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Kolangarakath A, Chalil Madathil K, Hegde S, Agrawal S, Bian M, Simmons L, Molloseau G, Holmstedt C, LeBlanc D, Harvey J, McGeorge T, Spampinato M, Roberts D. Barriers to integrating portable Magnetic Resonance Imaging systems in emergency medical service ambulances for stroke care. ERGONOMICS 2024:1-20. [PMID: 38916114 DOI: 10.1080/00140139.2024.2367157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/06/2024] [Indexed: 06/26/2024]
Abstract
This study examines the barriers to integrating portable Magnetic Resonance Imaging (MRI) systems into ambulance services to enable effective triaging of patients to the appropriate hospitals for timely stroke care and potentially reduce door-to-needle time for thrombolytic administration. The study employs a qualitative methodology using a digital twin of the patient handling process developed and demonstrated through semi-structured interviews with 18 participants, including 11 paramedics from an Emergency Medical Services system and seven neurologists from a tertiary stroke care centre. The interview transcripts were thematically analysed to determine the barriers based on the Systems Engineering Initiative for Patient Safety framework. Key barriers include the need for MRI operation skills, procedural complexities in patient handling, space constraints, and the need for training and policy development. Potential solutions are suggested to mitigate these barriers. The findings can facilitate implementing MRI systems in ambulances to expedite stroke treatment.
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Affiliation(s)
- Arvind Kolangarakath
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | - Kapil Chalil Madathil
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | - Sudeep Hegde
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | - Shubham Agrawal
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Mary Bian
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Lauren Simmons
- Department of Genetics and Biochemistry, Clemson University, Clemson, South Carolina, USA
| | - Gabby Molloseau
- College of Medicine, Medical University of South Carolina, Clemson, South Carolina, USA
| | - Christine Holmstedt
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dustin LeBlanc
- Department of Emergency Medicine, Medical University of South Carolina,Charleston, South Carolina, USA
| | - Jillian Harvey
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Todd McGeorge
- Charleston County Emergency Medical Services, Charleston, South Carolina, USA
| | - Maria Spampinato
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Donna Roberts
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
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Srinivasan Y, Andreadis K, Ballakur SS, Rameau A. Access to Otolaryngologic Telemedicine Care Across the COVID-19 Pandemic at an Urban Tertiary Hospital System. EAR, NOSE & THROAT JOURNAL 2024; 103:76S-84S. [PMID: 38488168 DOI: 10.1177/01455613241240560] [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: 05/31/2024] Open
Abstract
Objective: To describe associations between patients' demographic characteristics and access to telemedicine services in an urban tertiary academic medical system across the COVID-19 pandemic, and to identify potential barriers to access. Methods: This was a retrospective cohort study conducted at a single-center tertiary academic medical center. The study included adult patients undergoing outpatient otolaryngologic care in person or via telemedicine during 8 week timeframes: before the pandemic, at the onset of the pandemic, and during later parts of the pandemic. Patients were characterized by age, sex, race, insurance type, primary language, portal activation status, income estimate, and visit type. Where appropriate, chi-squared tests, Wilcoxon signed-rank tests, and logistic regression were used to compare demographic factors between the cohorts. Results: A total of 14,240 unique patients [median age, 58 years (range, 18-107 years); 56.5% were female] resulting in a total of 29,457 visits (94.8% in-person and 5.2% telemedicine) were analyzed. Patients seen in person were older than those using telemedicine. Telemedicine visits included a higher proportion of patients with private insurance, and fewer patients with government or no insurance compared to in-person visits. Race, income, and English as primary language were not found to have a significant effect on telemedicine use. Conclusion: In an urban tertiary medical center, we found significant differences in sociodemographic characteristics between patients who accessed otolaryngologic care in person versus via telemedicine through different phases of the COVID pandemic, reflecting possible barriers to care associated with telemedicine. Further studies are needed to develop interventions to improve access.
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Affiliation(s)
- Yashes Srinivasan
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Katerina Andreadis
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Sarita S Ballakur
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Anaïs Rameau
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY, USA
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Rullier C, Tarazona V, De Bandt D. Incidence of remote consultation on general practitioners' antibiotic prescriptions in 2021: a French observational study. BJGP Open 2024:BJGPO.2023.0196. [PMID: 38199798 DOI: 10.3399/bjgpo.2023.0196] [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: 10/02/2023] [Revised: 12/04/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND In patients with infectious diseases, remote consultation (RC) may be questionable compared with face-to-face office consultation (OC), not only because of the lack of physical examination but also because of the risk of overprescribing antibiotics (ATBs). AIM To analyse ATB prescription in OC versus RC in a sample of French GPs. DESIGN & SETTING This is a retrospective observational cohort study in general practice in 2021. Anonymised data were collected from voluntary GPs. METHOD The influence of the mode of consultation on ATB prescription was analysed using a χ² test. A secondary multivariate analysis investigated the factors influencing the use of OC or RC in patients who received at least one ATB. RESULTS In total, 35 503 consultations with an identifiable rating were included, corresponding to seven doctors' activities, practising with five locums and three residents. ATBs were prescribed in 10.41% of RCs and 6.77% of OCs (P<0.01). RC was associated with more frequent prescription of ATBs for respiratory and ear, nose, and throat (ENT) viral infections and urinary tract infections. For patients aged 20-40 years, ATB prescription was more associated with RC. CONCLUSION RC is associated with a more frequent ATB prescription than OC, mostly for patients aged 20-40 years, who are most likely to use new technologies; and for urinary tract infections or respiratory and ENT viral infections. Further studies on RC outcomes should be conducted to better analyse the impact of RC on the prescribing of ATBs.
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Affiliation(s)
- Cécile Rullier
- Family medicine department, University of Paris Saclay, Versailles-Saint-Quentin-en-Yvelines, Paris, France
| | - Vincent Tarazona
- Family medicine department, University of Paris Saclay, Versailles-Saint-Quentin-en-Yvelines, Paris, France
| | - David De Bandt
- Family medicine department, University of Paris Saclay, Versailles-Saint-Quentin-en-Yvelines, Paris, France
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Patel SR, Yeh HH, Eke-Usim A, Ahmedani BK, Rossom RC, Miller-Matero L, Simon GE, Penfold RB, Owen-Smith A, Beebani G, Akinyemi E. Reduced Disruption in Psychotherapy Visits Among Older Adults During the COVID-19 Pandemic. Am J Geriatr Psychiatry 2024; 32:644-645. [PMID: 38216356 DOI: 10.1016/j.jagp.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/18/2023] [Accepted: 12/27/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Shivali R Patel
- Department of Psychiatry (SRP), Michigan Medicine, Ann Arbor, MI.
| | - Hsueh-Han Yeh
- Center for Health Policy & Health Services Research (HHY, BKA, LMM), Henry Ford Health, Detroit, MI
| | - Angela Eke-Usim
- Department of Psychiatry (AEU), Authority Health, Detroit, MI
| | - Brian K Ahmedani
- Center for Health Policy & Health Services Research (HHY, BKA, LMM), Henry Ford Health, Detroit, MI; Behavioral Health Services (BKA, LMM, GB), Henry Ford Health, Detroit, MI
| | - Rebecca C Rossom
- Division of Research (RCR), HealthPartners Institute, Minneapolis, MA
| | - Lisa Miller-Matero
- Center for Health Policy & Health Services Research (HHY, BKA, LMM), Henry Ford Health, Detroit, MI; Behavioral Health Services (BKA, LMM, GB), Henry Ford Health, Detroit, MI
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute (GES, RBP), Seattle, WA
| | - Robert B Penfold
- Kaiser Permanente Washington Health Research Institute (GES, RBP), Seattle, WA
| | - Ashli Owen-Smith
- Department of Health Policy and Behavioral Sciences (AOS), Kaiser Permanente Georgia, Center for Research and Evaluation, Georgia State University School of Public Health, Atlanta, GA
| | - Ganj Beebani
- Behavioral Health Services (BKA, LMM, GB), Henry Ford Health, Detroit, MI
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Mihevc M, Lukančič MM, Črt Z, Potočnik TV, Šter MP, Klemenc-Ketiš Z, Susič AP. Towards Integrated Care for the Elderly: Exploring the Acceptability of Telemonitoring for Hypertension and Type 2 Diabetes Management. Int J Integr Care 2024; 24:16. [PMID: 38765055 PMCID: PMC11100527 DOI: 10.5334/ijic.7621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/07/2024] [Indexed: 05/21/2024] Open
Abstract
Introduction Telemonitoring has been proposed as an effective method to support integrated care for older people with hypertension and type 2 diabetes. This paper examines acceptability of telemontioring, its role in supporting integrated care, and identifies scale-up barriers. Methods A concurrent triangulation mixed-methods study, including in-depth interviews (n = 29) and quantitative acceptability tool (n = 55) was conducted among individuals who underwent a 12-month telemonitoring routine. The research was guided by the Theoretical Framework of Acceptability. Interviews were analysed using template content analysis (TCA). Results TCA identified seven domains of acceptability, with twenty-one subthemes influencing it positively or negatively. In the quantitative survey, acceptability was high across all seven domains with an overall score of 4.4 out of 5. Urban regions showed higher acceptability than rural regions (4.5 vs. 4.3), with rural participants perceiving initial training and participation effort as significantly more burdensome than their urban counterparts. Discussion Patients described several instances where telemonitoring supported self-management, education, treatment, and identification elements of the integrated care package. However, there were barriers that may limit its further scale-up. Conclusion For further scale-up, it is important to screen patients for monitoring eligibility, adapt telemonitoring devices to elderly needs, combine telemonitoring with health education, involve family members, and establish follow-up programmes.
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Affiliation(s)
- Matic Mihevc
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova ulica 9, SI-1000 Ljubljana, Slovenia
- Primary Healthcare Centre Trebnje, Goliev trg 3, SI-8210 Trebnje, Slovenia
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, SI-1000 Ljubljana, Slovenia
| | - Majda Mori Lukančič
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova ulica 9, SI-1000 Ljubljana, Slovenia
| | - Zavrnik Črt
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova ulica 9, SI-1000 Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, SI-1000 Ljubljana, Slovenia
| | - Tina Virtič Potočnik
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova ulica 9, SI-1000 Ljubljana, Slovenia
- Primary Healthcare Centre Slovenj Gradec, Partizanska pot 16, SI-2380 Slovenj Gradec, Slovenia
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska ulica 8, SI-2000 Maribor, Slovenia
| | - Marija Petek Šter
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, SI-1000 Ljubljana, Slovenia
| | - Zalika Klemenc-Ketiš
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova ulica 9, SI-1000 Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, SI-1000 Ljubljana, Slovenia
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska ulica 8, SI-2000 Maribor, Slovenia
| | - Antonija Poplas Susič
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova ulica 9, SI-1000 Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, SI-1000 Ljubljana, Slovenia
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Iguacel I, Antón I, Urcola F, Ariño M, Martínez-Jarreta B. Assessing patient satisfaction with telephone-based consultations before, during and after the COVID-19 pandemic in Spain. Aten Primaria 2024; 56:102792. [PMID: 37924620 PMCID: PMC10654540 DOI: 10.1016/j.aprim.2023.102792] [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: 08/04/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 11/06/2023] Open
Abstract
OBJECTIVE To validate a questionnaire to analyze the perception of users of primary care (PC) with telephone consultation (TC), and to study the satisfaction with TC by users of PC services. DESIGN A two-phase study was conducted. Firstly, a questionnaire on satisfaction with telemedicine services was validated. Secondly, a cross-sectional study on satisfaction with TC was conducted. SETTING PC. PARTICIPANTS 405 users of PC services in Zaragoza (Spain). MAIN OUTCOME MEASURE Our main outcome was the satisfaction with telemedicine services PC services. Factor analysis was carried out using the exploratory factor analysis with Varimax rotation. The reliability of the dimensions obtained was analyzed using Cronbach's alpha. The inferential analysis was conducted using parametric tests. RESULTS The questionnaire was a valid and reliable tool (α>0.9) to assess the satisfaction of PC service users with telemedicine services. Before COVID-19, the satisfaction of the users with PC was adequate (mean=6111/10). However, during the COVID-19 the attention in PC centers became mostly telephone-based and satisfaction lowered as disappointing (mean=3555/10). Regarding the future of telemedicine, users considered it as unsatisfactory (mean=2977/10). Being a woman, being unemployed and belonging to an area of low vulnerability led to a worse perception of telemedicine. CONCLUSION This questionnaire was a valid and reliable tool to assess the satisfaction of PC service users with telemedicine services. Perceptions of patient satisfaction decreased during COVID-19. Thus, TC seems to be a good option when the patients consider it to be a complementary rather than a substitute tool to follow-up their conditions.
