphia, PA, USA.
- Department of Medical Assistance Services, Commonwealth of Virginia, Richmond, VA, USA.
| | - Mandy K Salmon
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Maya Ambady
- Albright Stonebridge Group, Washington, DC, USA
- Center for Healthcare Innovation, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Kirstin M Piazza
- Center for Health Equity Research and Promotion, Michael J Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Corinne M Rhodes
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nwamaka D Eneanya
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Judy A Shea
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David Grande
- Leonard Davis Institute at the University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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13
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Kyei KA, Onajah GN, Daniels J. The emergence of telemedicine in a low-middle-income country: challenges and opportunities. Ecancermedicalscience 2024; 18:1679. [PMID: 38566762 PMCID: PMC10984837 DOI: 10.3332/ecancer.2024.1679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Indexed: 04/04/2024] Open
Abstract
The quality of cancer care delivery varies across different regions of Ghana, highlighting the need for improved access to quality healthcare services. Telemedicine has emerged as a promising solution to address this disparity, as it can reduce costs and improve access to healthcare services for cancer patients in remote areas. Despite the widely reported benefits of telemedicine, its adoption in low-resource settings has been slow due to several challenges. This study explores strategies for incorporating telemedicine into the current healthcare system in Ghana for the benefit of all patients especially those diagnosed with cancer. The study also highlights the current challenges and opportunities associated with the implementation and utilisation of telemedicine in Ghana. This research was a cross-sectional study conducted in Accra, Ghana that adopted a mixed-methods approach. Participants were selected through multi-stage probability sampling. Quantitative data were collected via a survey whereas qualitative data were obtained by means of in-depth interviews and focus group discussions among healthcare professionals, patients and key stakeholders in the telemedicine industry. The Statistical Program for the Social Sciences (version 21) was used to assemble, analyse and display the research data. The major challenges discussed centered on high initial investment costs, privacy and security concerns, poor internet connectivity, insufficient infrastructure and training of healthcare providers as well as the resistance to change among healthcare professionals. The study contributes to the understanding of telemedicine adoption in Ghana with findings underscoring the potential to address healthcare challenges while highlighting the need to overcome implementation obstacles. The study findings also provide valuable insights for policymakers, healthcare institutions and stakeholders to enhance telemedicine adoption in Ghana.
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Affiliation(s)
- Kofi Adesi Kyei
- Department of Radiography, University of Ghana, Legon, Accra, Ghana
- Accra Business School, Leaders Factory, Spintex, Accra, Ghana
- https://orcid.org/0000-0003-3485-5368
| | | | - Joseph Daniels
- National Radiotherapy, Oncology and Nuclear Medicine Centre, Korle Bu Teaching Hospital, P.O. Box KB 369, Korle Bu, Accra, Ghana
- https://orcid.org/0000-0002-1466-150X
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14
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Aggelidis X, Kritikou M, Makris M, Miligkos M, Papapostolou N, Papadopoulos NG, Xepapadaki P. Tele-Monitoring Applications in Respiratory Allergy. J Clin Med 2024; 13:898. [PMID: 38337592 PMCID: PMC10856055 DOI: 10.3390/jcm13030898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Respiratory allergic diseases affect over 500 million people globally and pose a substantial burden in terms of morbidity, mortality, and healthcare costs. Restrictive factors such as geographical disparities, infectious pandemics, limitations in resources, and shortages of allergy specialists in underserved areas impede effective management. Telemedicine encompasses real-time visits, store-and-forward option triage, and computer-based technologies for establishing efficient doctor-patient communication. Recent advances in digital technology, including designated applications, informative materials, digital examination devices, wearables, digital inhalers, and integrated platforms, facilitate personalized and evidence-based care delivery. The integration of telemonitoring in respiratory allergy care has shown beneficial effects on disease control, adherence, and quality of life. While the COVID-19 pandemic accelerated the adoption of telemedicine, certain concerns regarding technical requirements, platform quality, safety, reimbursement, and regulatory considerations remain unresolved. The integration of artificial intelligence (AI) in telemonitoring applications holds promise for data analysis, pattern recognition, and personalized treatment plans. Striking the balance between AI-enabled insights and human expertise is crucial for optimizing the benefits of telemonitoring. While telemonitoring exhibits potential for enhancing patient care and healthcare delivery, critical considerations have to be addressed in order to ensure the successful integration of telemonitoring into the healthcare landscape.
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Affiliation(s)
- Xenofon Aggelidis
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (X.A.); (M.M.); (N.P.)
| | - Maria Kritikou
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
| | - Michael Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (X.A.); (M.M.); (N.P.)
| | - Michael Miligkos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
| | - Niki Papapostolou
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (X.A.); (M.M.); (N.P.)
| | - Nikolaos G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
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15
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Zhan C, McNellis RJ, O'Malley PG, Buchongo PC, Kato EU, Tong ST, Liu L, Crosson J, Bierman AS, Eden AR, Miller T. A Pragmatic Approach to Identifying and Profiling Primary Care Clinicians and Primary Care Practices in the USA. J Gen Intern Med 2024:10.1007/s11606-024-08627-8. [PMID: 38273069 DOI: 10.1007/s11606-024-08627-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND There are no consistent data on US primary care clinicians and primary care practices owing to the lack of standard methods to identify them, hampering efforts in primary care improvement. METHODS We develop a pragmatic framework that identifies primary care clinicians and practices in the context of the US healthcare system, and applied the framework to the IQVIA OneKey Healthcare Professional database to identify and profile primary care clinicians and practices in the USA. RESULTS Our framework prescribes sequential steps to identify primary care clinicians by cross-examining clinician specialties and organizational affiliations, and then identify primary care practices based on organization types and presence of primary care clinicians. Applying this framework to the 2021 IQVIA data, we identified 365,751 physicians with a primary specialty in primary care, and after excluding those who further specialized (24%), served as hospitalists (5%), or worked in non-primary care settings (41%), we determined that 179,369 (49%) of them were actually practicing primary care. We identified 287,506 nurse practitioners and 134,083 physician assistants and determined that 88,574 (31%) and 29,781 (22%), respectively, were delivering primary care. We identified 94,489 primary care practices, and found that 45% of them were with one primary care physician, 15% had two physicians, 12% employed nurse practitioners or physician assistants only, and 19% employed both primary care physicians and specialists. CONCLUSIONS Our approach offers a pragmatic and consistent alternative to the diverse methods currently used to identify and profile primary care workforce and organizations in the USA.
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Affiliation(s)
- Chunliu Zhan
- Agency for Healthcare Research and Quality, Rockville, MD, USA.
- Agency for Healthcare Research and Quality Center for Evidence and Practice Improvement, Rockville, MD, USA.
| | - Robert J McNellis
- National Institutes of Health, Office of Disease Prevention, Bethesda, MD, USA
| | | | - Portia C Buchongo
- University of Maryland School of Public Health, College Park, MD, USA
| | | | | | - Lingrui Liu
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Jesse Crosson
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | | | - Aimee R Eden
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Therese Miller
- Agency for Healthcare Research and Quality, Rockville, MD, USA
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Wong C, Bent MA, Omar H, Abousamra O. Launching telemedicine in a tertiary ambulatory pediatric orthopedic clinic during the coronavirus disease-19 pandemic: a retrospective study. J Pediatr Orthop B 2024; 33:97-102. [PMID: 36723520 DOI: 10.1097/bpb.0000000000001056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Telemedicine services increased dramaticallyduring the coronavirus disease (COVID-19) pandemic, with limited studies on its implementation within pediatric orthopedics. The goal of this study was to examine patient satisfaction and the efficacy of pediatric orthopedic telemedicine visits. Two hundred and sixty-nine qualifying telehealth visits took place at a metropolitan area pediatric institute between 1 March and 30 May 2020. Patients were invited to complete an anonymous satisfaction survey on their telemedicine experience. Sixty-seven patients responded to the survey. A chart review was completed for all 269 telemedicine visits. Ninety-two percent (249/269) of telemedicine visits were with established patients, and 95% (256/269) of visits were satisfactorily completed without further evaluation, with one visit requiring urgent in-person evaluation. Overall, patients were satisfied with initiating the telemedicine visit (mean score of 4.56/5), as they felt comfortable discussing needs with the provider (4.68/5), and the visit saved time (4.61/5). However, patients were less enthused when deciding if telemedicine was of comparable quality to an in-person visit (3.68/5). Our analysis showed that telemedicine is a viable alternative to in-person visits for various pediatric orthopedic visits, with minimal urgent complications. Patients benefited primarily from the time savings when using a telemedicine visit. However, our study also demonstrates certain limitations of telemedicine, likely due to patients' perceived value of an in-person evaluation. Our study's findings should encourage the continued implementation of pediatric orthopedic telemedicine as an adjunct to in-person clinical practice.
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Affiliation(s)
- Cynthis Wong
- Department of Orthopaedics, Baylor University Medical Center, Dallas, Texas
| | - Melissa A Bent
- Children's Hospital of Los Angeles, Children's Orthopedic Center
- University of Southern California, Keck School of Medicine, Los Angeles, California, USA
| | - Hanna Omar
- Children's Hospital of Los Angeles, Children's Orthopedic Center
| | - Oussama Abousamra
- Children's Hospital of Los Angeles, Children's Orthopedic Center
- University of Southern California, Keck School of Medicine, Los Angeles, California, USA
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17
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Li X, Zeng Z, Fan X, Wang W, Luo X, Yang J, Chang Y. Trends and Patterns of Systemic Glucocorticoid Prescription in Primary Care Institutions in Southwest China, from 2018 to 2021. Risk Manag Healthc Policy 2023; 16:2849-2868. [PMID: 38146314 PMCID: PMC10749547 DOI: 10.2147/rmhp.s436747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/02/2023] [Indexed: 12/27/2023] Open
Abstract
Purpose The purpose of this study was to investigate the prescribing patterns and usage trends of systemic glucocorticoids in primary care institutions located in Southwest China from 2018 to 2021. Materials and Methods A retrospective cross-sectional analysis of systemic glucocorticoids prescriptions was conducted in 32 primary care institutions located in Southwest China between 2018 and 2021. Prescriptions of systemic glucocorticoids were classified as appropriate or inappropriate use. Inappropriate use was further classified into (1) inappropriate indications and (2) inappropriate selection of glucocorticoids. Generalized estimation equations were employed to investigate the factors associated with inappropriate utilization of systemic glucocorticoids. The seasonal autoregressive integrated moving average (SARIMA) model was employed to predict the rate of inappropriate glucocorticoids prescriptions. Results A total of 203,846 (92.89%) prescriptions were included, both the number of systemic glucocorticoids prescriptions and inappropriate prescriptions increased in winter. Diseases of the respiratory system (68.90%) were the most frequent targets of systemic glucocorticoids use. Of all prescriptions, 73.18% exhibited inappropriate indications, while 0.05% demonstrated inappropriate selection. The utilization of systemic glucocorticoids was deemed inappropriate for diseases of the respiratory system (94.19%), followed by diseases of the digestive system (87.75%). Physicians, who were female or younger than 33 years old, possess lower levels of education and professional titles and exhibit a higher likelihood of inappropriately prescribing systemic glucocorticoids. The phenomenon of inappropriate glucocorticoids use was commoner among male patients aged 65 years and older. After conducting model verification, it was determined that the SARIMA model could be used to predict the monthly rate of inappropriate systemic glucocorticoids prescriptions in primary care institutions in southwest China. Conclusion The inappropriate use of systemic glucocorticoids remains a significant concern in primary care institutions. In this regard, continuing education and professional knowledge training of physicians should be strengthened in the future.
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Affiliation(s)
- Xiaoyi Li
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
| | - Zhen Zeng
- Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou Province, People’s Republic of China
| | - Xingying Fan
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
| | - Wenju Wang
- School of Public Health, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
| | - Xiaobo Luo
- School of Public Health, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
| | - Junli Yang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
| | - Yue Chang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, Guizhou Province, People’s Republic of China
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Gingele AJ, Amin H, Vaassen A, Schnur I, Pearl C, Brunner-La Rocca HP, Boyne J. Integrating avatar technology into a telemedicine application in heart failure patients : A pilot study. Wien Klin Wochenschr 2023; 135:680-684. [PMID: 36732377 PMCID: PMC9894666 DOI: 10.1007/s00508-022-02150-8] [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] [Received: 09/02/2022] [Accepted: 12/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Heart failure is a severe condition and telemedicine can improve the care of heart failure. Many patients are unable to use telemedicine applications due to visual impairment and limited health-related literacy. Avatar technology might help to overcome these limitations. METHODS A telemedicine application was combined with a nurse avatar and offered to heart failure outpatients for 3 months. System usability and patient satisfaction were evaluated monthly by the system usability score (maximum score=100) and the patient satisfaction scale (maximum score=50). RESULTS In total, 37 heart failure patients were enrolled. The mean system usability score after 1 month was 73 (standard deviation=24) and 72 (standard deviation=10) after 3 months of follow-up, which was not significantly different (p = 0.40). The mean patient satisfaction scale after 1 month was 42 (standard deviation=5) and 39 (standard deviation=8) after 3 months, which was not significantly different (p = 0.10). CONCLUSION A nurse look-a-like avatar integrated into a telemedicine application was positively assessed by heart failure patients. Future studies are warranted to clarify the role of avatar technology in telemedicine.
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Affiliation(s)
- Arno Joachim Gingele
- Department of Cardiology, Maastricht University Medical Centre, P.Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Hesam Amin
- Department of Cardiology, Maastricht University Medical Centre, P.Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | | | | | | | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Centre, P.Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Josiane Boyne
- Department of Cardiology, Maastricht University Medical Centre, P.Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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Tan MS, Kang GCY, Fong RJK, Cheong NK, Shi H, Tan NC. Patients' perspectives on video consultation for non-communicable diseases: a qualitative study in Singapore. BJGP Open 2023; 7:BJGPO.2023.0103. [PMID: 37591556 PMCID: PMC11176708 DOI: 10.3399/bjgpo.2023.0103] [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: 06/05/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic increased the use of telemedicine in primary care services. Understanding patients' perspectives on telemedicine is pivotal for its wider adoption in managing non-communicable diseases (NCDs) in the community. AIM To explore the views and concerns of patients who have yet to use video consultation (VC) for NCD management in Singapore. DESIGN & SETTING This qualitative study was conducted in a primary care clinic in Singapore. METHOD In total, 16 patients participated in individual in-depth interviews. The participants had type 2 diabetes mellitus and/or hypertension and/or hyperlipidaemia without prior VC experience. They were purposively enrolled in the polyclinic. Audited transcripts were independently coded by two investigators. Thematic analysis was performed to identify perspectives on telemedicine based on the health, information, and technology zones of the Health Information Technology Acceptance Model. RESULTS The following three themes emerged: perceived benefits of VC utility; perceived barriers of VC adoption; and potential challenges of VC. Participants viewed VC as safe and convenient if they had stable NCD. They voiced concerns on possible suboptimal care owing to the absence of physical examination, network connectivity, and personal medical data security. Participants highlighted challenges of VC uptake such as digital health familiarity, availability of their own mobile and telemonitoring devices, and healthcare costs consideration. CONCLUSION Addressing the concerns and challenges highlighted by non-VC users can help physicians and policymakers explore ways to scale up telemedicine in Singapore. A hybrid clinical care model comprising in-person visits and VC may be the way forward for NCD management.
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Affiliation(s)
- Mui Suan Tan
- SingHealth Polyclinics, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore
| | - Gary Chun-Yun Kang
- SingHealth Polyclinics, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore
| | | | - Nian Kai Cheong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Haixiao Shi
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore
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Mozes I, Chudner I, Heymann A, Baron-Epel O. Shared Decision Making and Trust Matter: Patient's Use of Video Consultations and a Remote Medical Device in Primary Care. Telemed J E Health 2023; 29:1688-1695. [PMID: 36961399 DOI: 10.1089/tmj.2022.0536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
Background: There is growing interest in the incorporation of video consultations in primary care. Remote medical devices used for remote physical examinations are a new complementary addition to these consultations and may increase their effectiveness. This study examines a social behavioral-technological model by the factors predicting the acceptance of video consultation with or without a technological medical device, their perceived ease of use (PEU), and their perceived usefulness (PU), as well as social behavioral factors: trust and shared decision making. Methods: We conducted an online survey among patients who had visited a physician during 2021 and had the option to receive video consultations with or without remote medical devices. Structural equation modeling was applied to assess the proposed model of predicting the extent of future telemedicine use. Results: Among the 1,198 patient responders, the intention to use telemedicine video consultation had a significant positive association with trust, shared decision making, PEU, and PU and with high socioeconomic constructs. The intention to use telemedicine video consultation with a medical device had a significant positive association with shared decision making, PEU, and PU. The statistical results suggest a good fit with the proposed models. Conclusions: The proposed social behavioral-technological model demonstrated that to successfully adopt video consultations and new remote medical devices in primary care, there is a need for trust and shared decision making to be established in patient-physician relationships.
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Affiliation(s)
- Inbal Mozes
- School of Public Health, Haifa University, Haifa, Israel
| | - Irit Chudner
- School of Behavioral Sciences and Psychology, College of Management Academic Studies, Rishon Lezion, Israel
| | - Anthony Heymann
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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21
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Diel S, Doctor E, Reith R, Buck C, Eymann T. Examining supporting and constraining factors of physicians' acceptance of telemedical online consultations: a survey study. BMC Health Serv Res 2023; 23:1128. [PMID: 37858170 PMCID: PMC10588103 DOI: 10.1186/s12913-023-10032-6] [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] [Received: 06/30/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023] Open
Abstract
As healthcare demands exceed outpatient physicians' capacities, telemedicine holds far-reaching potential for both physicians and patients. It is crucial to holistically analyze physicians' acceptance of telemedical applications, such as online consultations. This study seeks to identify supporting and constraining factors that influence outpatient physicians' acceptance of telemedicine.We develop a model based on the unified theory of acceptance and use of technology (UTAUT). To empirically examine our research model, we conducted a survey among German physicians (n = 127) in 2018-2019. We used the partial least squares (PLS) modeling approach to test our model, including a mediation analysis. The results indicate that performance expectancy (β = .397, P < .001), effort expectancy (β = .134, P = .03), and social influence (β = .337, P < .001) strongly impact the intention to conduct online consultations and explain 55% of its variance. Structural conditions regarding data security comprise a key antecedent, associating with performance expectancy (β = .193, P < .001) and effort expectancy (β = .295, P < .001). Regarding potential barriers to usage intentions, we find that IT anxiety predicts performance (β = -.342, P < .001) and effort expectancy (β = -.364, P < .001), while performance expectancy fully mediates (βdirect = .022, P = .71; βindirect = -.138, P < .001) the direct relationship between IT anxiety and the intention to use telemedical applications.This research provides explanations for physicians' behavioral intention to use online consultations, underlining UTAUT's applicability in healthcare contexts. To boost acceptance, social influences, such as personal connections and networking are vital, as colleagues can serve as multipliers to reach convergence on online consultations among peers. To overcome physicians' IT anxiety, training, demonstrations, knowledge sharing, and management incentives are recommended. Furthermore, regulations and standards to build trust in the compliance of online consultations with data protection guidelines need reinforcement from policymakers and hospital management alike.