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Affiliation(s)
- Isabel Iguacel
- Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain; Instituto Agroalimentario de Aragón-IA2 (Universidad de Zaragoza-CITA), Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain
| | - Isabel Antón
- Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain; SAPIENF (B53_23R), Zaragoza, Spain
| | - Fernando Urcola
- Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain; SAPIENF (B53_23R), Zaragoza, Spain.
| | - Miguel Ariño
- Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain; SAPIENF (B53_23R), Zaragoza, Spain
| | - Begoña Martínez-Jarreta
- Scientific Research Group GIIS-063 of Aragon Institute of Health, Department of Occupational Medicine, University of Zaragoza, Zaragoza, Spain
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Şahin E, Yavuz Veizi BG, Naharci MI. Telemedicine interventions for older adults: A systematic review. J Telemed Telecare 2024; 30:305-319. [PMID: 34825609 DOI: 10.1177/1357633x211058340] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Telemedicine may help improve older adults' access, health outcomes, and quality of life indicators. This review aims to provide current evidence on the effectiveness of telemedicine in the aged population. METHOD A systematic literature search was conducted in PubMed, Google Scholar, and Web of Science electronic databases between January 2015 and September 2021 using the keywords "telemedicine" or "telehealth" and "older people" or "geriatrics" or "elderly." The articles were classified under three headings according to the purposes: feasibility, diagnosis and management of chronic diseases, and patient satisfaction. RESULTS A total of 22 articles were included. Across most disciplines, evidence has shown that telemedicine is as effective as usual care, if not more so, in the feasibility, chronic disease management, and patient satisfaction of the elderly. However, a few studies reported challenges such as difficulty with technology, hearing problems, and the inability to perform hands-on examinations for physicians. CONCLUSION Findings from this review support the view that health care providers can use telemedicine to manage elderly individuals in conjunction with usual health care. However, future research is needed to eliminate barriers to increasing telemedicine use among older adults.
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Affiliation(s)
- Ebru Şahin
- Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Department of Geriatrics, University of Health Sciences, Ankara, Turkey
| | - Betül Gülsüm Yavuz Veizi
- Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Department of Geriatrics, University of Health Sciences, Ankara, Turkey
| | - Mehmet Ilkin Naharci
- Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, Department of Geriatrics, University of Health Sciences, Ankara, Turkey
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Abel B, Bongartz M, Rapp K, Roigk P, Peiter J, Metz B, Finger B, Büchele G, Wensing M, Roth C, Schmidberger O, König HH, Gottschalk S, Dams J, Deuster O, Immel D, Micol W, Bauer JM, Benzinger P. Multimodal home-based rehabilitation intervention after discharge from inpatient geriatric rehabilitation (GeRas): study protocol for a multicenter randomized controlled trial. BMC Geriatr 2024; 24:69. [PMID: 38233746 PMCID: PMC10795216 DOI: 10.1186/s12877-023-04634-2] [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: 08/07/2023] [Accepted: 12/22/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Geriatric rehabilitation aims to maintain the functional reserves of older adults in order to optimize social participation and prevent disability. After discharge from inpatient geriatric rehabilitation, patients are at high risk for decreased physical capacity, increased vulnerability, and limitations in mobility. As a result, ageing in place becomes uncertain for a plethora of patients after discharge from geriatric rehabilitation and effective strategies to prevent physical decline are required. Collaboration between different health-care providers is essential to improve continuity of care after discharge from inpatient geriatric rehabilitation. The aim of this study is to evaluate the effectiveness of a multi-professional home-based intervention program (GeRas) to improve functional capacity and social participation in older persons after discharge from inpatient geriatric rehabilitation. METHODS The study is a multicenter, three-arm, randomized controlled trial with a three-month intervention period. Two hundred and seventy community-dwelling older people receiving inpatient geriatric rehabilitation will be randomized with a 1:1:1 ratio to one of the parallel intervention groups (conventional IG or tablet IG) or the control group (CG). The participants of both IGs will receive a home-based physical exercise program supervised by physical therapists, a nutritional recommendation by a physician, and social counseling by social workers of the health insurance company. The collaboration between the health-care providers and management of participants will be realized within a cloud environment based on a telemedicine platform and supported by multi-professional case conferences. The CG will receive usual care, two short handouts on general health-related topics, and facultative lifestyle counseling with general recommendations for a healthy diet and active ageing. The primary outcomes will be the physical capacity measured by the Short Physical Performance Battery and social participation assessed by the modified Reintegration to Normal Living Index, three months after discharge. DISCUSSION The GeRas program is designed to improve the collaboration between health-care providers in the transition from inpatient geriatric rehabilitation to outpatient settings. Compared to usual care, it is expected to improve physical capacity and participation in geriatric patients after discharge from inpatient geriatric rehabilitation. TRIAL REGISTRATION German Clinical Trials Register (DRKS00029559). Registered on October 05, 2022.
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Grants
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- German Innovation Fund (‘New Forms of Care’) coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- Universitätsklinikum Heidelberg (8914)
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Affiliation(s)
- Bastian Abel
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Martin Bongartz
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Patrick Roigk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Janine Peiter
- Geriatric Center Karlsruhe, ViDia Christian Clinics Karlsruhe, Karlsruhe, Germany
| | - Brigitte Metz
- Geriatric Center Karlsruhe, ViDia Christian Clinics Karlsruhe, Karlsruhe, Germany
| | - Benjamin Finger
- Department of Telemedicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Catharina Roth
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver Schmidberger
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Deuster
- Interdisciplinary Center for Clinical Trials (IZKS) at the University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Désirée Immel
- AOK Baden-Württemberg, Statutory Health Insurance Company, Stuttgart, Germany
| | - William Micol
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen M Bauer
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Petra Benzinger
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany.
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Raquel Costa-Brito A, Bovolini A, Rúa-Alonso M, Vaz C, Francisco Ortega-Morán J, Blas Pagador J, Vila-Chã C. Home-based exercise interventions delivered by technology in older adults: A scoping review of technological tools usage. Int J Med Inform 2024; 181:105287. [PMID: 37972483 DOI: 10.1016/j.ijmedinf.2023.105287] [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: 07/01/2023] [Revised: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Despite technology-based systems being considered promising tools to stimulate and increase physical function at home, most older adults are unfamiliar with technology, which may pose some difficulties. Technology-related parameters, such as adherence, acceptance, and acceptability, are crucial to achieving higher efficacy levels of home-based exercise interventions delivered by technology. In this scoping review, we aimed to revise the use of home-based technological tools to improve physical function in the older population, focusing on the user's experience and perspective. Methods This scoping review was conducted following PRISMA guidelines. The search was conducted in April 2022 and updated in April 2023. A total of 45 studies were included in the review. Results Most studies (95.5%) met the technology usage levels defined by the research team or reported satisfactory technology usage levels. Positive health-related outcomes were reported in 80% of studies. Although the existence of guidelines to correctly define and use measures associated with technology use, including adherence, acceptance and acceptability, some terms are still being used interchangeably. Some concerns related to the lack of an international consensus regarding technology usage measures and the exclusion of older adults who did not own or have previous experience with technology in a large percentage of the included studies may have limited the results obtained. Conclusions Altogether, home-based exercise interventions delivered through technology were associated with positive health-related outcomes in older adults, and technology usage levels are considered satisfactory. Older adults are willing and able to use technology autonomously if adequate support is provided.
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Affiliation(s)
| | - Antonio Bovolini
- Polytechnic of Guarda, Guarda, Portugal; Research Center in Sports Sciences, Health Sciences, and Human Development, Vila Real, Portugal
| | - María Rúa-Alonso
- Polytechnic of Guarda, Guarda, Portugal; Research Center in Sports Sciences, Health Sciences, and Human Development, Vila Real, Portugal; Performance and Health Group, Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruna, A Coruña, Spain
| | | | | | - J Blas Pagador
- Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Carolina Vila-Chã
- Polytechnic of Guarda, Guarda, Portugal; Research Center in Sports Sciences, Health Sciences, and Human Development, Vila Real, Portugal.
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Scarlata S, Okoye C, Zotti S, Lauretani F, Nouvenne A, Cerundolo N, Bruni AA, Torrini M, Finazzi A, Mazzarone T, Lunian M, Zucchini I, Maccioni L, Guarino D, Fabbri Della Faggiola S, Capacci M, Bianco MG, Guarona G, Bellelli G, Monzani F, Virdis A, Antonelli Incalzi R, Ungar A, Ticinesi A. Advancing healthcare through thoracic ultrasound research in older patients. Aging Clin Exp Res 2023; 35:2887-2901. [PMID: 37950845 PMCID: PMC10721707 DOI: 10.1007/s40520-023-02590-w] [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: 09/27/2023] [Accepted: 10/08/2023] [Indexed: 11/13/2023]
Abstract
This paper reports the proceedings of a meeting convened by the Research Group on Thoracic Ultrasound in Older People of the Italian Society of Gerontology and Geriatrics, to discuss the current state-of-the-art of clinical research in the field of geriatric thoracic ultrasound and identify unmet research needs and potential areas of development. In the last decade, point-of-care thoracic ultrasound has entered clinical practice for diagnosis and management of several respiratory illnesses, such as bacterial and viral pneumonia, pleural effusion, acute heart failure, and pneumothorax, especially in the emergency-urgency setting. Very few studies, however, have been specifically focused on older patients with frailty and multi-morbidity, who frequently exhibit complex clinical pictures needing multidimensional evaluation. At the present state of knowledge, there is still uncertainty on the best requirements of ultrasound equipment, methodology of examination, and reporting needed to optimize the advantages of thoracic ultrasound implementation in the care of geriatric patients. Other issues regard differential diagnosis between bacterial and aspiration pneumonia, objective grading of interstitial syndrome severity, quantification and monitoring of pleural effusions and solid pleural lesions, significance of ultrasonographic assessment of post-COVID-19 sequelae, and prognostic value of assessment of diaphragmatic thickness and motility. Finally, application of remote ultrasound diagnostics in the community and nursing home setting is still poorly investigated by the current literature. Overall, the presence of several open questions on geriatric applications of thoracic ultrasound represents a strong call to implement clinical research in this field.
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Affiliation(s)
- Simone Scarlata
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Department of Medicine and Surgery, Research Unit of Geriatrics, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Chukwuma Okoye
- School of Medicine and Surgery, University of Milano-Bicocca, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy.
- Department of Neurobiology, Care Sciences and Society, Department of Geriatrics Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Sonia Zotti
- Department of Medicine and Surgery, Research Unit of Geriatrics, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Fulvio Lauretani
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Antonio Nouvenne
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Nicoletta Cerundolo
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Adriana Antonella Bruni
- Acute Geriatric Unit, Fondazione IRCCS San Gerardo de Tintori, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
| | - Monica Torrini
- Geriatrics and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Alberto Finazzi
- School of Medicine and Surgery, University of Milano-Bicocca, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
| | - Tessa Mazzarone
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Marco Lunian
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Irene Zucchini
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Lorenzo Maccioni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Daniela Guarino
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | | | - Marco Capacci
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Maria Giovanna Bianco
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Guglielmo Guarona
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
- Acute Geriatric Unit, Fondazione IRCCS San Gerardo de Tintori, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
| | - Fabio Monzani
- Casa di Cura Venerabile Confraternita di Misericordia Navacchio, 56023, Pisa, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Raffaele Antonelli Incalzi
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Department of Medicine and Surgery, Research Unit of Geriatrics, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Andrea Ungar
- Geriatrics and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
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11
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Cheng L, Chan WK, Peng Y, Qin H. Towards data-driven tele-medicine intelligence: community-based mental healthcare paradigm shift for smart aging amid COVID-19 pandemic. Health Inf Sci Syst 2023; 11:14. [PMID: 36923686 PMCID: PMC10011761 DOI: 10.1007/s13755-022-00198-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 10/06/2022] [Indexed: 03/18/2023] Open
Abstract
Purpose Telemedicine are experiencing an unprecedented boom globally since the beginning of the COVID-19 pandemic. As the most vulnerable groups amid COVID-19, the digital delivery of healthcare poses great challenges to the elderly population, caregiver, health service providers, and health policy makers. To bridge the service delivery gaps between the telemedicine demand side and supply side, explore evidence-based approach for integrated care, address challenges for aging policy, and build foundation for the development of data-driven and community-based telemedicine, our R&D team applied translational research to design and develop telemedicine "SMART" for enhancing elderly mental health wellbeing amid COVID-19. Our aim is to investigate the preparedness mechanisms of mental health disease including response, intervention, and connection these three healthcare delivery pipelines with the collection, consolidation, and synergy of heath parameters and social determinants, using data analytics approach to achieve Evidence-Based Medicine (EBM). Methods A mix of quantitative and qualitative research design for scientifically rigorous consultation and analysis was conducted from Jan 2020 to June 2021 in Hong Kong. An exploratory and descriptive qualitative design was used in this study. The data were collected through focus group discussions conducted from elderly and their caregivers living in 10 main districts of Hong Kong. Our research pilot tested "SMART" targeting for elderly with mental health improvement needs. Baseline questionnaire with 110 tele-medicine product users includes questions on demographic information, self-rated mental health digital adoption. The follow-up five focus group discussions with 57 users (elderly and their caregivers) further explore the social determinants of telemedicine transformation and help propose the integrated telemedicine paradigm shift framework establishment, development, and enhancement. Results Grounded on the baseline needs assessment and feedbacks collected, it is evident that multi-dimensional health information from the four various streams (community, clinic, home, remote) and customized digital health solutions are playing a key role in addressing elderly mental health digital service needs and bridging digital divide. The designed tele-medicine product lines up health service provider (supplier side) and elderly specific needs (demand side) with our three-level design, enables elderly and their families to follow and control their own health management and connect with the service provider, community of practice (CoP), and health policy makers. Conclusion It's beneficial to involve elderly and gerontechnology stakeholders as part of Community-Based Participatory Research (CBPR) before and throughout the developing and delivery phases an integrated and age-friendly digital intervention. The challenges in applying and disseminating telemedicine reflected by the elderly and caregivers can be used as important input for further development and indicators for the sustainable and integrated elderly primary care framework. Supplementary Information The online version contains supplementary material available at 10.1007/s13755-022-00198-4.
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Affiliation(s)
- Lan Cheng
- Big Data Bio-Intelligence Lab, Big Data Institute, The Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong
| | - WK Chan
- Department of Computer Science and Engineering, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Yi Peng
- School of Government, Nanjing University, Nanjing, China
| | - Harry Qin
- Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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12
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Fikree S, Hafid S, Lawson J, Agarwal G, Griffith LE, Jaakkimainen L, Mangin D, Howard M. The association between patients' frailty status, multimorbidity, and demographic characteristics and changes in primary care for chronic conditions during the COVID-19 pandemic: a pre-post study. Fam Pract 2023; 40:523-530. [PMID: 37624946 DOI: 10.1093/fampra/cmad089] [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] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The purpose of this study was to assess the impact of SARS-COV-2 (Severe acute respiratory syndrome coronavirus 2) pandemic on primary care management (frequency of monitoring activities, regular prescriptions, and test results) of older adults with common chronic conditions (diabetes, hypertension, and chronic kidney disease) and to examine whether any changes were associated with age, sex, neighbourhood income, multimorbidity, and frailty. METHODS A research database from a sub-set of McMaster University Sentinel and Information Collaboration family practices was used to identify patients ≥65 years of age with a frailty assessment and 1 or more of the conditions. Patient demographics, chronic conditions, and chronic disease management information were retrieved. Changes from 14 months pre to 14 months since the pandemic were described and associations between patient characteristics and changes in monitoring, prescriptions, and test results were analysed using regression models. RESULTS The mean age of the 658 patients was 75 years. While the frequency of monitoring activities and prescriptions related to chronic conditions decreased overall, there were no clear trends across sub-groups of age, sex, frailty level, neighbourhood income, or number of conditions. The mean values of disease monitoring parameters (e.g. blood pressure) did not considerably change. The only significant regression model demonstrated that when controlling for all other variables, patients with 2 chronic conditions and those with 4 or more conditions were twice as likely to have reduced numbers of eGFR (Estimated glomerular filtration rate) measures compared to those with only 1 condition ((OR (odds ratio) = 2.40, 95% CI [1.19, 4.87]); (OR = 2.19, 95% CI [1.12, 4.25]), respectively). CONCLUSION In the first 14 months of the pandemic, the frequency of common elements of chronic condition care did not notably change overall or among higher-risk patients.
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Affiliation(s)
- Shireen Fikree
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Shuaib Hafid
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Jennifer Lawson
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Liisa Jaakkimainen
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, Canada
- Department of General Practice and Clinical Skills, University of Otago Christchurch, New Zealand
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Canada
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13
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Trankle SA, Reath J. Afterhours telehealth in Australian residential aged care facilities: a mixed methods evaluation. BMC Health Serv Res 2023; 23:1263. [PMID: 37968685 PMCID: PMC10652444 DOI: 10.1186/s12913-023-10257-5] [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: 01/22/2023] [Accepted: 10/31/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The aged care system in Australia is under pressure. Residential aged care facilities (RACFs) and general practitioners (GPs) have difficulty providing the care needed by their residents, particularly after hours. Many residents are given ambulance support and transferred to hospital emergency departments (EDs) for care that could be provided at RACFs. The MyEmergencyDoctor (MED) service was commissioned in a 12-month program (February 2020-February 2021) using ED physicians to provide afterhours telehealth care in six RACFs. METHODS Using the NASSS framework, we synthesised descriptive analyses of statistical data from the MED service, RACFs and the ambulance service and a thematic analysis of interview data collected from GPs, RACF and MED service staff, and family members of residents. RESULTS Most calls to MED (179/209) were resolved with in-house treatment thereby reducing ambulance usage and hospital admissions. Interviews further revealed that MED enabled timely care for residents who were unwell but did not need hospital transfer. Technology, training, and rapid access to MED assisted RACF staff and complemented usual GP care. MED potentially reduced GP burnout. Refresher training was considered important especially in RACFs with high staff turnover, as was greater afterhours access to medications. CONCLUSIONS The afterhours telehealth model provided in-house care and reduced ambulance transfers, and GPs and RACF staff generally felt supported. The service was easy to use and fostered good communications with GPs and RACF staff. Some GPs preferred to provide their own care, commenting on the need for a good understanding of patient and family needs and of the local context. Other stakeholders suggested this model could be extended to palliative care settings and to normal business hours when GPs were unavailable. The reduced ambulance and hospital use suggested benefits to wider health systems, however policies and funding that remunerate GPs, support community-based care and provide additional staffing in RACFs are needed to sustain afterhours telehealth in RACFs. Use of the NASSS (non-adoption, abandonment, scale-up, spread, and sustainability) Framework provided a valuable explanatory lens for our analyses.
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Affiliation(s)
- Steven A Trankle
- Department of General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Jennifer Reath
- Department of General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
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14
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Li ZG, Ge JJ, Zhang C, Peng XQ, Wu QF, You H. Information-Motivation-Behavioral Skills Model Supplemented With the Moderated-Mediation Path: A Framework for Interpreting Patients' Online Medical Services Utilization. Am J Health Promot 2023; 37:924-932. [PMID: 37385229 DOI: 10.1177/08901171231186313] [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: 07/01/2023]
Abstract
PURPOSE This study aimed to explore the internal determinants affecting patients' utilization of online medical services (OMS) based on the information-motivation-behavioral skills model from a behavioral perspective. DESIGN A cross-sectional study. SETTING This study was conducted in three medical institutions in Jiangsu Province, China. SUBJECTS 470 internet users were enrolled from patients who came to the outpatient clinics. MEASURES A self-administered questionnaire with feasible reliability and validity was used to investigate the demographic characteristics and OMS utilization-related information, motivation, behavioral skills, intention, and behavior. ANALYSIS According to the constructed framework, structural equation modeling was used to test the relationships between those factors and OMS utilization behaviors. RESULTS All direct paths are established except the path between information and intention. Information and motivation positively affected OMS utilization behavior through behavioral skills and intention (P < .001). Motivation and behavioral skills could positively influence OMS utilization behavior through intention (P < .01). Motivation was found to be the largest predictor of OMS utilization behavior. Moreover, gender played a moderating role in the interpretation of the behavior. CONCLUSIONS Interventions should be conducted regarding information, motivation, and behavioral skills to promote patients' use of OMS. At the same time, the impact of gender on intervention effectiveness should also be considered.
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Affiliation(s)
- Zhi-Guang Li
- The First Affiliated Hospital with Nanjing Medical University, China
| | - Jin-Jin Ge
- School of Public Health, Nanjing Medical University, China
| | - Chi Zhang
- Xiangya School of Nursing, Central South University, China
| | - Xue-Qing Peng
- Chengdu Center for Disease Control and Prevention, China
| | - Qi-Feng Wu
- School of Public Health, Nanjing Medical University, China
| | - Hua You
- School of Public Health, Nanjing Medical University, China
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15
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Clay-Williams R, Hibbert P, Carrigan A, Roberts N, Austin E, Fajardo Pulido D, Meulenbroeks I, Nguyen HM, Sarkies M, Hatem S, Maka K, Loy G, Braithwaite J. The diversity of providers' and consumers' views of virtual versus inpatient care provision: a qualitative study. BMC Health Serv Res 2023; 23:724. [PMID: 37400807 DOI: 10.1186/s12913-023-09715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 06/16/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND A broad-based international shift to virtual care models over recent years has accelerated following COVID-19. Although there are increasing numbers of studies and reviews, less is known about clinicians' and consumers' perspectives concerning virtual modes in contrast to inpatient modes of delivery. METHODS We conducted a mixed-methods study in late 2021 examining consumers' and providers' expectations of and perspectives on virtual care in the context of a new facility planned for the north-western suburbs of Sydney, Australia. Data were collected via a series of workshops, and a demographic survey. Recorded qualitative text data were analysed thematically, and surveys were analysed using SPSS v22. RESULTS Across 12 workshops, 33 consumers and 49 providers from varied backgrounds, ethnicities, language groups, age ranges and professions participated. Four advantages, strengths or benefits of virtual care reported were: patient factors and wellbeing, accessibility, better care and health outcomes, and additional health system benefits, while four disadvantages, weaknesses or risks of virtual care were: patient factors and wellbeing, accessibility, resources and infrastructure, and quality and safety of care. CONCLUSIONS Virtual care was widely supported but the model is not suitable for all patients. Health and digital literacy and appropriate patient selection were key success criteria, as was patient choice. Key concerns included technology failures or limitations and that virtual models may be no more efficient than inpatient care models. Considering consumer and provider views and expectations prior to introducing virtual models of care may facilitate greater acceptance and uptake.