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Affiliation(s)
- Sören Diel
- Branch Business & Information Systems Engineering of the Fraunhofer FIT and FIM Research Center for Information Management, University of Bayreuth, Wittelsbacherring 10, 95444, Bayreuth, Germany
| | - Eileen Doctor
- Branch Business & Information Systems Engineering of the Fraunhofer FIT and FIM Research Center for Information Management, University of Bayreuth, Wittelsbacherring 10, 95444, Bayreuth, Germany.
| | - Riccardo Reith
- Chair of General Business Management, University of Bayreuth, Universitätsstraße 30, 95447, Bayreuth, Germany
| | - Christoph Buck
- Faculty of Informatics, Augsburg University of Applied Sciences and Branch Business & Information Systems Engineering of the Fraunhofer FIT, Alter Postweg 101, 86159, Augsburg, Germany
- QUT Business School, Centre for Future Enterprise, Queensland University of Technology, 2 George St, Brisbane, QLD-4000, Australia
| | - Torsten Eymann
- Branch Business & Information Systems Engineering of the Fraunhofer FIT and FIM Research Center for Information Management, University of Bayreuth, Wittelsbacherring 10, 95444, Bayreuth, Germany
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22
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Pogorzelska K, Marcinowicz L, Chlabicz S. Understanding satisfaction and dissatisfaction of patients with telemedicine during the COVID-19 pandemic: An exploratory qualitative study in primary care. PLoS One 2023; 18:e0293089. [PMID: 37847684 PMCID: PMC10581451 DOI: 10.1371/journal.pone.0293089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Due to the COVID-19 pandemic, healthcare organizations had to face challenging circumstances and modify the usual modality of service provision, introducing telehealth services in their routine patient care to lessen the risk of direct human-to-human exposure. Patients expressed concerns about personal visits to healthcare units and the possibility of accessing telemedicine turned out to be an effective tool for the continuity of care. Due to the limited experience with telemedicine before the COVID-19 pandemic in Poland, we sought to fill this gap by studying the experiences of Polish patients. Our study aimed to understand how patients define satisfaction and dissatisfaction with telemedicine during the COVID-19 pandemic in primary care. MATERIAL AND METHODS Twenty semi-structured interviews with primary care patients in the Podlaskie Voivodeship, Poland were conducted to understand satisfaction with telemedicine. Interview transcripts were analyzed using qualitative content analysis. The qualitative content analysis process involved familiarizing ourselves with the data, extracting text regarding satisfaction and dissatisfaction with the teleconsultation, condensing it into meaningful units assigning codes to them, and organizing codes into subcategories and categories. The entire analysis process was done through reflection and discussion until a consensus was reached between the researchers. RESULTS From the participants' perspective, satisfaction with telemedicine was associated with receiving enough space to express their concerns. It was reported that they trusted their primary care physicians and felt comfortable during telemedicine consultations. Participants noted that connecting with a known, trusted doctor was more important than having a face-to-face visit with an unfamiliar physician. In our study, the participants equated satisfaction with treatment effectiveness. It was emphasized that in the event of unknown or unstable conditions, patients would prefer to be seen in person and receive a physical examination. CONCLUSION In our research telemedicine met with a positive reception and was recognized by the majority of patients who made use of it as a valuable channel of contact with a primary care physician. In order to increase the level of patient satisfaction, the focus should be on improving aspects such as physician engagement and showing empathy during telemedicine, as well as providing complete, exhaustive information on the treatment process. Respecting patient needs and preferences during performing telemedicine visits is the goal of patient-centered care.
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Affiliation(s)
- Karolina Pogorzelska
- Department of Family Medicine, The Medical University of Bialystok, Bialystok, Poland
| | - Ludmila Marcinowicz
- Department of Obstetrics, Gynecology and Maternity Care, The Medical University of Bialystok, Bialystok, Poland
| | - Slawomir Chlabicz
- Department of Family Medicine, The Medical University of Bialystok, Bialystok, Poland
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Erku D, Khatri R, Endalamaw A, Wolka E, Nigatu F, Zewdie A, Assefa Y. Digital Health Interventions to Improve Access to and Quality of Primary Health Care Services: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6854. [PMID: 37835125 PMCID: PMC10572344 DOI: 10.3390/ijerph20196854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023]
Abstract
Global digital technology advances offer the potential to enhance primary health care (PHC) quality, reach, and efficiency, driving toward universal health coverage (UHC). This scoping review explored how digital health solutions aid PHC delivery and UHC realization by examining the context, mechanisms, and outcomes of eHealth interventions. A comprehensive literature search was conducted, capturing qualitative and quantitative studies, process evaluations, and systematic or scoping reviews. Our analysis of 65 articles revealed that a well-functioning digital ecosystem-featuring adaptable, interoperable digital tools, robust Information and Communications Technology foundations, and enabling environments-is pivotal for eHealth interventions' success. Facilities with better digital literacy, motivated staff, and adequate funding demonstrated a higher adoption of eHealth technologies, leading to improved, coordinated service delivery and higher patient satisfaction. However, eHealth's potential is often restricted by existing socio-cultural norms, geographical inequities in technology access, and digital literacy disparities. Our review underscores the importance of considering the digital ecosystem's readiness, user behavior, broader health system requirements, and PHC capacity for adopting digital solutions while assessing digital health interventions' impact.
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Affiliation(s)
- Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, Nathan, QLD 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD 4111, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia; (R.K.); (A.E.); (Y.A.)
| | - Resham Khatri
- School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia; (R.K.); (A.E.); (Y.A.)
| | - Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia; (R.K.); (A.E.); (Y.A.)
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia; (E.W.); (F.N.); (A.Z.)
| | - Frehiwot Nigatu
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia; (E.W.); (F.N.); (A.Z.)
| | - Anteneh Zewdie
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia; (E.W.); (F.N.); (A.Z.)
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia; (R.K.); (A.E.); (Y.A.)
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Zhao Q, Li C, Zhang Y, Tang HT, Wang J, Yu XH, Zhao Y, Xing Y, Yu J, Ye J, Shan EF, Li XW. Economic evaluations of electronic health interventions for people with age-related cognitive impairment and their caregivers: A systematic review. Int J Geriatr Psychiatry 2023; 38:e5990. [PMID: 37655517 DOI: 10.1002/gps.5990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 08/12/2023] [Indexed: 09/02/2023]
Abstract
OBJECTS Dementia has physical, social and economic impacts, causing considerable distress for people with age-related cognitive impairment (PWACI) and their caregivers. Electronic health (e-health) interventions can provide convenient education to improve the coping competence of caregivers and have become an important approach to supporting them. Understanding the economic evidence of e-health interventions will facilitate the decision making and implementation of integrating e-health into routine health services. The present review aimed to appraise economic evidence related to e-health interventions for PWACI and their caregivers. METHODS We systematically searched multiple cross-disciplinary databases from inception to February 28, 2023. Two reviewers independently selected the trials, assessed the quality, and checked the data. A descriptive-analytical narrative method was used to analyze the review findings. RESULTS Thirteen studies were analyzed, including 12 randomized controlled trials and one quasi-experimental study. All included studies were conducted in developed countries. The included studies reported limited economic information. There were six cost-effectiveness analysis, five cost-consequence analysis and one partial economic evaluation. The included studies were heterogeneous, and varied in quality. The results demonstrated that e-health multicomponent interventions can reduce the cost of health service utilization in short term (10-104 weeks). CONCLUSIONS Few studies calculated the incremental cost-effectiveness ratio to evaluate the cost-effectiveness of e-health interventions. Preliminary evidence indicates that e-health interventions can reduce the cost of health service utilization in the short term, but the cost-effectiveness of e-health interventions hasn't been identified. More robust evidence is needed to clarify the value of e-health interventions for PWACI and their caregivers.
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Affiliation(s)
- Qing Zhao
- School of Public Health, Southern Medical University, Guangzhou, China
- School of Health Management, Southern Medical University, Guangzhou, China
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Cheng Li
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yu Zhang
- School of Humanities, Changzhou Vocational Institute of Textile and Garment, Changzhou, China
| | - Hui-Ting Tang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Jing Wang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Xiao-Hong Yu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yue Zhao
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Ying Xing
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Jie Yu
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Juan Ye
- Department of Internal Neurology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - En-Fang Shan
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Xian-Wen Li
- School of Nursing, Nanjing Medical University, Nanjing, China
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Enckell A, Laine MK, Kautiainen H, Lehto MT, Pitkälä KH, Rahkonen O, Roitto HM, Kauppila T. Comparison of two GP service provider models in older adults: a register-based follow-up study. BJGP Open 2023; 7:BJGPO.2022.0101. [PMID: 37185139 PMCID: PMC10646206 DOI: 10.3399/bjgpo.2022.0101] [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: 07/03/2022] [Revised: 11/13/2022] [Accepted: 02/23/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND In Finland, there have been various strategies attempting to provide access to GPs. The 'restricted-List General Practitioner model' (rLGP) was launched in primary health care (PHC) in the city of Vantaa after the 'named General Practitioner model' (nGP) failed to provide sufficient access to GPs. This was done to improve access to GP appointments for those most needing care. AIM To evaluate the impact of the transition from nGP to rLGP on access to non-urgent scheduled appointments among patients aged ≥75 years. DESIGN & SETTING A register-based follow-up study in public PHC in Vantaa, Finland. METHOD The study focused on patients aged ≥75 years who used PHC from 2004-2008. It looked at the number of non-urgent and urgent scheduled appointments, patient contacts, home visits, PHC emergency department appointments, and cancelled appointments, which were recorded 7 years before and after the transition from nGP to rLGP in 2011 and adjusted to patient-years. Non-urgent appointments were booked to the patient's own nGP or rLGP in public PHC, whereas urgent appointments could be to any GP. RESULTS The number of non-urgent scheduled appointments to GPs was halved during the time of nGP, before launching the rLGP. Simultaneously, the number of urgent scheduled appointments more than tripled. The number of both started to plateau a year before the rLGP was launched. The number of both non-urgent and urgent scheduled appointments remained mainly at that level after rLGP was implemented. CONCLUSION The rLGP model was unsuccessful in improving access to non-urgent scheduled appointments to GPs.
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Affiliation(s)
- Aina Enckell
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- City of Espoo, Welfare and Health Sector, Espoo, Finland
| | - Merja K Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Mika T Lehto
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- City of Vantaa, Vantaa, Finland
| | - Kaisu H Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Hanna-Maria Roitto
- Department of Neurosciences, University of Helsinki, Helsinki, Finland
- Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Timo Kauppila
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Etz RS, Solid CA, Gonzalez MM, Britton E, Stange KC, Reves SR. Telemedicine in Primary Care: Lessons Learned About Implementing Health Care Innovations During the COVID-19 Pandemic. Ann Fam Med 2023; 21:297-304. [PMID: 37487734 PMCID: PMC10365867 DOI: 10.1370/afm.2979] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 07/26/2023] Open
Abstract
PURPOSE During the COVID-19 pandemic, telemedicine emerged as an important tool in primary care. Technology and policy-related challenges, however, revealed barriers to adoption and implementation. This report describes the findings from weekly and monthly surveys of primary care clinicians regarding telemedicine during the first 2 years of the pandemic. METHODS From March 2020 to March 2022, we conducted electronic surveys using convenience samples obtained through social networking and crowdsourcing. Unique tokens were used to confidentially track respondents over time. A multidisciplinary team conducted quantitative and qualitative analyses to identify key concepts and trends. RESULTS A total of 36 surveys resulted in an average of 937 respondents per survey, representing clinicians from all 50 states and multiple specialties. Initial responses indicated general difficulties in implementing telemedicine due to poor infrastructure and reimbursement mechanisms. Over time, attitudes toward telemedicine improved and respondents considered video and telephone-based care important tools for their practice, though not a replacement for in-person care. CONCLUSIONS The implementation of telemedicine during COVID-19 identified barriers and opportunities for technology adoption and highlighted steps that could support primary care clinics' ability to learn, adapt, and implement technology.