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Affiliation(s)
- Robyn Clay-Williams
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia.
| | - Peter Hibbert
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Ann Carrigan
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
- Centre for Elite Performance, Macquarie University, Expertise & Training, Sydney, NSW, Australia
| | - Natalie Roberts
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Isabelle Meulenbroeks
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Hoa Mi Nguyen
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Mitchell Sarkies
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Katherine Maka
- Western Sydney Local Health District, Sydney, NSW, Australia
| | - Graeme Loy
- Western Sydney Local Health District, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
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16
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Yoon S, Hoe PS, Chan A, Malhotra R, Visaria A, Matchar D, Goh H, Seng B, Ramakrishnan C, Koh MS, Yee TP, Nadarajan GD, Bee YM, Graves N, Jafar TH, Ong ME. Impact of COVID-19 on perceived wellbeing, self-management and views of novel modalities of care among medically vulnerable patients in Singapore. Chronic Illn 2023; 19:314-326. [PMID: 34964364 PMCID: PMC9996168 DOI: 10.1177/17423953211067458] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study aims to examine the impact of COVID-19 measures on wellbeing and self-management in medically vulnerable non-COVID patients and their views of novel modalities of care in Singapore. METHODS Patients with cardiovascular disease (CVD), respiratory disease, chronic kidney disease, diabetes and cancer were recruited from the SingHealth cluster and national cohort of older adults. Data on demographics, chronic conditions and perceived wellbeing were collected using questionnaire. We performed multivariable regression to examine factors associated with perceived wellbeing. Qualitative interviews were conducted to elicit patient's experience and thematically analyzed. RESULTS A total of 91 patients participated. Male patients compared with female patients perceived a lower impact of the pandemic on subjective wellbeing. Patients with CVD compared to those having conditions other than CVD perceived a lower impact. Impacts of the pandemic were primarily described in relation to emotional distress and interference in maintaining self-care. Hampering of physical activity featured prominently, but most did not seek alternative ways to maintain activity. Despite general willingness to try novel care modalities, lack of physical interaction and communication difficulties were perceived as main barriers. DISCUSSION Findings underline the need to alleviate emotional distress and develop adaptive strategies to empower patients to maintain wellbeing and self-care.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, 121579Duke-NUS Medical School, Singapore
| | - Pei Shan Hoe
- Centre for Ageing Research and Education (CARE), 121579Duke-NUS Medical School, Singapore
| | - Angelique Chan
- Health Services and Systems Research, 121579Duke-NUS Medical School, Singapore.,Centre for Ageing Research and Education (CARE), 121579Duke-NUS Medical School, Singapore
| | - Rahul Malhotra
- Health Services and Systems Research, 121579Duke-NUS Medical School, Singapore.,Centre for Ageing Research and Education (CARE), 121579Duke-NUS Medical School, Singapore
| | - Abhijit Visaria
- Centre for Ageing Research and Education (CARE), 121579Duke-NUS Medical School, Singapore
| | - David Matchar
- Health Services and Systems Research, 121579Duke-NUS Medical School, Singapore.,Department of Medicine (General Internal Medicine), 22957Duke University Medical Center, Durham, North Carolina, USA
| | - Hendra Goh
- Health Services and Systems Research, 121579Duke-NUS Medical School, Singapore
| | - Bridget Seng
- Centre for Ageing Research and Education (CARE), 121579Duke-NUS Medical School, Singapore
| | | | - Mariko S Koh
- 121579Duke-NUS Medical School, Singapore.,Department of Respiratory and Critical Care Medicine, 37581Singapore General Hospital, Singapore
| | - Tiew Pei Yee
- 121579Duke-NUS Medical School, Singapore.,Department of Respiratory and Critical Care Medicine, 37581Singapore General Hospital, Singapore
| | | | - Yong Mong Bee
- Department of Endocrinology, 37581Singapore General Hospital, Singapore
| | - Nicholas Graves
- Health Services and Systems Research, 121579Duke-NUS Medical School, Singapore
| | - Tazeen H Jafar
- Health Services and Systems Research, 121579Duke-NUS Medical School, Singapore.,Department of Medicine, 9615Aga Khan University, Karachi, Pakistan.,Duke Global Health Institute, 3065Duke University, Durham, North Carolina, USA
| | - Marcus Eh Ong
- Health Services and Systems Research, 121579Duke-NUS Medical School, Singapore.,Department of Emergency Medicine, 37581Singapore General Hospital, Singapore
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17
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Hempel S, Ganz D, Saluja S, Bolshakova M, Kim T, Turvey C, Cordasco K, Basu A, Page T, Mahmood R, Motala A, Barnard J, Wong M, Fu N, Miake-Lye IM. Care coordination across healthcare systems: development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel. BMJ Open 2023; 13:e060232. [PMID: 37197809 DOI: 10.1136/bmjopen-2021-060232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVE For large, integrated healthcare delivery systems, coordinating patient care across delivery systems with providers external to the system presents challenges. We explored the domains and requirements for care coordination by professionals across healthcare systems and developed an agenda for research, practice and policy. DESIGN The modified Delphi approach convened a 2-day stakeholder panel with moderated virtual discussions, preceded and followed by online surveys. SETTING The work addresses care coordination across healthcare systems. We introduced common care scenarios and differentiated recommendations for a large (main) healthcare organisation and external healthcare professionals that contribute additional care. PARTICIPANTS The panel composition included health service providers, decision makers, patients and care community, and researchers. Discussions were informed by a rapid review of tested approaches to fostering collaboration, facilitating care coordination and improving communication across healthcare systems. OUTCOME MEASURES The study planned to formulate a research agenda, implications for practice and recommendations for policy. RESULTS For research recommendations, we found consensus for developing measures of shared care, exploring healthcare professionals' needs in different care scenarios and evaluating patient experiences. Agreed practice recommendations included educating external professionals about issues specific to the patients in the main healthcare system, educating professionals within the main healthcare system about the roles and responsibilities of all involved parties, and helping patients better understand the pros and cons of within-system and out-of-system care. Policy recommendations included supporting time for professionals with high overlap in patients to engage regularly and sustaining support for care coordination for high-need patients. CONCLUSIONS Recommendations from the stakeholder panel created an agenda to foster further research, practice and policy innovations in cross-system care coordination.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - David Ganz
- Geriatrics Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
| | - Sonali Saluja
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Timothy Kim
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Carolyn Turvey
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine at the University of Iowa, Iowa City, Iowa, USA
- Rural Health Resource Center, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
| | - Kristina Cordasco
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aashna Basu
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Care in the Community Service, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Tonya Page
- Office of Community, Clinical Integration & Field Support, Veteran Affairs Central Office, Kentucky City, Kentucky, USA
| | - Reshma Mahmood
- Santa Maria and San Luis Obispo Community Outpatient Clinics, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Jenny Barnard
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Michelle Wong
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ning Fu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
- School of Public Administration and Emergency Management, Jinan University, Guangzhou, Guangdong, China
| | - Isomi M Miake-Lye
- VA West Los Angeles Evidence-based Synthesis Program, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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18
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Adepoju OE, Dang P, Valdez MR. Comparing In-Person Only, Telemedicine Only, and Hybrid Health Care Visits Among Older Adults in Safety-Net Clinics. TELEMEDICINE REPORTS 2023; 4:93-99. [PMID: 37283857 PMCID: PMC10240331 DOI: 10.1089/tmr.2023.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 06/08/2023]
Abstract
Introduction Older adults face challenges in seeking health care. This study examined factors associated with in-person only versus telemedicine only versus hybrid health care visits among adults 65+ in safety-net clinics. Methods Data were obtained from a large Texas-based Federally Qualified Health Center (FQHC) network. The dataset included 12,279 appointments for 3914 unique older adults between March and November 2020. The outcome of interest was a 3-level indicator of telemedicine visits: in-person visits only, telemedicine visits only, and hybrid (in person + telemedicine) visits during the study period. We used a multinomial logit model adjusting for patient level characteristics to assess the strength of the relationships. Results Compared to their white counterparts, black and Hispanic older adults were significantly likely to have telemedicine only visits versus in-person only visits (black RRR: 0.59, 95% confidence interval [CI]: 0.41-0.86; Hispanic RRR: 0.46, 95% CI: 0.36-0.60). However, there were no significant racial and ethnic differences in hybrid utilization (black RRR: 0.91, 95% CI: 0.67-1.23; Hispanic RRR: 0.86, 95% CI: 0.70-1.07). Discussion Our findings suggest that hybrid opportunities may bridge racial and ethnic disparities in access to care. Clinics should consider building capacity for both in-person and telemedicine opportunities as complementary strategies.
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Affiliation(s)
- Omolola E. Adepoju
- Department of Health Systems and Population Health Sciences, College of Medicine, University of Houston, Houston, Texas, USA
- Humana Integrated Health Systems Sciences Institute, Houston, Texas, USA
| | - Patrick Dang
- Humana Integrated Health Systems Sciences Institute, Houston, Texas, USA
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19
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Cunha AS, Pedro AR, Cordeiro JV. Facilitators and barriers to access hospital medical specialty telemedicine consultations during the COVID-19 pandemic: Systematic Review. J Med Internet Res 2023. [PMID: 37262124 DOI: 10.2196/44188] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND COVID-19 pandemic accelerated the digital transition in healthcare, which required a rapid adaptation of stakeholders. Telemedicine has emerged as an ideal tool to ensure continuity of care by allowing remote access to specialized medical services. However, its rapid implementation has exacerbated disparities in healthcare access, especially for the most vulnerable populations. OBJECTIVE To characterize the determinants factors (facilitators and barriers) of access to hospital medical specialty telemedicine consultations during the COVID-19 pandemic; to identify the main opportunities and challenges (technological, ethical, legal and/or social) generated by the use of telemedicine in the context of the COVID-19 pandemic. METHODS A systematic review was conducted according to PRISMA guidelines. Four databases (Scopus, Web of Science, PubMed and Cochrane COVID-19 Study Register) were searched for empirical studies published between January 3rd, 2020, and December 31st, 2021, using established criteria. The protocol of this review was registered and published in PROSPERO (CRD42022302825). A methodological quality assessment was performed, and results were integrated into a thematic synthesis. The identification of main opportunities and challenges was done by interpreting and aggregating the thematic synthesis results. RESULTS Of the 106 studies identified, 9 met the inclusion criteria and the intended quality characteristics. All studies were originally from the United States of America (USA). The following facilitating factors of telemedicine use were identified: health insurance coverage; prevention of SARS-CoV-2 infection; access to Internet services; access to technological devices; better management of work-life balance; and savings in travel costs. We identified the following barriers to telemedicine use: lack of access to Internet services; lack of access to technological devices; racial and ethnic disparities; low digital literacy; low income; age; language barriers; health insurance coverage; concerns about data privacy and confidentiality; geographic disparities; and need for complementary diagnostic tests or for the delivery of test results. CONCLUSIONS The facilitating factors and barriers identified in this systematic review present different opportunities and challenges, including those of technological nature (access to technological devices and internet services, level of digital literacy), sociocultural and demographic nature (ethnic and racial disparities, geographical disparities, language barriers, age), socioeconomic nature (income level and health insurance coverage), and ethical and legal nature (data privacy and confidentiality). To expand telemedicine access to hospital-based specialty medical consultations and provide high-quality care to all, including the most vulnerable communities, the challenges identified must be thoroughly researched and addressed with informed and dedicated responses. CLINICALTRIAL
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Affiliation(s)
- Ana Soraia Cunha
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal, Avenida Padre Cruz, Lisbon, PT
| | - Ana Rita Pedro
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal, Lisbon, PT
| | - João Valente Cordeiro
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal, Lisbon, PT
- Interdisciplinary Centre of Social Sciences (CICS.NOVA), Universidade NOVA de Lisboa, Lisbon, Portugal, Lisbon, PT
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20
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Little CC, Russell S, Hwang C, Goldberg L, Brown S, Kirke D, Courey M. Applications of Telemedicine in Speech-Language Pathology: Evaluation of Patient Satisfaction. Laryngoscope 2023; 133:895-900. [PMID: 35848893 DOI: 10.1002/lary.30303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The study aimed to evaluate patient satisfaction with speech-language therapy televisits and to identify factors influencing the level of satisfaction. METHODS Participants were recruited from an academic tertiary voice and swallowing center who had completed ≥1 telehealth session of speech-language therapy with a speech-language pathologist between March, 2020 and April, 2021. Patient satisfaction was assessed using the Short Assessment of Patient Satisfaction (SAPS), a validated 7-item survey. Demographic characteristics of participants were collected from a review of patient charts. RESULTS 65/239 patients completed the SAPS survey, representing a response rate of 27%. The average age of study participants was 54.92 ± 16.45 years, with 49.2% identifying as female, 33.9% as male, and 16.9% as trans-female. The mean SAPS score was 22.60 ± 3.89, with 84.62% of patients satisfied or very satisfied with their visit. Patients were most satisfied with provider respect (3.91 ± 0.34) and care received (3.74 ± 0.64), and least satisfied with visit length (2.32 ± 1.38) and explanation of treatment results (2.62 ± 1.72). Patient satisfaction was positively correlated with younger age and an increased number of televisits. Satisfaction did not differ significantly by gender identity, type of therapy received, insurance type, travel distance, or prior in-person therapy. CONCLUSION Clinicians are able to achieve high patient satisfaction with speech-language therapy when delivered by telehealth. Patient satisfaction remained high across diverse patient populations and range of clinical needs. Clinicians should remain cognizant of the unique limitations of older patients when conducting telehealth visits. LAY SUMMARY Clinicians are able to achieve high patient satisfaction with speech-language therapy when delivered via telehealth. Satisfaction remained high regardless of gender identity, type of therapy received, type of insurance, travel distance, or completion of prior in-person therapy. LEVEL OF EVIDENCE 4 Laryngoscope, 133:895-900, 2023.
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Affiliation(s)
- Christine C Little
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Stephen Russell
- Department of Otolaryngology, Naval Medical Center, San Diego, California, U.S.A
| | - Chaewon Hwang
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - Leanne Goldberg
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Sarah Brown
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Diana Kirke
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Mark Courey
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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21
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Shahid S, Hogeveen S, Sky P, Chandra S, Budhwani S, de Silva R, Bhatia RS, Seto E, Shaw J. Health equity related challenges and experiences during the rapid implementation of virtual care during COVID-19: a multiple case study. Int J Equity Health 2023; 22:44. [PMID: 36906566 PMCID: PMC10007658 DOI: 10.1186/s12939-023-01849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/18/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Virtual care quickly became of crucial importance to health systems around the world during the COVID-19 pandemic. Despite the potential of virtual care to enhance access for some communities, the scale and pace at which services were virtualized did not leave many organizations with sufficient time and resources to ensure optimal and equitable delivery of care for everyone. The objective of this paper is to outline the experiences of health care organizations rapidly implementing virtual care during the first wave of the COVID-19 pandemic and examine whether and how health equity was considered. METHODS We used an exploratory, multiple case study approach involving four health and social service organizations providing virtual care services to structurally marginalized communities in the province of Ontario, Canada. We conducted semi-structured qualitative interviews with providers, managers, and patients to understand the challenges experienced by organizations and the strategies put in place to support health equity during the rapid virtualization of care. Thirty-eight interviews were thematically analyzed using rapid analytic techniques. RESULTS Organizations experienced challenges related to infrastructure availability, digital health literacy, culturally appropriate approaches, capacity for health equity, and virtual care suitability. Strategies to support health equity included the provision of blended models of care, creation of volunteer and staff support teams, participation in community engagement and outreach, and securement of infrastructure for clients. We put our findings into the context of an existing framework conceptualizing access to health care and expand on what this means for equitable access to virtual care for structurally marginalized communities. CONCLUSION This paper highlights the need to pay greater attention to the role of health equity in virtual care delivery and situate that conversation around existing inequitable structures in the health care system that are perpetuated when delivering care virtually. An equitable and sustainable approach to virtual care delivery will require applying an intersectionality lens on the strategies and solutions needed to address existing inequities in the system.
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Affiliation(s)
- Simone Shahid
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada.
| | - Sophie Hogeveen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Philina Sky
- Waasegiizhig Nanaandawe'iyewigamig, PO Box 320, Keewatin, ON, P0X 1C0, Canada
| | - Shivani Chandra
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - Suman Budhwani
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - Ryan de Silva
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - R Sacha Bhatia
- Peter Munk Cardiac Centre, University Health Network, 585 University Ave, Toronto, ON, M5G 2N2, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 55 College St, Toronto, ON, M5T 3M6, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 55 College St, Toronto, ON, M5T 3M6, Canada.,Centre for Digital Therapeutics, Techna Institute, University Health Network, 90 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - James Shaw
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada.,Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
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22
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How COVID-19 Broke the Barriers Related to the Implementation of Telecare-Patients' Experiences with a New form of Providing Health Services in Primary Health Care. Healthcare (Basel) 2023; 11:healthcare11040497. [PMID: 36833033 PMCID: PMC9956090 DOI: 10.3390/healthcare11040497] [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: 01/13/2023] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has significantly contributed to accelerating the development of telemedicine and eHealth. The main aim of this study was to assess the attitudes of patients towards remote care implemented in general practice (GP) during the pandemic. METHODS The study was a pilot study conducted in March-April 2021, considering technical aspects of using teleconsultations, and evaluating the difficulties, advantages and disadvantages for patients. When assessing opinions, a simple Likert scale was used, where a value of 1 meant the worst possible assessment or strong disagreement and the upper value the best or full agreement of the respondent. RESULTS The study covered 408 respondents. Their biggest organizational challenge reaching GPs by telephone, regardless of the patients' home location (p = 0.23698). Obtaining e-documents was not problematic but was rated as worse by men (p = 0.048295). Respondents rated the overall effectiveness of teleconsultations more highly if they could speak directly with a doctor (p = 0.0005). There were no differences in willingness to recommend teleconsultations based on gender (p = 0.2432), place of residence (p = 0.7878), age (p = 0.290355) or education (p = 0.9109), but people assessing the overall effectiveness of telemedicine more highly were more willing to recommend it (p = 0.000). CONCLUSIONS Respondents assess teleconsultations in a differentiated way, noticing both positive and negative features of the remote form of providing health services.
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23
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Dryden EM, Kennedy MA, Conti J, Boudreau JH, Anwar CP, Nearing K, Pimentel CB, Hung WW, Moo LR. Perceived benefits of geriatric specialty telemedicine among rural patients and caregivers. Health Serv Res 2023; 58 Suppl 1:26-35. [PMID: 36054487 PMCID: PMC9843069 DOI: 10.1111/1475-6773.14055] [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: 01/21/2023] Open
Abstract
OBJECTIVE Explore the perceived benefits of a Veterans Health Administration (VHA) geriatric specialty telemedicine service (GRECC Connect) among rural, older patients and caregivers to contribute to an assessment of its quality and value. DATA SOURCES In Spring 2021, we interviewed a geographically diverse sample of rural, older patients and their caregivers who participated in GRECC Connect telemedicine visits. STUDY DESIGN A cross-sectional qualitative study focused on patient and caregiver experiences with telemedicine, including perceived benefits and challenges. DATA COLLECTION We conducted 30 semi-structured qualitative interviews with rural, older (≥65) patients enrolled in the VHA and their caregivers via videoconference or phone. Interviews were recorded, transcribed, and analyzed using a rapid qualitative analysis approach. PRINCIPAL FINDINGS Participants described geriatric specialty telemedicine visits focused on cognitive assessments, tailored physical therapy, medication management, education on disease progression, support for managing multiple comorbidities, and suggestions to improve physical functioning. Participants reported that, in addition to prescribing medications and ordering tests, clinicians expedited referrals, coordinated care, and listened to and validated both patient and caregiver concerns. Perceived benefits included improved patient health; increased patient and caregiver understanding and confidence around symptom management; and greater feelings of empowerment, hopefulness, and support. Challenges included difficulty accessing some recommended programs and services, uncertainty related to instructions or follow-up, and not receiving as much information or treatment as desired. The content of visits was well aligned with the domains of the Age-Friendly Health Systems and Geriatric 5Ms frameworks (Medication, Mentation, Mobility, what Matters most, and Multi-complexity). CONCLUSIONS Alignment of patient and caregiver experiences with widely-used models of comprehensive geriatric care indicates that high-quality geriatric care can be provided through virtual modalities. Additional work is needed to develop strategies to address challenges and optimize and expand access to geriatric specialty telemedicine.
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Affiliation(s)
- Eileen M. Dryden
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Meaghan A. Kennedy
- New England Geriatric Research, Education, and Clinical CenterVA Bedford Healthcare SystemBedfordMassachusettsUSA,Department of Family MedicineBoston University School of MedicineBostonMassachusettsUSA
| | - Jennifer Conti
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Jacqueline H. Boudreau
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Chitra P. Anwar
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Kathryn Nearing
- Eastern Colorado VA Geriatric Research Education and Clinical CenterAuroraColoradoUSA,Division of Geriatric MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Camilla B. Pimentel
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA,New England Geriatric Research, Education, and Clinical CenterVA Bedford Healthcare SystemBedfordMassachusettsUSA,Department of Public Health, Zuckerberg College of Health SciencesUniversity of Massachusetts LowellLowellMassachusettsUSA
| | - William W. Hung
- Bronx Geriatric Research Education and Clinical CenterJames J. Peters VA Medical CenterBronxNew YorkUSA,Department of Geriatrics and Palliative MedicineIcahn School of MedicineNew York CityNew YorkUSA
| | - Lauren R. Moo
- New England Geriatric Research, Education, and Clinical CenterVA Bedford Healthcare SystemBedfordMassachusettsUSA,Department of NeurologyHarvard Medical SchoolBostonMassachusettsUSA
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24
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Li W, Gui J, Luo X, Yang J, Zhang T, Tang Q. Determinants of intention with remote health management service among urban older adults: A Unified Theory of Acceptance and Use of Technology perspective. Front Public Health 2023; 11:1117518. [PMID: 36778558 PMCID: PMC9909471 DOI: 10.3389/fpubh.2023.1117518] [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: 12/06/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
Background Although older adults health management systems have been shown to have a significant impact on health levels, there remains the problem of low use rate, frequency of use, and acceptance by the older adults. This study aims to explore the significant factors which serve as determinants of behavioral intention to use the technology, which in turn promotes actual use. Methods This study took a total of 402 urban older adults over 60 years to explore the impact of the use behavior toward remote health management (RHM) through an online questionnaire. Based on the Unified Theory of Acceptance and Use of Technology (UTAUT), the author adds four dimensions: perceived risk, perceived value, perceived interactivity and individual innovation, constructed an extended structural equation model of acceptance and use of technology, and analyzed the variable path relationship. Results In this study, the factor loading is between 0.61 and 0.98; the overall Cronbach's Alpha coefficients are >0.7; The composite reliability ranges from 0.59 to 0.91; the average variance extraction ranges from 0.51 to 0.85, which shows the good reliability, validity, and discriminant validity of the constructed model. The influencing factors of the behavioral intention of the older adults to accept the health management system are: effort expectation, social influences, perceived value, performance expectation, perceived interactivity and perceived risk. Effort expectation has a significant positive impact on performance expectation. Individual innovation positively impacts performance expectation and perceived interactivity. Perceived interactivity and behavioral intention have a significant positive effect on the use behavior of the older adults, while the facilitating conditions have little effect on the use behavior. Conclusions This paper constructs and verifies the extended model based on UTAUT, fully explores the potential factors affecting the use intention of the older adult users. According to the research findings, some suggestions are proposed from the aspects of effort expectation, performance expectation, perceived interaction and perceived value to improve the use intention and user experience of Internet-based health management services in older adults.