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Affiliation(s)
- Rebecca S Etz
- Larry A. Green Center for the Advancement of Primary Health Care for the Public Good, Richmond, Virginia
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | | | - Martha M Gonzalez
- Larry A. Green Center for the Advancement of Primary Health Care for the Public Good, Richmond, Virginia
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Erin Britton
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia
| | - Kurt C Stange
- Larry A. Green Center for the Advancement of Primary Health Care for the Public Good, Richmond, Virginia
- Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio
| | - Sarah R Reves
- Larry A. Green Center for the Advancement of Primary Health Care for the Public Good, Richmond, Virginia
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
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27
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Shatla I, El-Zein RS, Ubaid A, ElBallat A, Sammour Y, Kennedy KF, Barta K, Brand-Moody T, Cordle F, Williams L, Giocondo M, Gupta S, Ramza B, Steinhaus D, Yousuf O, Spertus JA, Wimmer AP. An Analysis of Telehealth in the Outpatient Management of Atrial Fibrillation During the COVID-19 Pandemic. Am J Cardiol 2023; 192:174-181. [PMID: 36812701 PMCID: PMC9940901 DOI: 10.1016/j.amjcard.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 02/22/2023]
Abstract
The COVID-19 pandemic accelerated adaption of a telehealth care model. We studied the impact of telehealth on the management of atrial fibrillation (AF) by electrophysiology providers in a large, multisite clinic. Clinical outcomes, quality metrics, and indicators of clinical activity for patients with AF during the 10-week period of March 22, 2020 to May 30, 2020 were compared with those from the 10-week period of March 24, 2019 to June 1, 2019. There were 1946 unique patient visits for AF (1,040 in 2020 and 906 in 2019). During 120 days after each encounter, there was no difference in hospital admissions (11.7% vs 13.5%, p = 0.25) or emergency department visits (10.4% vs 12.5%, p = 0.15) in 2020 compared with 2019. There was a total of 31 deaths within 120 days, with similar rates in 2020 and 2019 (1.8% vs 1.3%, p = 0.38). There was no significant difference in quality metrics. The following clinical activities occurred less frequently in 2020 than in 2019: offering escalation of rhythm control (16.3% vs 23.3%, p <0.001), ambulatory monitoring (29.7% vs 51.7%, p <0.001), and electrocardiogram review for patients on antiarrhythmic drug therapy (22.1% vs 90.2%, p <0.001). Discussions about risk factor modification were more frequent in 2020 compared with 2019 (87.9% vs 74.8%, p <0.001). In conclusion, the use of telehealth in the outpatient management of AF was associated with similar clinical outcomes and quality metrics but differences in clinical activity compared with traditional ambulatory encounters. Longer-term outcomes warrant further investigation.
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Affiliation(s)
- Islam Shatla
- Department of Internal Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Rayan S El-Zein
- Department of Internal Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Aamer Ubaid
- Department of Internal Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Ahmed ElBallat
- Department of Internal Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Yasser Sammour
- Department of Internal Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Kevin F Kennedy
- Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Kayla Barta
- Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Tara Brand-Moody
- Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Faith Cordle
- Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - LeAndrea Williams
- Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Michael Giocondo
- Department of Internal Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Sanjaya Gupta
- Department of Internal Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Brian Ramza
- Department of Internal Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Daniel Steinhaus
- Department of Internal Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Omair Yousuf
- Department of Internal Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - John A Spertus
- Department of Internal Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Alan P Wimmer
- Department of Internal Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
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Cataldo F, Mendoza A, Chang S, Buchanan G, Van Dam NT. Enhancing Therapeutic Processes in Videoconferencing Psychotherapy: Interview Study of Psychologists' Technological Perspective. JMIR Form Res 2023; 7:e40542. [PMID: 36927506 PMCID: PMC10019766 DOI: 10.2196/40542] [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: 06/25/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic caused a surge in the use of telehealth platforms. Psychologists have shifted from face-to-face sessions to videoconference sessions. Therefore, essential information that is easily obtainable via in-person sessions may be missing. Consequently, therapeutic work could be compromised. OBJECTIVE This study aimed to explore the videoconference psychotherapy (VCP) experiences of psychologists around the world. Furthermore, we aimed to identify technological features that may enhance psychologists' therapeutic work through augmented VCP. METHODS In total, 17 psychologists across the world (n=7, 41% from Australia; n=1, 6% from England; n=5, 29% from Italy; n=1, 6% from Mexico; n=1, 6% from Spain; and n=2, 12% from the United States) were interviewed. We used thematic analysis to examine the data collected from a sample of 17 psychologists. We applied the Chaos Theory to interpret the system dynamics and collected details about the challenges posed by VCP. For collecting further information about the technology and processes involved, we relied on the Input-Process-Output (IPO) model. RESULTS The analysis resulted in the generation of 9 themes (input themes: psychologists' attitude, trust-reinforcing features, reducing cognitive load, enhancing emotional communication, and engaging features between psychologists and patients; process themes: building and reinforcing trust, decreasing cognitive load, enhancing emotional communication, and increasing psychologist-patient engagement) and 19 subthemes. Psychologists found new strategies to deal with VCP limitations but also reported the need for more technical control to facilitate therapeutic processes. The suggested technologies (eye contact functionality, emergency call functionality, screen control functionality, interactive interface with other apps and software, and zooming in and out functionality) could enhance the presence and dynamic nature of the therapeutic relationship. CONCLUSIONS Psychologists expressed a desire for enhanced control of VCP sessions. Psychologists reported a decreased sense of control within the therapeutic relationship owing to the influence of the VCP system. Great control of the VCP system could better approximate the critical elements of in-person psychotherapy (eg, observation of body language). To facilitate improved control, psychologists would like technology to implement features such as improved eye contact, better screen control, emergency call functionality, ability to zoom in and out, and an interactive interface to communicate with other apps. These results contribute to the general perception of the computer as an actual part of the VCP process. Thus, the computer plays a key role in the communication, rather than remaining as a technical medium. By adopting the IPO model in the VCP environment (VCP-IPO model), the relationship experience may help psychologists have more control in their VCP sessions.
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Affiliation(s)
- Francesco Cataldo
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Australia
| | - Antonette Mendoza
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Australia
| | - Shanton Chang
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Australia
| | - George Buchanan
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Australia
| | - Nicholas T Van Dam
- School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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Neunaber T, Meister S. Digital Maturity and Its Measurement of General Practitioners: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4377. [PMID: 36901387 PMCID: PMC10001864 DOI: 10.3390/ijerph20054377] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
The work of general practitioners (GPs) is increasingly characterized by digitalization. Their progress in digitalization can be described by the concept of digital maturity and measured using maturity models. The aim of this scoping review is to provide an overview of the state of research on digital maturity and its measurement in primary care, specifically for GPs. The scoping review was conducted according to Arksey and O'Malley, considering the reporting scheme for PRISMA-ScR. For the literature search, we used PubMed and Google Scholar as the main sources of information. A total of 24 international, mostly Anglo-American studies, were identified. The understanding of digital maturity varied widely. In most studies, it was understood in a highly technical way and associated with the adoption of electronic medical records. More recent, but mostly unpublished, studies have attempted to capture overall digital maturity. So far, the understanding of digital maturity of GPs is still very diffuse-the research literature is still in its infancy. Future research should therefore aim to explore the dimensions of digital maturity of GPs to be able to develop a consistent and validated model for measuring digital maturity.
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Affiliation(s)
- Timo Neunaber
- Health Informatics, Faculty of Health/School of Medicine, Witten/Herdecke University, 58455 Witten, Germany
| | - Sven Meister
- Health Informatics, Faculty of Health/School of Medicine, Witten/Herdecke University, 58455 Witten, Germany
- Department Healthcare, Fraunhofer Institute for Software and Systems Engineering, 44227 Dortmund, Germany
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Del Hoyo J, Millán M, Garrido-Marín A, Aguas M. Are we ready for telemonitoring inflammatory bowel disease? A review of advances, enablers, and barriers. World J Gastroenterol 2023; 29:1139-1156. [PMID: 36926667 PMCID: PMC10011957 DOI: 10.3748/wjg.v29.i7.1139] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/02/2022] [Accepted: 02/09/2023] [Indexed: 02/21/2023] Open
Abstract
This review summarizes the evidence about telemonitoring in patients with inflammatory bowel disease (IBD). To give an overview of the advances performed, as well as the enablers and barriers which favoured/hindered telemonitoring implementation. We performed a literature search in PubMed, EMBASE, MEDLINE, Cochrane Database, Web of Science and Conference Proceedings. Titles and abstracts published up to September 2022 were screened for a set of inclusion criteria: telemonitoring intervention, IBD as the main disease, and a primary study performed. Ninety-seven reports were selected for full review. Finally, 20 were included for data extraction and critical appraisal. Most studies used telemonitoring combined with tele-education, and programs evolved from home telemanagement systems towards web portals through mHealth applications. Web systems demonstrated patients’ acceptance, improvement in quality of life, disease activity and knowledge, with a good cost-effectiveness profile in the short-term. Initially, telemonitoring was almost restricted to ulcerative colitis, but new patient reported outcome measures, home-based tests and mobile devices favoured its expansion to different patients´ categories. However, technological and knowledge advances led to legal, ethical, economical and logistic issues. Standardization of remote healthcare is necessary, to improve the interoperability of systems as well as to address liability concerns and users´ preferences. Telemonitoring IBD is well accepted and improves clinical outcomes at a lower cost in the short-term. Funders, policymakers, providers, and patients need to align their interests to overcome the emerging barriers for its full implementation.