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Affiliation(s)
- Wenjia Li
- College of Communication and Art Design, University of Shanghai for Science and Technology, Shanghai, China
| | - Jingjing Gui
- College of Communication and Art Design, University of Shanghai for Science and Technology, Shanghai, China
| | - Xin Luo
- College of Communication and Art Design, University of Shanghai for Science and Technology, Shanghai, China
| | - Jidong Yang
- School of Creativity and Art, Shanghai Tech University, Shanghai, China
| | - Ting Zhang
- School of Design and Art, Shanghai Dianji University, Shanghai, China
| | - Qinghe Tang
- Shanghai East Hospital, Tongji University, Shanghai, China,*Correspondence: Qinghe Tang ✉
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25
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Borchers P, Pfisterer D, Scherpf M, Voigt K, Bergmann A. Needs- and user-oriented development of contactless camera-based telemonitoring in heart disease-Results of an acceptance survey from the Home-based Healthcare Project (feasibility project). PLoS One 2023; 18:e0282527. [PMID: 36881604 PMCID: PMC9990940 DOI: 10.1371/journal.pone.0282527] [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: 06/30/2022] [Accepted: 02/16/2023] [Indexed: 03/08/2023] Open
Abstract
Home-based telemonitoring in heart failure patients can reduce all-cause mortality and the relative risk of heart failure-related hospitalization compared to standard care. However, technology use depends, among other things, on user acceptance, making it important to include potential users early in development. In a home-based healthcare project (a feasibility project) a participatory approach was chosen in preparation for future development of contactless camera-based telemonitoring in heart disease patients. The project study patients (n = 18) were surveyed regarding acceptance and design expectations, and acceptance-enhancing measures and design suggestions were then drawn from the results. The study patients corresponded to the target group of potential future users. 83% of respondents showed high acceptance. 17% of those surveyed were more skeptical with moderate or low acceptance. The latter were female, mostly living alone, and without technical expertise. Low acceptance was associated with a higher expectation of effort and lower perception of self-efficacy and lower integratability into daily rhythms. For the design, the respondents found independent operation of the technology very important. Furthermore, concerns were expressed about the new measuring technology, e.g., anxiety about constant surveillance. The acceptance of a new generation of medical technology (contactless camera-based measuring technology) for telemonitoring is already quite high in the surveyed group of older users (60+). Specific user expectations concerning design should be considered during development to increase acceptance by potential users even more.
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Affiliation(s)
- Peggy Borchers
- Faculty of Medicine Carl Gustav Carus, Department of General Practice, Medical Clinic III, Technische Universität Dresden, Dresden, Germany
- * E-mail:
| | - David Pfisterer
- Faculty of Medicine Carl Gustav Carus, Department of General Practice, Medical Clinic III, Technische Universität Dresden, Dresden, Germany
| | - Matthieu Scherpf
- Institute for Biomedical Engineering, Technische Universität Dresden, Dresden, Germany
| | - Karen Voigt
- Faculty of Medicine Carl Gustav Carus, Department of General Practice, Medical Clinic III, Technische Universität Dresden, Dresden, Germany
| | - Antje Bergmann
- Faculty of Medicine Carl Gustav Carus, Department of General Practice, Medical Clinic III, Technische Universität Dresden, Dresden, Germany
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26
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Carson H, Wang KH, Paek H, Hoffman P, Arakaki A, Gonzalez-Colaso R, Barakat LA, Villanueva M, Womack JA. Equity and use of telehealth modalities among people living with HIV during the COVID-19 pandemic. Digit Health 2023; 9:20552076231218840. [PMID: 38107977 PMCID: PMC10722925 DOI: 10.1177/20552076231218840] [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] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Background COVID-19 forced a rapid transition to telehealth. Little is known about the use of telephone versus video visits among people living with or at risk for HIV (PWH). Setting We studied electronic health record data from an urban HIV clinic. Our sample included visit- and person-level data. Visit-level data came from appointments scheduled from 30 March 2020 to 31 May 2020. Person-level data came from patients 18+ years of age who completed at least one telephone or video visit during the period of interest. Methods We performed a cross-sectional analysis. Our primary outcome was telehealth modality (telephone or video). We compared visit completion status by telehealth modality. We evaluated associations between patient characteristics and telehealth modality using logistic regression. Results In total, 1742 visits included information on telehealth modality: 1432 telephone (82%) and 310 (18%) video visits. 77% of telephone visits were completed compared to 75% of video visits (p = 0.449). The clinic recorded 643 completed telehealth visits in April and 623 in May 2020. The proportion of telephone visits decreased from 84% in April to 79% in May (p = 0.031). Most patients participated in telephone versus video visits (415 vs. 88 patients). Older age (adjusted odds ratio [AOR] 3.28; 95% confidence interval [CI], 1.37-7.82) and Black race (AOR 2.42; 95% CI, 1.20-4.49) were positively associated with telephone visits. Patient portal enrollment (AOR 0.06; 95% CI, 0.02-0.16) was negatively associated with telephone visits. Conclusion PWH used telephone more than video visits, suggesting that telephone visits are a vital healthcare resource for this population.
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Affiliation(s)
- Hannah Carson
- Yale School of Medicine and Yale Physician Associate Program, New Haven, CT, USA
| | - Karen H. Wang
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | - Hyung Paek
- Yale School of Medicine and Yale School of Public Health, Department of Biostatistics, New Haven, CT, USA
| | - Pamela Hoffman
- Yale School of Medicine, Child Study Center, New Haven, CT, USA
| | - Andrew Arakaki
- Yale School of Public Health, Department of Chronic Disease Epidemiology New Haven, CT, USA
| | | | - Lydia A Barakat
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | | | - Julie A Womack
- VA Connecticut Healthcare System and Yale School of Nursing, West Haven, CT, USA
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27
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Serina PT, Davoodi NM, Guthrie KM, Merchant RC, Goldberg EM. Physician Views of Telehealth for Special Populations of Older Adults: Preliminary Findings. J Patient Exp 2023; 10:23743735231160418. [PMID: 36936379 PMCID: PMC10017932 DOI: 10.1177/23743735231160418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
This study's objective was to determine how frontline physicians perceived telehealth for older adults with sensory impairments, cognitive impairments, mobility challenges, or those receiving end-of-life care. We conducted a multiple-methods study of US emergency, geriatric, and primary care physicians. Phase 1 involved semi-structured interviews with 48 physicians on their experiences using telehealth with older adults. In phase 2, we used those qualitative findings to generate a web-based survey administered to 74 physicians. In phase 3, we reintegrated qualitative data to enrich survey results. We identified 3 key findings: (1) 50% of emergency physicians, 33% of geriatricians, and 18% of primary care physicians considered telehealth to be a poor substitute for providing end-of-life care (p = .68); (2) for hearing, vision, and cognitive impairments, 61%, 58%, and 54%, respectively, saw telehealth as a good or fair substitute for providing care (p = .14); and (3) 98% indicated that telehealth was a good or fair substitute for in-person care for those with mobility impairment (p < .001). Preferences and comfort using telehealth with older adults vary by clinical context, patient population, and physician specialty, requiring tailored adaptations.
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Affiliation(s)
- Peter T Serina
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Natalie M Davoodi
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Kate M Guthrie
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth M Goldberg
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Elizabeth Goldberg, Department of Emergency Medicine, Leprino Building, 7th Floor, Campus Box B-215, 12401 E. 17th Avenue, Aurora, CO 80045, USA.
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Overactive Bladder and Cognitive Impairment: The American Urogynecologic Society and Pelvic Floor Disorders Research Foundation State-of-the-Science Conference Summary Report. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:S1-S19. [PMID: 36548636 DOI: 10.1097/spv.0000000000001272] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Overactive bladder (OAB) is prevalent in older adults in whom management is complicated by comorbidities and greater vulnerability to the cognitive effects of antimuscarinic medications. OBJECTIVES The aim of this study is to provide a comprehensive evidence-based summary of the 2021 State-of-the-Science (SOS) conference and a multidisciplinary expert literature review on OAB and cognitive impairment. STUDY DESIGN The American Urogynecologic Society and the Pelvic Floor Disorders Research Foundation convened a 3-day collaborative conference. Experts from multidisciplinary fields examined cognitive function, higher neural control of the OAB patient, risk factors for cognitive impairment in older patients, cognitive effects of antimuscarinic medications for OAB treatment, OAB phenotyping, conservative and advanced OAB therapies, and the need for a multidisciplinary approach to person-centered treatment. Translational topics included the blood-brain barrier, purine metabolome, mechanotransduction, and gene therapy for OAB targets. RESULTS Research surrounding OAB treatment efficacy in cognitively impaired individuals is limited. Short- and long-term outcomes regarding antimuscarinic effects on cognition are mixed; however, greater anticholinergic burden and duration of use influence risk. Oxybutynin is most consistently associated with negative cognitive effects in short-term, prospective studies. Although data are limited, beta-adrenergic agonists do not appear to confer the same cognitive risk. CONCLUSIONS The 2021 SOS summary report provides a comprehensive review of the fundamental, translational, and clinical research on OAB with emphasis on cognitive impairment risks to antimuscarinic medications. Duration of use and antimuscarinic type, specifically oxybutynin when examining OAB treatments, appears to have the most cognitive impact; however, conclusions are limited by the primarily cognitively intact population studied. Given current evidence, it appears prudent to minimize anticholinergic burden by emphasizing nonantimuscarinic therapeutic regimens in the older population and/or those with cognitive impairment.
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Wang Q, Liu J, Zhou L, Tian J, Chen X, Zhang W, Wang H, Zhou W, Gao Y. Usability evaluation of mHealth apps for elderly individuals: a scoping review. BMC Med Inform Decis Mak 2022; 22:317. [PMID: 36461017 PMCID: PMC9717549 DOI: 10.1186/s12911-022-02064-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Usability is a key factor affecting the acceptance of mobile health applications (mHealth apps) for elderly individuals, but traditional usability evaluation methods may not be suitable for use in this population because of aging barriers. The objectives of this study were to identify, explore, and summarize the current state of the literature on the usability evaluation of mHealth apps for older adults and to incorporate these methods into the appropriate evaluation stage. METHODS Electronic searches were conducted in 10 databases. Inclusion criteria were articles focused on the usability evaluation of mHealth apps designed for older adults. The included studies were classified according to the mHealth app usability evaluation framework, and the suitability of evaluation methods for use among the elderly was analyzed. RESULTS Ninety-six articles met the inclusion criteria. Research activity increased steeply after 2013 (n = 92). Satisfaction (n = 74) and learnability (n = 60) were the most frequently evaluated critical measures, while memorability (n = 13) was the least evaluated. The ratios of satisfaction, learnability, operability, and understandability measures were significantly related to the different stages of evaluation (P < 0.05). The methods used for usability evaluation were questionnaire (n = 68), interview (n = 36), concurrent thinking aloud (n = 25), performance metrics (n = 25), behavioral observation log (n = 14), screen recording (n = 3), eye tracking (n = 1), retrospective thinking aloud (n = 1), and feedback log (n = 1). Thirty-two studies developed their own evaluation tool to assess unique design features for elderly individuals. CONCLUSION In the past five years, the number of studies in the field of usability evaluation of mHealth apps for the elderly has increased rapidly. The mHealth apps are often used as an auxiliary means of self-management to help the elderly manage their wellness and disease. According to the three stages of the mHealth app usability evaluation framework, the critical measures and evaluation methods are inconsistent. Future research should focus on selecting specific critical measures relevant to aging characteristics and adapting usability evaluation methods to elderly individuals by improving traditional tools, introducing automated evaluation tools and optimizing evaluation processes.