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Affiliation(s)
- Javier Del Hoyo
- Department of Gastroenterology, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
| | - Mónica Millán
- Department of Surgery, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
| | - Alejandro Garrido-Marín
- Department of Gastroenterology, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
| | - Mariam Aguas
- Department of Gastroenterology, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
- Health Research Institute La Fe, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
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Pettersson L, Johansson S, Demmelmaier I, Gustavsson C. Disability digital divide: survey of accessibility of eHealth services as perceived by people with and without impairment. BMC Public Health 2023; 23:181. [PMID: 36707791 PMCID: PMC9880913 DOI: 10.1186/s12889-023-15094-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Sustainable and effective eHealth requires accessibility for everyone. Little is known about how accessibility of eHealth is perceived among people with various impairments. The aim of this study was to compare use and perceived difficulty in the use of eHealth among people with and without impairment, and how different types of impairment were associated with perceived difficulty in the use of eHealth. METHODS This study used data collected in a nationwide survey in Sweden. Snowball sampling was used to recruit participants with self-reported impairment, from June to October 2019. In February 2020, the survey was posted to people in the general population who were matched to the participants with impairment by age, gender and county of residence. Multiple logistic regression was used to analyse the use of four eHealth services, and perceived difficulty in the use of six eHealth services. RESULTS In total, 1631 participants with, and 1084 participants without impairment responded to the survey. Participants with impairment reported less use and more difficulty in the use of all eHealth services as compared to participants without impairment. When comparing types of impairment, booking healthcare appointments online was least used and most avoided by participants with communication, language and calculation impairments (adjusted odds ratio (aOR) use 0.64, 95% confidence interval (95%CI) 0.49-0.83; aOR avoid 1.64, 95%CI 1.19-2.27), and intellectual impairments (aOR use 0.28, 95%CI 0.20-0.39; aOR avoid 2.88, 95%CI 1.86-4.45). The Swedish national web-portal for health information and services, 1177.se, was reported difficult to use the most among participants with communication, language and calculation impairments (aOR 2.24, 95%CI 1.50-3.36), deaf-blindness (aOR 11.24, 95%CI 3.49-36.23) and hearing impairment (aOR 2.50, 95%CI 1.17-5.35). CONCLUSIONS The results confirm the existence of an eHealth disability digital divide. People with impairment were not one homogeneous group, but differed in perceived difficulties in regard to eHealth. Based on a purposeful subgrouping of impairments, we showed that people with communication, language and calculation impairments, and intellectual impairments, reported least use and most difficulty in using eHealth. The findings can guide further research in creating eHealth that is accessible for all, including those with the most significant difficulties.
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Affiliation(s)
- Linda Pettersson
- Center for Clinical Research Dalarna, Uppsala University, Nissers Väg 3, SE-791 82, Falun, Sweden. .,Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-751 22, Uppsala, Sweden. .,Primary Healthcare Center Mora, Mora Hospital, SE-792 85, Mora, Sweden.
| | - Stefan Johansson
- grid.5037.10000000121581746School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, SE-100 44, Stockholm, Sweden
| | - Ingrid Demmelmaier
- grid.8993.b0000 0004 1936 9457Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-751 22 Uppsala, Sweden
| | - Catharina Gustavsson
- grid.8993.b0000 0004 1936 9457Center for Clinical Research Dalarna, Uppsala University, Nissers Väg 3, SE-791 82 Falun, Sweden ,grid.8993.b0000 0004 1936 9457Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-751 22 Uppsala, Sweden ,grid.411953.b0000 0001 0304 6002School of Health and Welfare, Dalarna University, SE-791 88 Falun, Sweden
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Eldaly AS, Maniaci MJ, Paulson MR, Avila FR, Torres-Guzman RA, Maita K, Garcia JP, Forte AJ. Patient satisfaction with telemedicine in acute care setting: A systematic review. J Clin Transl Res 2022; 8:540-556. [PMID: 36518201 PMCID: PMC9741928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/15/2022] [Accepted: 10/15/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Telemedicine has revolutionized health-care services with its unprecedented abilities to connect patients with health-care professional across the distances. Patient satisfaction is an important measure of the quality and effectiveness of health-care services. AIM The goal of this systematic review is to investigate patient satisfaction with telemedicine in acute care setting. METHODS AND RESULTS Four sources of data were searched PubMed, Cumulative Index of Nursing and Allied Health Literature, Scopus, and Web of Science. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis as our basis of organization. Our analysis has showed that acute telemedicine was effective in managing a broad spectrum of acute medical conditions while achieving high levels of patient satisfaction. CONCLUSION Patient satisfaction is a complex product of expectations and experiences. Furthermore, it is an important indicator of the quality of the service. Despite the challenging nature of acute medicine, telemedicine services were successful in improving the quality of the service and achieving high levels of patient satisfaction. RELEVANCE FOR PATIENTS Telemedicine is rapidly evolving as an essential component of our healthcare system. Implementing telemedicine in acute care is a relatively new concept and patient satisfaction in these settings needs to be evaluated.
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Affiliation(s)
- Abdullah S. Eldaly
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Michael J. Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, United States
| | - Margaret R. Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, Wisconsin, United States
| | - Francisco R. Avila
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | | | - Karla Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - John P. Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Antonio J. Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
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Potkin MT, Mishkin AD, Cheung SG, Hicks-Puig C, Magoon C, Capote J, Muskin PR. Consultation-Liaison Telepsychiatry: A Coded Thematic Analysis of Clinicians' Reported Experiences. J Acad Consult Liaison Psychiatry 2022:S2667-2960(22)00628-0. [PMID: 36584768 DOI: 10.1016/j.jaclp.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Telepsychiatry is now common practice. Within consultation-liaison psychiatry (CLP), previous work has shown that telepsychiatry is feasible and satisfactory. To date, there has not been qualitative work done within CLP to describe the clinician's experience with telepsychiatry. OBJECTIVE This study aimed to perform a thematic analysis of clinicians' perceived benefits and limitations of providing telepsychiatry in CLP. METHODS An anonymous clinician survey querying demographics, education, training, technological experience, and practice characteristics was distributed via social media and professional listservs, the quantitative results of which are presented elsewhere. Two questions (What was the best/worst aspect of adapting to telepsychiatry?) required free-text responses; comments were allowed elsewhere. We performed a thematic analysis of the text responses because of its flexibility and ability to develop new insights. We synthesized and generated a codebook iteratively. Initial coding was completed by 3 co-authors independently, followed by discussion to build consensus. We used qualitative content analysis to better understand common trends and frequencies in the data. Saturation of themes was reached. RESULTS A total of 333 behavioral health clinicians completed the survey, including 197 CLP participants. Most respondents (98.5%) responded to at least 1 open-answer question, with 314 reporting the worst aspects of telepsychiatry and 315 reporting the best aspects. Respondents made insightful comments about boundaries, public health implications, and the need for training. We categorized the results into implications for practice, therapeutic relationship, and uniquely affected populations. CONCLUSIONS These results show that telepsychiatry has both unique benefits and limitations within CLP. Our work examines and describes these nuances. We believe that future use of telepsychiatry will be synergistic with in-person care and that the 2 modalities will be used together to maximize benefits. A public health focus on improving Internet access and simplifying interstate licensure would improve equitable access and utilization of outpatient telepsychiatry. Telepsychiatry can be successful for inpatient Consultation-Liaison work but requires thoughtful triage and teamwork.
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Affiliation(s)
- Maxmoore T Potkin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY
| | - Adrienne D Mishkin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY; Blood and Marrow Transplantation and Cell Therapy Program, Columbia University Irving Medical Center, New York, NY.
| | - Stephanie G Cheung
- Department of Psychiatry, New York University Langone School of Medicine, New York, NY
| | - Christian Hicks-Puig
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY
| | - Christopher Magoon
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY
| | - Justin Capote
- Private Practice, Telepsychiatry Services, New York, NY
| | - Philip R Muskin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY
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Sołomacha S, Sowa P, Kiszkiel Ł, Laskowski PP, Alimowski M, Szczerbiński Ł, Szpak A, Moniuszko-Malinowska A, Kamiński K. Patient's Perspective of Telemedicine in Poland-A Two-Year Pandemic Picture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:115. [PMID: 36612438 PMCID: PMC9819744 DOI: 10.3390/ijerph20010115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/10/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
The outbreak of the COVID-19 pandemic caused the healthcare system to drastically reduce in-person visits and suddenly switch to telemedicine services to provide clinical care to patients. The implementation of teleconsultation in medical facilities was a novelty for most Polish patients. In Poland, the main telehealth services were provided in the form of telephone consultations. The aim of this study is to determine patients' perceptions of telemedicine in the context of their experiences with the healthcare system during the COVID-19 pandemic. In this study, we presented how the evaluation of telemedicine services from the perspective of patients in Poland changed in the context of the ongoing pandemic. We conducted two surveys (year by year) on a representative quota sample of the Polish population (N = 623). This ensured that our observations took into account the evolution of views on telemedicine over time. We confirmed the well-known relationship that innovations introduced in the healthcare sector require a longer period of adaptation. We also identified significant concerns that limit the positive perception of telemedicine and compared them with experiences described in other countries.
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Affiliation(s)
- Sebastian Sołomacha
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Waszyngtona 13A, 15-089 Białystok, Poland
- Doctoral School, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Paweł Sowa
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Waszyngtona 13A, 15-089 Białystok, Poland
| | - Łukasz Kiszkiel
- Society and Cognition Unit, University of Bialystok, 15-403 Bialystok, Poland
| | | | - Maciej Alimowski
- Doctoral School of Social Sciences, University of Bialystok, 15-403 Bialystok, Poland
| | - Łukasz Szczerbiński
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, 15-276 Bialystok, Poland
- Clinical Research Centre, Medical University of Bialystok, 15-276 Białystok, Poland
| | - Andrzej Szpak
- Witold Chodźko Institute of Rural Medicine, 20-090 Lublin, Poland
| | - Anna Moniuszko-Malinowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, 15-089 Białystok, Poland
| | - Karol Kamiński
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Waszyngtona 13A, 15-089 Białystok, Poland
- Department of Cardiology, University Hospital of Bialystok, 15-276 Białystok, Poland
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Abstract
Public health measures associated with coronavirus disease (COVID-19) have accelerated the adoption of virtual health care across Canada. We explore the opportunities that virtual care presents in achieving the Quadruple Aim and challenges to navigate, through the lens of care for older adults. In particular, we recommend virtual care-related policies related to older adults that address (a) limited uptake among the socio-economically disadvantaged, (b) user-centered design of virtual care technologies, and (c) integration of iterative evaluations to ensure equitable and efficient achievement of desired outcomes. As virtual care accelerates forward, we must not leave older Canadians behind.