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Affiliation(s)
- Qiuyi Wang
- grid.73113.370000 0004 0369 1660Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433 China
| | - Jing Liu
- grid.73113.370000 0004 0369 1660Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433 China
| | - Lanshu Zhou
- grid.73113.370000 0004 0369 1660Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433 China
| | - Jing Tian
- grid.73113.370000 0004 0369 1660Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433 China
| | - Xuemei Chen
- grid.73113.370000 0004 0369 1660Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433 China
| | - Wei Zhang
- grid.73113.370000 0004 0369 1660Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433 China
| | - He Wang
- grid.73113.370000 0004 0369 1660Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433 China
| | - Wanqiong Zhou
- grid.73113.370000 0004 0369 1660Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433 China
| | - Yitian Gao
- grid.73113.370000 0004 0369 1660Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433 China
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30
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Chan A, Cohen R, Robinson KM, Bhardwaj D, Gregson G, Jutai JW, Millar J, Ríos Rincón A, Roshan Fekr A. Evidence and User Considerations of Home Health Monitoring for Older Adults: Scoping Review. JMIR Aging 2022; 5:e40079. [PMID: 36441572 DOI: 10.2196/40079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Home health monitoring shows promise in improving health outcomes; however, navigating the literature remains challenging given the breadth of evidence. There is a need to summarize the effectiveness of monitoring across health domains and identify gaps in the literature. In addition, ethical and user-centered frameworks are important to maximize the acceptability of health monitoring technologies. OBJECTIVE This review aimed to summarize the clinical evidence on home-based health monitoring through a scoping review and outline ethical and user concerns and discuss the challenges of the current user-oriented conceptual frameworks. METHODS A total of 2 literature reviews were conducted. We conducted a scoping review of systematic reviews in Scopus, MEDLINE, Embase, and CINAHL in July 2021. We included reviews examining the effectiveness of home-based health monitoring in older adults. The exclusion criteria included reviews with no clinical outcomes and lack of monitoring interventions (mobile health, telephone, video interventions, virtual reality, and robots). We conducted a quality assessment using the Assessment of Multiple Systematic Reviews (AMSTAR-2). We organized the outcomes by disease and summarized the type of outcomes as positive, inconclusive, or negative. Second, we conducted a literature review including both systematic reviews and original articles to identify ethical concerns and user-centered frameworks for smart home technology. The search was halted after saturation of the basic themes presented. RESULTS The scoping review found 822 systematic reviews, of which 94 (11%) were included and of those, 23 (24%) were of medium or high quality. Of these 23 studies, monitoring for heart failure or chronic obstructive pulmonary disease reduced exacerbations (4/7, 57%) and hospitalizations (5/6, 83%); improved hemoglobin A1c (1/2, 50%); improved safety for older adults at home and detected changing cognitive status (2/3, 66%) reviews; and improved physical activity, motor control in stroke, and pain in arthritis in (3/3, 100%) rehabilitation studies. The second literature review on ethics and user-centered frameworks found 19 papers focused on ethical concerns, with privacy (12/19, 63%), autonomy (12/19, 63%), and control (10/19, 53%) being the most common. An additional 7 user-centered frameworks were studied. CONCLUSIONS Home health monitoring can improve health outcomes in heart failure, chronic obstructive pulmonary disease, and diabetes and increase physical activity, although review quality and consistency were limited. Long-term generalized monitoring has the least amount of evidence and requires further study. The concept of trade-offs between technology usefulness and acceptability is critical to consider, as older adults have a hierarchy of concerns. Implementing user-oriented frameworks can allow long-term and larger studies to be conducted to improve the evidence base for monitoring and increase the receptiveness of clinicians, policy makers, and end users.
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Affiliation(s)
- Andrew Chan
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada
| | - Rachel Cohen
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Katherine-Marie Robinson
- School of Engineering Design and Teaching Innovation, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada.,Department of Philosophy, Faculty of Arts, University of Ottawa, Ottawa, ON, Canada
| | - Devvrat Bhardwaj
- Department of Electrical Engineering and Computer Science, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Geoffrey Gregson
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada
| | - Jeffrey W Jutai
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,LIFE Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jason Millar
- School of Engineering Design and Teaching Innovation, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada.,Department of Philosophy, Faculty of Arts, University of Ottawa, Ottawa, ON, Canada
| | - Adriana Ríos Rincón
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada
| | - Atena Roshan Fekr
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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31
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Ingram LA, Dye C, Boger H, Luo Y, Hayes T. A qualitative study of health care access among African American older adults in a socio-demographically under-resourced region during the COVID-19 pandemic. Front Public Health 2022; 10:893718. [PMID: 36504932 PMCID: PMC9731102 DOI: 10.3389/fpubh.2022.893718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background In the U.S., health inequities experienced by the African American community, specifically among those ages 65 and older, have been well-documented in research literature. Alongside the findings regarding disparities in disease prevalence and management, researchers have also highlighted disparities in health care access. Despite recent evidence of health inequities experienced by African Americans during the COVID pandemic, there is little research on the lived experience of this group in this critical time, health care access challenges that may be exacerbated by the pandemic, and the community's outlook for the future in addressing health disparities. Methods We conducted a qualitative study of African Americans to gather their perspectives about access to health care, particularly during the COVID-19 pandemic. Study participants consisted of African Americans, ages 50-85 years, who spoke English as their primary language, who resided in one of 17 counties in South Carolina that represent a region of the State known as the corridor of economic disadvantage. Results Forty-seven telephone interviews were conducted. While research has shown that certain populations experienced health care access disparities during the early COVID pandemic, these disparities did not appear to be exacerbated in our sample. However, participants noted an increase in the use of telehealth, and identified challenges to using this technology. Participants made recommendations about how to address disparities in health care access in their communities. Conclusion Our qualitative approach was useful in obtaining perspectives about access to health care during the COVID-19 pandemic from African American older adults. Continued research with older African Americans, particularly those in under-resourced communities are warranted to further elucidate these findings.
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Affiliation(s)
- Lucy Annang Ingram
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, SC, United States,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States,*Correspondence: Lucy Annang Ingram
| | - Cheryl Dye
- Institute for Engaged Aging, Clemson University, Clemson, SC, United States
| | - Heather Boger
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, United States
| | - Ye Luo
- Institute for Engaged Aging, Clemson University, Clemson, SC, United States
| | - Tara Hayes
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, SC, United States
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Buse CR, Kelly EA, Muss HB, Nyrop KA. Perspectives of older women with early breast cancer on telemedicine during post-primary treatment. Support Care Cancer 2022; 30:9859-9868. [PMCID: PMC9664432 DOI: 10.1007/s00520-022-07437-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Caroline R. Buse
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Erin A.O’Hare Kelly
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Hyman B. Muss
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Kirsten A. Nyrop
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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Chen K, Davoodi NM, Strauss DH, Li M, Jiménez FN, Guthrie KM, Goldberg EM. Strategies to Ensure Continuity of Care Using Telemedicine with Older Adults during COVID-19: A Qualitative Study of Physicians in Primary Care and Geriatrics. J Appl Gerontol 2022; 41:2282-2295. [PMID: 35711106 PMCID: PMC9207584 DOI: 10.1177/07334648221109728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/24/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives: Our objective was to interview primary care physicians (PCPs) and geriatricians on their experiences using telemedicine during the COVID-19 pandemic to examine strategies used to maintain continuity of care with their patients, ages 65 and older. Methods: Using purposive sampling, we selected physicians based on community size (metro/suburban/rural) and practice setting (academic/community) and conducted semi-structured interviews via Zoom (mean: 30 minutes). Interviews were recorded, transcribed, coded, and analyzed using framework analysis. Results: We enrolled 33 physicians (15 PCPs and 18 geriatricians) from July to November 2020. Findings indicate that many physicians successfully bridged the digital divide by: assessing patients' technological readiness in advance, being flexible with telehealth modes, using available home or facility-based staff, educating patients on telehealth privacy and usefulness, making accommodations for disabilities, and involving caregivers. Discussion: These findings can inform future policy and practice and assist physicians in resolving addressable barriers to telehealth use among older patients.
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Affiliation(s)
- Kevin Chen
- The Warren Alpert Medical School of
Brown University, Providence, RI, USA
| | - Natalie M. Davoodi
- Department of Emergency Medicine, The Warren Alpert Medical School of
Brown University, Providence, RI, USA
| | - Daniel H. Strauss
- The Warren Alpert Medical School of
Brown University, Providence, RI, USA
| | | | | | - Kate M. Guthrie
- Department of Psychiatry and Human
Behavior, The Warren Alpert Medical School of
Brown University, Providence, RI, USA
| | - Elizabeth M. Goldberg
- Department of Emergency Medicine, The Warren Alpert Medical School of
Brown University, Providence, RI, USA
- Department of Health Services,
Policy and Practice, Brown University School of Public
Health, Providence, RI, USA
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Roytman GR, Cheung KH, Bathulapalli H, Goertz CM, Long CR, Lisi AJ. Characteristics of Chiropractic Patients in the Veterans Health Administration During the COVID-19 Pandemic: A Cross-Sectional Analysis. J Manipulative Physiol Ther 2022; 45:615-622. [PMID: 37294219 PMCID: PMC10254439 DOI: 10.1016/j.jmpt.2023.04.002] [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: 08/30/2022] [Revised: 03/25/2023] [Accepted: 04/08/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether patient characteristics were associated with face-to-face (F2F) and telehealth visits for those receiving chiropractic care for musculoskeletal conditions in the US Veterans Health Administration (VHA) during the COVID-19 pandemic. METHODS A retrospective cross-sectional analysis of all patients (veterans, dependents, and spouses) who received chiropractic care nationwide at the VHA from March 1, 2020, to February 28, 2021, was performed. Patients were allocated into 1 of the following 3 groups: only telehealth visits, only F2F visits, and combined F2F and telehealth visits. Patient characteristics included age, sex, race, ethnicity, marital status, and Charlson Comorbidity Index. Multinomial logistic regression estimated associations of these variables with visit type. RESULTS The total number of unique patients seen by chiropractors between March 2020 and February 2021 was 62 658. Key findings were that patients of non-White race and Hispanic or Latino ethnicity were more likely to attend telehealth-only visits (Black [odds ratio 1.20, 95% confidence interval {1.10-1.31}], other races [1.36 {1.16-1.59}], and Hispanic or Latino [1.35 {1.20-1.52}]) and combination telehealth and F2F care (Black [1.32 {1.25-1.40}], other races [1.37 {1.23-1.52}], and Hispanic or Latino [1.63 {1.51-1.76}]). Patients younger than 40 years of age were more likely to choose telehealth visits ([1.13 {1.02-1.26}], 66-75 years [1.17 {1.01-1.35}], and >75 years [1.26 {1.06-1.51}] vs those 40-55 years of age). Sex, visit frequency, and Charlson Comorbidity Index showed significant relationships as well, while marital status did not. CONCLUSION During the COVID-19 pandemic, VHA patients with musculoskeletal complaints using chiropractic telehealth were more ethnically and racially diverse than those using F2F care alone.
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Affiliation(s)
- Gregory R Roytman
- Yale Center for Medical Informatics, Yale University, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut.
| | - Kei-Hoi Cheung
- Yale Center for Medical Informatics, Yale University, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Harini Bathulapalli
- Yale Center for Medical Informatics, Yale University, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
| | - Christine M Goertz
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Cynthia R Long
- Palmer Center for Chiropractic Research, Davenport, Iowa
| | - Anthony J Lisi
- Yale Center for Medical Informatics, Yale University, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
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Yang W, Zhang X, Chen J, Miao W, Zheng C, Qian X, Geng G. Effects of internet-based interventions on improvement of glycemic control and self-management in older adults with diabetes: Systematic review and meta-analysis. Prim Care Diabetes 2022; 16:475-483. [PMID: 35654678 DOI: 10.1016/j.pcd.2022.05.004] [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: 02/14/2022] [Revised: 05/09/2022] [Accepted: 05/22/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess and summarize the effects of internet-based interventions on diabetes control and self-management of older adults with diabetes. METHODS PubMed, Web of Science and three Chinese databases were searched to identified articles published in until December 2021. Clinical trials if they covered the effects of internet-based interventions on diabetes control and self-management of older adults with diabetes were included. All data analysis were performed by Review Manager 5.3. RESULTS Sixteen studies with a total of 5604 participants met the inclusion criteria. Our primary outcomes included HbA1c control and self-management. (1) HbA1c control: results indicated statistically difference and high heterogeneity [Q = 112.9, df = 8, p < 0.001, I2 = 93%], in the subgroup analysis of studies in China, results showed a significant influence of internet-based interventions on HbA1c control [Q = 21.31, df = 5, p = 0.03, I2 = 77%]; (2) self-management: in the subgroup analysis of study duration ≤ 6 months [Q = 84.62, df = 2, p < 0.001, I2 = 98%]. CONCLUSION Internet-based interventions are promising on diabetes control and self-management of older adults with diabetes, but still preliminary due to the heterogeneity of intervention components and the limited number of higher methodological quality trials. AVAILABILITY OF DATA AND MATERIAL Applicable.