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Payán DD, Frehn JL, Garcia L, Tierney AA, Rodriguez HP. Telemedicine implementation and use in community health centers during COVID-19: Clinic personnel and patient perspectives. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100054. [PMID: 35169769 PMCID: PMC8830142 DOI: 10.1016/j.ssmqr.2022.100054] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 01/12/2023]
Abstract
In March 2020, federal and state telehealth policy changes catalyzed telemedicine adoption and use in community health centers. There is a dearth of evidence on telemedicine implementation and use in these safety net settings and a lack of information reflecting the perspectives of patients with limited English proficiency. We conducted in-depth interviews with clinic personnel and patients during the pandemic in two federally qualified health centers that primarily serve Chinese and Latino immigrants. Twenty-four interviews (clinic personnel = 15; patients who primarily speak a language other than English = 9) were completed remotely between December 2020 and April 2021. Interview scripts included questions about their telemedicine experiences, technology, resources and needs, barriers, facilitators, language access, and continued use, with a brief socio-demographic survey. Data analyses involved a primarily deductive approach and thematic analysis of transcript content. Both FQHCs adopted telemedicine in a few weeks and transitioned primarily to video and audio-only visits within two months. Findings reveal third-party language interpretation services were challenging to integrate into telemedicine video visits. Bilingual personnel who provided language concordant care were seen as essential for efficient and high-quality patient telemedicine experiences. Audio-only visits were of particular benefit to reach patients of older age, with limited English proficiency, and with limited digital literacy. Continued use of telemedicine is contingent on reimbursement policy decisions and interventions to increase patient digital literacy and technological resources. Results highlight the importance of reimbursing audio-only visits post-pandemic and investing in efforts to improve the quality of language services in telemedicine encounters.
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Affiliation(s)
- Denise D Payán
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, 5200 N Lake Road, Merced, CA, 95343, USA
| | - Jennifer L Frehn
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, 5200 N Lake Road, Merced, CA, 95343, USA
| | - Lorena Garcia
- Department of Public Health Sciences, School of Medicine, University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA
| | - Aaron A Tierney
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, USA
| | - Hector P Rodriguez
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, USA
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Neshnash M, Metwally N, Ismail M, Joudeh A, Al-Dahshan A, Sharif AR, Sharief N, Nur M, Selim N. Satisfaction of primary care physicians towards initiation of phone consultations during the COVID-19 pandemic management in Qatar: a cross-sectional study. BMC PRIMARY CARE 2022; 23:44. [PMID: 35279085 PMCID: PMC8917813 DOI: 10.1186/s12875-022-01654-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Objectives
To assess primary care physicians’ satisfaction towards initiation of phone consultation during COVID-19 pandemic management in Qatar and to identify the factors associated with dis/satisfaction.
Design
A cross-sectional web-based survey was conducted from 1 June to 30 July 2020.
Setting
All the available 27 public primary healthcare centers in Qatar at the time of the study.
Participants
Two hundred ninety-four primary care physicians working in the publicly run primary healthcare corporation in Qatar.
Primary outcome measures
Overall satisfaction of primary care physicians with the initiation of phone consultation during the COVID-19 pandemic in Qatar and their satisfaction towards each aspect of this management.
Results
Two hundred thirty-nine primary care physicians participated in the survey with a response rate of 53.1%. Overall, about 45% and 21% of respondents agreed that COVID-19 disease management has highly impacted and very highly impacted their daily practice, respectively. More than half of the physicians (59.9%) indicated being satisfied/highly satisfied with the initiation of telephone consultation service. On the other hand, few physicians were satisfied (14.3%) or highly satisfied (3.4%) with conducting telephone consultations with patients who lack previous electronic medical records. Also, only 20.3% and 3.8% of physicians were satisfied and highly satisfied with the lack of physical examination in telephone consultations, respectively. On bivariate analysis, primary care physicians’ age was significantly associated with the perceived level of impact of COVID-19 management on daily practice (P = 0.03). There was no significant association between participants’ characteristics and the level of satisfaction toward telephone consultations. On the other hand, there was a statistically significant association between physicians’ age (p = 0.048) and gender (p = 0.014) and their level of satisfaction toward communication and support.
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Almeida PFD, Santos AMD, Silva Cabral LMD, Anjos EFD, Fausto MCR, Bousquat A. Water, land, and air: how do residents of Brazilian remote rural territories travel to access health services? Arch Public Health 2022; 80:241. [PMID: 36419173 PMCID: PMC9682791 DOI: 10.1186/s13690-022-00995-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 10/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ensuring adequate and safe means of travel is essential for maintaining and improving the health and well-being of residents of rural communities worldwide. This article maps costs, distances, travel times, and means of elective and urgent/emergency health transport in Brazilian remote rural municipalities. METHODS Multiple case studies were conducted in 27 remote rural municipalities using a qualitative method. A total of 178 key informants (managers, doctors, and nurses) were interviewed. Secondary data from national information systems were analyzed for the socioeconomic characterization, to identify the costs, distances, and travel times. Through the thematic content analysis of the interviews, the means of transport, and strategies developed by managers, professionals and users for their provision were identified. RESULTS The costs of traveling between remote rural municipalities and locations where most of specialized and hospital services are centered can compromise a significant part of the families' income. The insufficiency, restriction of days, times, and routes of health transport affects the selection of beneficiaries based on socioeconomic criteria in places of high vulnerability and less investment in road infrastructure. In remote rural municipalities, travelling to seek health care involves inter-municipal and intra-municipal flows, as their territories have dispersed populations. Several means of transport were identified - air, river, and land - which are often used in a complementary way in the same route. Some patients travel for more than 1000 km, with travel times exceeding 20 h, especially in the Amazon region. While the demands for urgent and emergency transport are partially met by national public policy, the same is not true for the elective transport of patients. The impossibility of providing health transport under the exclusive responsibility of the municipalities is identified. CONCLUSIONS For the remote rural municipalities populations, the absence of national public policies for sufficient, continuous, and timely provision of transport for health services worsens the cycle of inequities and compromises the assumption of the universal right to health care.
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Affiliation(s)
- Patty Fidelis de Almeida
- grid.411173.10000 0001 2184 6919Collective Health Institute, Federal Fluminense University - Niterói, Rio de Janeiro, Brazil
| | - Adriano Maia dos Santos
- grid.8399.b0000 0004 0372 8259Multidisciplinary Health Institute, Federal University of Bahia - Vitória da Conquista, Bahia, Brazil
| | - Lucas Manoel da Silva Cabral
- grid.412211.50000 0004 4687 5267Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eduarda Ferreira dos Anjos
- grid.8399.b0000 0004 0372 8259Multidisciplinary Health Institute, Federal University of Bahia - Vitória da Conquista, Bahia, Brazil
| | | | - Aylene Bousquat
- grid.11899.380000 0004 1937 0722Public Health Faculty, University of São Paulo, São Paulo, Brazil
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Valentine JA, Mena L, Millett G. Telehealth Services: Implications for Enhancing Sexually Transmitted Infection Prevention. Sex Transm Dis 2022; 49:S36-S40. [PMID: 36219706 DOI: 10.1097/olq.0000000000001699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
ABSTRACT In the United States, sexually transmitted infections (STIs) are among the most persistent threats to health equity. Increasing access to STI prevention and control services through the provision of Remote Health and Telehealth can improve sexual health outcomes. Telehealth has been shown to increase access to care and even improve health outcomes. The increased flexibility offered by Telehealth services accommodates both patient and provider. Although both Telehealth and Remote Health strategies are important for STI prevention, share common attributes, and, in some circumstances, overlap, this article will focus more specifically on considerations for Telehealth and how it can contribute to increasing health equity by offering an important complement to and, in some cases, substitute for in-person STI services for some populations. Telehealth assists a variety of different populations, including those experiencing STI disparities; however, although the Internet offers a promising resource for many American households and increasing percentages of Americans are using its many resources, not all persons have equal access to the Internet. In addition to tailoring STI programs to accommodate unique patient populations, these programs will likely be faced with adapting services to fit reimbursement and licensing regulations.
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Affiliation(s)
- Jo A Valentine
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Leandro Mena
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Allen J. Exploring Adult Patients’ Perceptions and Experiences of Telemedicine Consultations in Primary Care: A Qualitative Systematic Review. INTERNATIONAL JOURNAL OF MEDICAL STUDENTS 2022. [DOI: 10.5195/ijms.2022.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The COVID-19 pandemic transformed a gradual uptake of telemedicine, into a sudden worldwide implementation of telemedicine consultations. Primary care is a particular area affected and one where telemedicine consultations are expected to be the future. However, for effective long-term implementation it is vital that patient perceptions and experiences are understood. The aim of this qualitative systematic review was to explore the perceptions and experiences of adults who have used telemedicine consultations in primary care. Studies were identified through a search of four electronic databases (MEDLINE, EMBASE, CINAHL, and CENTRAL) alongside reference list and citation searches. Quality assessment was conducted using the CASP checklist and data was synthesized using a simplified approach to thematic analysis. From 2492 identified records, ten studies met the eligibility criteria all of which were judged as either good or moderate quality. Three themes were identified which were potential benefits, potential barriers, and beneficial prerequisites for telemedicine consultations in primary care. Within these themes, sixteen sub-themes were identified with examples including accessibility and convenience for potential benefits, lack of face-to-face interaction and impersonal consultations for potential barriers, and continuity of care for beneficial prerequisites. Analysing these subthemes, four main recommendations for practice can be made which are to utilise continuity of care, offer both video and telephone consultations, provide adequate support, and that healthcare professionals should demonstrate an explicit understanding of the patient’s health issues. Further research is needed to explore and expand on this topic area and future research should be viewed as a continuous process.
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Thomas B, Thadani A, Chen PV, Christie IC, Kern LM, Rajan M, Kadiyala H, Helmer DA. Veterans’ ambulatory care experience during COVID-19: veterans’ access to and satisfaction with primary care early in the pandemic. BMC PRIMARY CARE 2022; 23:245. [PMID: 36131246 PMCID: PMC9491256 DOI: 10.1186/s12875-022-01851-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 09/11/2022] [Indexed: 11/10/2022]
Abstract
Background The COVID-19 pandemic caused widespread changes to healthcare, but few studies focus on ambulatory care during the early phase of the pandemic. We characterize veterans’ ambulatory care experience, specifically access and satisfaction, early in the pandemic. Methods We employed a semi-structured telephone interview to capture quantitative and qualitative data from patients scheduled with a primary care provider between March 1 – June 30, 2020. Forty veterans were randomly identified at a single large urban Veterans Health Administration (VHA) medical center. The interview guide utilized 56 closed and open-ended questions to characterize veterans’ perceptions of access to and satisfaction with their primary care experience at VHA and non-VHA primary care sources. We also explored the context of veterans' daily lives during the pandemic. We analyzed quantitative data using descriptive statistics and verbatim quotes using a matrix analysis. Results Veterans reported completing more appointments (mean 2.6 (SD 2.2)) than scheduled (mean 2.3 (SD 2.2)) mostly due to same-day or urgent visits, with a shift to telephone (mean 2.1 (SD 2.2)) and video (mean 1.5 (SD 0.6)). Among those who reported decreased access to care early in the pandemic (n = 27 (67%)), 15 (56%) cited administrative barriers (“The phone would hang up on me”) and 9 (33%) reported a lack of provider availability (“They are not reaching out like they used to”). While most veterans (n = 31 (78%)) were highly satisfied with their VHA care (mean score 8.6 (SD 2.0 on a 0–10 scale), 9 (23%) reported a decrease in satisfaction since the pandemic. The six (15%) veterans who utilized non-VHA providers during the period of interest reported, on average, higher satisfaction ratings (mean 9.5 (SD 1.2)). Many veterans reported psychosocial effects such as the worsening of mental health (n = 6 (15%)), anxiety concerning the virus (n = 12 (30%)), and social isolation (n = 8 (20%), “I stay inside and away from people”). Conclusions While the number of encounters reported suggest adequate access and satisfaction, the comments regarding barriers to care suggest that enhanced approaches may be warranted to improve and sustain veteran perceptions of adequate access to and satisfaction with primary care during times of crisis. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01851-3.
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Fang Y, Jiang S, Jiang P, Zhou H, Yang M. Are Rural Primary Care Providers Able to Competently Manage Common Illnesses? A Cross-Sectional Study in Rural Sichuan, Western China. Healthcare (Basel) 2022; 10:healthcare10091750. [PMID: 36141362 PMCID: PMC9498850 DOI: 10.3390/healthcare10091750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/25/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Strengthening primary care is a key focus of the latest healthcare reforms in China. However, many challenges, including the workforce competence, still exist. This study aimed to evaluate the common disease management competency of rural primary care providers in Sichuan Province, western China. Methods: A cross-sectional study was conducted in 9 township health centers and 86 village clinics in 3 counties. Diarrhea and respiratory infection were selected as the evaluation cases. General partitioners were assessed through their abilities to (1) take history; (2) make diagnoses; (3) propose treatment; and (4) deal with clinical cases. Results: In total, 362 healthcare workers were surveyed, and 130 general practitioners were enrolled into our study. On average, rural primary care providers could only answer 46.4% of questions absolutely correctly, with 29.7% partly correctly and 23.8% incorrectly. Conclusion: We suggest strengthening training to improve rural primary care providers’ competencies, especially their capacities of history taking. Policy action is also needed to address regional disparities.
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Affiliation(s)
- Yian Fang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
- School of Public Health, Peking University, Beijing 100191, China
| | - Shaohua Jiang
- The First Affiliated Hospital, Xinjiang Medical University, Urumqi 833054, China
| | - Pei Jiang
- School of Public Health, North Sichuan Medical College, Nanchong 637100, China
| | - Huan Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Min Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
- Faculty of Health, Design and Art, Swinburne University of Technology, Melbourne 3122, Australia
- Correspondence:
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Alqahtani SS, Alraqi AD, Alageel AA. Physicians' satisfaction with telehealth services among family physicians in Cluster 1 hospitals. J Family Med Prim Care 2022; 11:5563-5568. [PMID: 36505646 PMCID: PMC9730943 DOI: 10.4103/jfmpc.jfmpc_920_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/15/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022] Open
Abstract
Background Physicians are increasingly applying telehealth services in the hospital. The use of telehealth services helps to ensure that doctors treat patients and write prescriptions remotely without the need to meet physically with the patient. Methods The study used a descriptive survey design, in which collection and sampling of data were standardized to represent the population of all physicians. The target population was all doctors in all private healthcare systems, King Saud Medical City (KSMC), and four hospitals in the southwest area of Saudi Arabia. Data were collected via a simple random sampling system and engaged questionnaires. Microsoft Office Excel was used for data entry and preparation of graphs and charts. Results We collected data from 151 physicians in Cluster 1 hospitals. Most were males (74.8%) with a mean age of 31.14 years. Of these, 57.6% thought that telemedicine saved physicians' traveling time, 27.8% were satisfied with telemedicine services, 28.5% were not satisfied, and 43.7% were neutral; 61.6% thought that telemedicine was important for them, and 53.6% liked using telemedicine because of the similarity of participants' values and society values underlying its uses; 59.6% reported that telemedicine improved their job effectiveness and performance, while 58.9% reported that telemedicine enabled them to accomplish tasks more quickly and made them more productive. Conclusion Physicians expressed a high level of satisfaction and a positive attitude toward telemedicine. Future researches are essential to see how attitudes about telemedicine have altered since the pandemic.
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Affiliation(s)
- Saad S. Alqahtani
- Family Medicine Resident, King Saud Medical City, Riyadh City, Saudi Arabia,Address for correspondence: Dr. Saad S. Alqahtani, Family Medicine Resident, King Saud Medical City, Riyadh city, Saudi Arabia. E-mail:
| | - Abdullah D. Alraqi
- Family Medicine Resident, King Saud Medical City, Riyadh City, Saudi Arabia
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Valenti-Hein C. Integrating Spiritual Care in Population Health and Care Management: Two Case Examples. Prof Case Manag 2022; 27:229-238. [PMID: 35901254 DOI: 10.1097/ncm.0000000000000564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE/OBJECTIVES The purpose of this case study is to describe the movement of spiritual care into outpatient, managed care and population health settings, as it has evolved in a major not-for-profit health care system in the United States. The objective is to begin to establish the effectiveness of integrating spiritual care as a part of the interdisciplinary team (IDT) in these contexts. PRIMARY PRACTICE SETTINGS The case study presents two practice settings: a remote patient monitoring program for patients with complex medical conditions, and integration into population health as a part of a Medicare Advantage Insurance program that is a cooperative venture between the health care system (Ascension) and an established insurance program (Centene). FINDINGS/CONCLUSIONS The cases presented suggest that the integration of spiritual care into the outpatient, managed care and population health contexts has a threefold benefit: enhancing patient care, increasing the effectiveness of the IDT, and providing for the care and support of the members of the IDTs themselves. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE The cases presented suggest inclusion of spiritual care in the care management/population health approach to patient care is viable and valuable both for the benefit of the patient and the functioning of the care team.
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Affiliation(s)
- Charles Valenti-Hein
- Charles Valenti-Hein, MDiv, PhD, is part of the Ascension On Demand Spiritual Care Team. He is Board Certified by the Association of Professional Chaplains, and an ordained pastor in the Presbyterian Church, USA. He holds an MDiv from McCormick Theological Seminary in Chicago, Illinois, and a PhD in Systematic Theology from Marquette University in Milwaukee, Wisconsin
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Appleman ER, O'Connor MK, Rockefeller W, Morin P, Moo LR. Using Video Telehealth to Deliver Patient-Centered Collaborative Care: The G-IMPACT Pilot. Clin Gerontol 2022; 45:1010-1019. [PMID: 32228299 DOI: 10.1080/07317115.2020.1738000] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: This pilot project aimed to explore a new model of healthcare delivery to older adult medically complex Veterans by combining telehealth technology with an interdisciplinary medical team operating in real time.Methods: The Geriatric-Interdisciplinary Mobile Patient Access Team (G-IMPACT) was comprised of a field team including a nurse practitioner and technology assistant who visited enrolled patients in their homes using synchronous video to link to a suite of geriatric specialists in a video-enabled room at a Veterans Affairs hospital. Clinicians interacted with patients, caregivers, and each other to develop mutually agreed upon treatment plans that were then immediately implemented in the field.Results: 11 total visits were conducted with 9 Veteran patients aged 55-91 (mean = 75.3 years). Both patients and clinicians reported a high level of satisfaction across multiple metrics, including visit quality, and positive indirect indicators of effectiveness were apparent from qualitative data.Conclusions: Nurse practitioner facilitated video visits allowed geriatric patients to meet with multiple specialists simultaneously with both high patient satisfaction and increased real-time care coordination.Clinical Implications: This project identified challenges and opportunities afforded by this type of real-time telehealth care delivery and can inform the development of future interdisciplinary mobile medical teams.
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Affiliation(s)
- Erica R Appleman
- Edith Nourse Rogers Memorial Veterans Hospital, Department of Psychology, Bedford, Massachusetts, USA
| | - Maureen K O'Connor
- Edith Nourse Rogers Memorial Veterans Hospital, Department of Psychology, Bedford, Massachusetts, USA.,Boston University School of Medicine, Department of Neurology, Boston, Massachusetts, USA
| | - Whitney Rockefeller
- Department of Veterans Affairs Office of Healthcare Transformation, Washington, District of Columbia, USA
| | - Peter Morin
- Department of Veterans Affairs, Geriatric Research Education and Clinical Center, Bedford, Massachusetts, USA
| | - Lauren R Moo
- Department of Veterans Affairs, Geriatric Research Education and Clinical Center, Bedford, Massachusetts, USA.,Harvard Medical School, Department of Neurology, Cambridge, Massachusetts, USA
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Hart DA. Sex Differences in Biological Systems and the Conundrum of Menopause: Potential Commonalities in Post-Menopausal Disease Mechanisms. Int J Mol Sci 2022; 23:ijms23084119. [PMID: 35456937 PMCID: PMC9026302 DOI: 10.3390/ijms23084119] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/30/2022] [Accepted: 04/05/2022] [Indexed: 02/04/2023] Open
Abstract
Sex-specific differences in biology and physiology likely start at the time of conception and progress and mature during the pre-puberty time frame and then during the transitions accompanying puberty. These sex differences are impacted by both genetics and epigenetic alterations during the maturation process, likely for the purpose of preparing for successful reproduction. For females, later in life (~45–50) they undergo another transition leading to a loss of ovarian hormone production at menopause. The reasons for menopause are not clear, but for a subset of females, menopause is accompanied by an increased risk of a number of diseases or conditions that impact a variety of tissues. Most research has mainly focused on the target cells in each of the affected tissues rather than pursue the alternative option that there may be commonalities in the development of these post-menopausal conditions in addition to influences on specific target cells. This review will address some of the potential commonalities presented by an integration of the literature regarding tissue-specific aspects of these post-menopausal conditions and data presented by space flight/microgravity (a condition not anticipated by evolution) that could implicate a loss of a regulatory function of the microvasculature in the risk attached to the affected tissues. Thus, the loss of the integration of the paracrine relationships between endothelial cells of the microvasculature of the tissues affected in the post-menopausal environment could contribute to the risk for post-menopausal diseases/conditions. The validation of this concept could lead to new approaches for interventions to treat post-menopausal conditions, as well as provide new understanding regarding sex-specific biological regulation.
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Affiliation(s)
- David A. Hart
- Department of Surgery and Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 4N1, Canada; ; Tel.: +1-403-220-4571
- Bone & Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
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May S, Fehler G, Jonas K, Zahn T, Heinze M, Muehlensiepen F. [Opportunities and challenges for the use of video consultations in nursing homes from the caregiver perspective: a qualitative pre-post study]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 169:48-58. [PMID: 35165047 DOI: 10.1016/j.zefq.2021.11.007] [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: 09/09/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The implementation of medical video consultations in nursing homes can support primary care in rural areas and counteract the shortage of physicians. So far, video consultations have been limited to pilot projects and have not yet been comprehensively implemented. The present study addresses potentials of video consultations and challenges that may arise during the implementation of medical video consultations. METHODS Twenty-one guided interviews (pre-implementation: n = 13; post-implementation: n = 8) were conducted with a total of 13 participants (physicians, nurses and medical technical assistants). The data was analyzed using qualitative content analysis. The results were contrasted in a pre-post analysis. RESULTS Almost all of the interviewees' expectations regarding video consultations described prior to implementation have been met: time savings, improved communication, reduction of information breaks and increase in the quality of care. After implementation, other unexpected advantages of telemedical care became apparent, such as the possibility of regular monitoring or the improved ability to plan routine visits without interrupting the daily schedule. At the same time, the implementation of video consultations is associated with the following challenges: defining responsibilities, acquiring experience in handling video consultation tools, providing for sufficient qualification and training, dealing with new billing modalities as well as missing links between nursing documentation and medical information systems. DISCUSSION Video consultations can improve health care routines in nursing homes, lead to a wider availability of medical services, and contribute to improving patient safety and the quality of care. However, various aspects and contextual factors need to be addressed when implementing video consultations. These include: implementation of technical requirements, initial training with test consultations, continuous interactive development of potential fields of application, and the definition of the respective responsibilities of caregivers, physicians and medical assistants.
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Affiliation(s)
- Susann May
- Zentrum für Versorgungsforschung, Medizinische Hochschule Brandenburg, Rüdersdorf bei Berlin, Deutschland.
| | - Georgia Fehler
- Zentrum für Versorgungsforschung, Medizinische Hochschule Brandenburg, Rüdersdorf bei Berlin, Deutschland
| | - Kai Jonas
- bbw Hochschule Berlin, Berlin, Deutschland
| | | | - Martin Heinze
- Zentrum für Versorgungsforschung, Medizinische Hochschule Brandenburg, Rüdersdorf bei Berlin, Deutschland; Abteilung Psychiatrie und Psychotherapie, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin, Deutschland
| | - Felix Muehlensiepen
- Zentrum für Versorgungsforschung, Medizinische Hochschule Brandenburg, Rüdersdorf bei Berlin, Deutschland; Fakultät für Gesundheitswissenschaften, Gemeinsame Fakultät der Universität Potsdam, der Brandenburgischen Technischen Universität Cottbus- Senftenberg und der Medizinischen Hochschule Brandenburg Theodor Fontane, Potsdam, Deutschland
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Rousseau A, Gaucher L, Gautier S, Mahrez I, Baumann S. How midwives implemented teleconsultations during the COVID-19 health crisis: a mixed-methods study. BMJ Open 2022; 12:e057292. [PMID: 35365534 PMCID: PMC8977454 DOI: 10.1136/bmjopen-2021-057292] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Our primary and secondary objectives were to measure and understand the determinants of independent midwives' implementation of teleconsultations and their intention to continue these in the future. DESIGN A two-phase mixed-methods approach: (1) quantitative data to measure factors determining the initiation and continuation of teleconsultation, collected by an online survey from 29 April to 15 May 2020, at the end of the first COVID-19 lockdown, followed by (2) qualitative data to understand these determinants, by interviewing some participants in May-July 2020 to explore the quantitative findings in more detail. SETTING Mainland France PARTICIPANTS: The target population comprised independent midwives currently practising in France. PRIMARY AND SECONDARY OUTCOME MEASURES The primary and secondary outcomes were binary variables: implementation of teleconsultations, and intention to continue them. The qualitative results provided the themes explaining these decisions. RESULTS We obtained 1491 complete responses from independent midwives, that is, 28.3% of French independent midwives, and interviewed 22 volunteers among them. Among the 1491, 88.5% implemented teleconsultations and 65.8% intended to continue them. Both individual and organisational factors favoured implementation of teleconsultations: older age (adjusted OR (aOR): 0.40, 95% CI: 0.28 to 0.58), female gender (aOR: 6.88, 95% CI: 2.71 to 17.48), married or living with a partner (aOR: 1.67, 95% CI: 1.10 to 2.52) and working in a group practice (midwives only-aOR: 2.34, 95% CI: 1.47 to 3.72; multiprofessional group-aOR: 1.75, 95% CI: 1.16 to 2.64). The qualitative analysis did not identify any new factors but helped us to understand the satisfaction better: midwives adopted telemedicine for their patients' access to and continuity of care, to maintain their professional activity and income, and to limit the risks of infection. CONCLUSION Personal and organisational factors motivated the implementation of teleconsultation during the pandemic, but maintaining it raises technical, regulatory, and ethical issues.
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Affiliation(s)
- Anne Rousseau
- CESP, Inserm U1018, Epidémiologie Clinique Team, UVSQ, Paris-Saclay University, Montigny le Bretonneux, France
- Midwifery department, UFR S. Veil-Santé, UVSQ, Montigny le Bretonneux, France
- Obstetric deparment, Poissy-Saint Germain-en-Laye Hospital, Poissy, France
| | - Laurent Gaucher
- Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, Bron, France
- Research on Healthcare Performance (RESHAPE), Inserm U1290, Université Claude Bernard, Lyon, France
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Sylvain Gautier
- CESP, Inserm U1018, Primary care and prevention team, UVSQ, Paris-Saclay University, Villejuif, France
- Hospital Department of epidemiology and public health, Raymond Poincaré hospital, AP-HP, GHU Paris-Saclay, Garches, France
| | - Ines Mahrez
- Midwifery department, UFR S. Veil-Santé, UVSQ, Montigny le Bretonneux, France
| | - Sophie Baumann
- Midwifery department, UFR S. Veil-Santé, UVSQ, Montigny le Bretonneux, France
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Vaucel JA, Enaud N, Paradis C, Bragança C, Courtois A, Lan M, Gil-Jardine C, Enaud R, Labadie M, Deguigne M, Roux GL, Descatha A, Azzouz R, Nisse P, Patat AM, Paret N, Blanc-Brisset I, Nardon A, Haro LD, Simon N, Delcourt N, Pelissier F, Tournoud C, Puskarczyk E, Langrand J, Laborde-Casterot H, Care W, Vodovar D. Poison control centres and alternative forms of communication: comparison of response rates between text message and telephone follow-up. Clin Toxicol (Phila) 2022; 60:947-953. [PMID: 35311427 DOI: 10.1080/15563650.2022.2051537] [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: 11/03/2022]
Abstract
INTRODUCTION In recent years, the number of patients managed by poison control centres (PCCs) has increased without a proportional increase in the number of physicians. To improve efficiency without neglecting patient follow-up, some PCCs have begun using text messages. We evaluated the difference in response rates between text messaging and traditional telephone follow-up. MATERIALS AND METHODS This retrospective, monocentric, non-randomised cohort study was conducted using data from calls made by the New Aquitaine PCC between February 27, 2019, and March 31, 2019. Patients were contacted up to three times by a phone call or short message service (SMS). RESULTS For the analysis, 823 patients were included. At the end of follow-up, the response rates were similar in the phone call and SMS group (94 vs. 94%; p = 0.76) with median [interquartile range] response times of 0 min [0; 27 min] and 29 min [6; 120 min], respectively. The response rates did not differ in subgroups stratified according to sex, self-poisoning vs. relative response, age class, and solicitation during working hours vs. outside of working hours (all p > 0.5). Moreover, health practitioners required 2.4-fold more time to call than to send text messages (p < 0.001), and all practitioners were satisfied or very satisfied with text messaging implementation. CONCLUSION Patients had good adherence to text messages. Text messages are easy to use, rapid, and allow the physician to easily prioritise follow-up without occupying the emergency line. Additionally, the costs of installation and maintenance are low for text message systems; these low costs facilitate the implementation of such services in various medical situations.
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Affiliation(s)
- Jules-Antoine Vaucel
- Service des Urgences Adulte [Emergency Department], Centre Hospitalier et Universitaire Pellegrin, Bordeaux, France.,Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], Centre Hospitalier et Universitaire Pellegrin, Bordeaux Cedex, France
| | - Nicolas Enaud
- Service des Urgences [Emergency Department], Centre Hospitalier d'Arcachon, La Teste de Buch, France
| | - Camille Paradis
- Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], Centre Hospitalier et Universitaire Pellegrin, Bordeaux Cedex, France
| | - Coralie Bragança
- Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], Centre Hospitalier et Universitaire Pellegrin, Bordeaux Cedex, France
| | - Arnaud Courtois
- Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], Centre Hospitalier et Universitaire Pellegrin, Bordeaux Cedex, France
| | - Maxime Lan
- Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], Centre Hospitalier et Universitaire Pellegrin, Bordeaux Cedex, France
| | - Cédric Gil-Jardine
- Service des Urgences Adulte [Emergency Department], Centre Hospitalier et Universitaire Pellegrin, Bordeaux, France.,Bordeaux Population Health Research Center, IETO Team, Université de Bordeaux, Bordeaux, France
| | | | - Raphaël Enaud
- Service d'Hépato Gastroentérologie Pédiatrique [Pediatric Hepato Gastroenterology Department], Centre Hospitalier et Universitaire Pellegrin, Bordeaux Cedex, France
| | - Magali Labadie
- Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], Centre Hospitalier et Universitaire Pellegrin, Bordeaux Cedex, France
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