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Affiliation(s)
- Wenwen Yang
- School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Xiaoyi Zhang
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jianqun Chen
- Nantong North Nursing Home, Nantong, Jiangsu, China
| | - Weiwei Miao
- School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Chen Zheng
- School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Xiangyun Qian
- Nursing Department Nantong Third People's Hospital, Nantong, Jiangsu, China.
| | - Guiling Geng
- School of Medicine, Nantong University, Nantong, Jiangsu, China.
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Shah DA, Sall D, Peng W, Sharer R, Essary AC, Radhakrishnan P. Exploring the role of telehealth in providing equitable healthcare to the vulnerable patient population during COVID-19. J Telemed Telecare 2022:1357633X221113711. [PMID: 35833345 PMCID: PMC9283958 DOI: 10.1177/1357633x221113711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022]
Abstract
The COVID 19 pandemic resulted in widespread telehealth implementation. Existent health disparities were widened, with under-represented minorities (URM) disproportionately affected by COVID. In this study, we assess the role of telehealth in improving access to care in the URMs and vulnerable populations. We noted a statistically significant increase in the number of visits in Hispanic or Latino patients (15.2% increase, p < 0.01) and Black patients (19% increase, p < 0.01). Based on payer type, there was a statistically significant increase in the number of visits in the Medicare (10.2%, p = 0.0001) and Medicaid (16.2%, p < 0.01) groups. We also noted increased access to care with telehealth in patients who were 65 and older (10.6%, p = 0.004). This highlights the importance of telehealth in increasing access to care and promoting health equity in the URM and vulnerable patient populations.
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Affiliation(s)
| | - Dana Sall
- HonorHealth, Internal Medicine
- Clinical Assistant Professor,
University of Arizona-Phoenix
| | | | - Rustan Sharer
- HonorHealth, Internal Medicine
- HonorHealth, Clinical Informatics
| | - Alison C Essary
- HonorHealth, Academic Affairs
- HonorHealth, Clinical Informatics
| | - Priya Radhakrishnan
- HonorHealth, Internal Medicine
- HonorHealth, Academic Affairs
- HonorHealth, Clinical Informatics
- Clinical Professor University of
Arizona College of Medicine-Phoenix
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37
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Zhang Y, Leuk JSP, Teo WP. Domains, feasibility, effectiveness, cost, and acceptability of telehealth in aging care: a scoping review of systematic reviews (Preprint). JMIR Aging 2022; 6:e40460. [PMID: 37071459 PMCID: PMC10155091 DOI: 10.2196/40460] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/02/2022] [Accepted: 01/29/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Aging is becoming a major global challenge. Compared with younger adults, the older population has greater health needs but faces inadequate access to appropriate, affordable, and high-quality health care. Telehealth can remove geographic and time boundaries, as well as enabling socially isolated and physically homebound people to access a wider range of care options. The impacts of different telehealth interventions in terms of their effectiveness, cost, and acceptability in aging care are still unclear. OBJECTIVE This scoping review of systematic reviews aimed to provide an overview of the domains of telehealth implemented in aging care; synthesize evidence of telehealth's feasibility, effectiveness, cost benefits, and acceptability in the context of aging care; identify gaps in the literature; and determine the priorities for future research. METHODS Guided by the methodological framework of the Joanna Briggs Institute, we reviewed systematic reviews concerning all types of telehealth interventions involving direct communication between older users and health care providers. In total, 5 major electronic databases, PubMed, Embase (Ovid), Cochrane Library, CINAHL, and PsycINFO (EBSCO), were searched on September 16, 2021, and an updated search was performed on April 28, 2022, across the same databases as well as the first 10 pages of the Google search. RESULTS A total of 29 systematic reviews, including 1 post hoc subanalysis of a previously published large Cochrane systematic review with meta-analysis, were included. Telehealth has been adopted in various domains in aging care, such as cardiovascular diseases, mental health, cognitive impairment, prefrailty and frailty, chronic diseases, and oral health, and it seems to be a promising, feasible, effective, cost-effective, and acceptable alternative to usual care in selected domains. However, it should be noted that the generalizability of the results might be limited, and further studies with larger sample sizes, more rigorous designs, adequate reporting, and more consistently defined outcomes and methodologies are needed. The factors affecting telehealth use among older adults have been categorized into individual, interpersonal, technological, system, and policy levels, which could help direct collaborative efforts toward improving the security, accessibility, and affordability of telehealth as well as better prepare the older population for digital inclusion. CONCLUSIONS Although telehealth remains in its infancy and there is a lack of high-quality studies to rigorously prove the feasibility, effectiveness, cost benefit, and acceptability of telehealth, mounting evidence has indicated that it could play a promising complementary role in the care of the aging population.
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Affiliation(s)
- Yichi Zhang
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
- Ageing Research Institute for Society and Education, Interdisciplinary Graduate Programme, Nanyang Technological University, Singapore, Singapore
| | - Jessie Siew-Pin Leuk
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Wei-Peng Teo
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
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Javier-DesLoges J, Meagher M, Soliman S, Yuan J, Hakimi K, Ghali F, Nalawade V, Patel DN, Monga M, Murphy JD, Derweesh I. Disparities in Telemedicine Utilization for Urology Patients During the COVID-19 Pandemic. Urology 2022; 163:76-80. [PMID: 34979219 PMCID: PMC8719918 DOI: 10.1016/j.urology.2021.11.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine the odds of accessing telemedicine either by phone or by video during the COVID-19 pandemic. METHODS We performed a retrospective study of patients who were seen at a single academic institution for a urologic condition between March 15, 2020 and September 30, 2020. The primary outcome was to determine characteristics associated with participating in a telemedicine appointment (video or telephone) using logistic regression multivariable analysis. We used a backward model selection and variables that were least significant were removed. We adjusted for reason for visit, patient characteristics such as age, sex, ethnicity, race, reason for visit, preferred language, and insurance. Variables that were not significant that were removed from our final model included median income estimated by zip code, clinic location, provider age, provider sex, and provider training. RESULTS We reviewed 4234 visits: 1567 (37%) were telemedicine in the form of video 1402 (33.1%) or telephone 164 (3.8%). The cohort consisted of 2516 patients, Non-Hispanic White (n = 1789, 71.1%) and Hispanic (n = 417, 16.6%). We performed multivariable logistic regression analysis and demonstrated that patients who were Hispanic, older, or had Medicaid insurance were significantly less likely to access telemedicine during the pandemic. We did not identify differences in telemedicine utilization when stratifying providers by their age, sex, or training type (physician or advanced practice provider). CONCLUSION We conclude that there are differences in the use of telemedicine and that this difference may compound existing disparities in care. Additionally, we identified that these differences were not associated with provider attributes. Further study is needed to overcome barriers in access to telemedicine.
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Affiliation(s)
| | - Margaret Meagher
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Shady Soliman
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Julia Yuan
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Kevin Hakimi
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Fady Ghali
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Vinit Nalawade
- Department of Radiation Medicine and Applied Sciences, UC San Diego School of Medicine, La Jolla, CA
| | - Devin N Patel
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Manoj Monga
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, UC San Diego School of Medicine, La Jolla, CA
| | - Ithaar Derweesh
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA.
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Budhwani S, Fujioka J, Thomas-Jacques T, De Vera K, Challa P, De Silva R, Fuller K, Shahid S, Hogeveen S, Chandra S, Bhatia RS, Seto E, Shaw J. Challenges and strategies for promoting health equity in virtual care: findings and policy directions from a scoping review of reviews. J Am Med Inform Assoc 2022; 29:990-999. [PMID: 35187571 PMCID: PMC9006706 DOI: 10.1093/jamia/ocac022] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/12/2022] [Accepted: 02/16/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We sought to understand and synthesize review-level evidence on the challenges associated with accessibility of virtual care among underserved population groups and to identify strategies that can improve access to, uptake of, and engagement with virtual care for these populations. MATERIALS AND METHODS A scoping review of reviews was conducted (protocol available at doi: 10.2196/22847). A total of 14 028 records were retrieved from MEDLINE, EMBASE, CINAHL, Scopus, and Epistemonikos databases. Data were abstracted, and challenges and strategies were identified and summarized for each underserved population group and across population groups. RESULTS A total of 37 reviews were included. Commonly occurring challenges and strategies were grouped into 6 key thematic areas based on similarities across communities: (1) the person's orientation toward health-related needs, (2) the person's orientation toward health-related technology, (3) the person's digital literacy, (4) technology design, (5) health system structure and organization, and (6) social and structural determinants of access to technology-enabled care. We suggest 4 important directions for policy development: (1) investment in digital health literacy education and training, (2) inclusive digital health technology design, (3) incentivizing inclusive digital health care, and (4) investment in affordable and accessible infrastructure. DISCUSSION AND CONCLUSION Challenges associated with accessibility of virtual care among underserved population groups can occur at the individual, technological, health system, and social/structural determinant levels. Although the policy approaches suggested by our review are likely to be difficult to achieve in a given policy context, they are essential to a more equitable future for virtual care.
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Affiliation(s)
- Suman Budhwani
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Jamie Fujioka
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Tyla Thomas-Jacques
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Kristina De Vera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Priyanka Challa
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ryan De Silva
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Kaitlin Fuller
- University of Toronto Libraries, University of Toronto, Toronto, Ontario, Canada
| | - Simone Shahid
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Sophie Hogeveen
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Shivani Chandra
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - R Sacha Bhatia
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Ontario Health, Toronto, Ontario, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Centre for Global eHealth Innovation, University Health Network, Techna Institute, Toronto, Ontario, Canada
| | - James Shaw
- Corresponding Author: James Shaw, PhD, Women’s College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, ON M5S 1B3, Canada;
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Telemedicine Use by Older Adults in a COVID-19 Epicenter. J Emerg Med 2022; 63:325-331. [PMID: 35999159 PMCID: PMC8818355 DOI: 10.1016/j.jemermed.2022.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/08/2022] [Accepted: 01/25/2022] [Indexed: 11/23/2022]
Abstract
Background In early 2020, New York City was the epicenter of the Coronavirus disease 2019 (COVID-19) pandemic in the United States. Older adults were at especially high risk. Telemedicine (TM) was used to shift care from overburdened emergency departments (EDs) to provide health care to a community in lockdown. TM options presented unique challenges to our diverse older adult population, including visual, hearing, cognitive, and language limitations. Objective Our objective was to evaluate the use of TM during the peak of the pandemic in New York City. Methods We conducted a retrospective chart review of patients 65 years and older evaluated remotely via TM during our pandemic surge. Chart extraction was performed by six emergency physicians. Outcomes included demographics, technical limitations, rates of ED referral, and 30-day mortality. Results During the study period, a total of 140 encounters were reviewed. The mean age was 73 years. Overall, 20% of patients in the cohort were emergently referred to the ED. Use of TM by this age cohort increased 20-fold as compared with a similar time frame pre-pandemic. ED referral was highest in those over 75 (45.9% > 75 years). Forty-three percent used family to assist. Thirty-day mortality was 7%. Conclusion TM use by older adults grew substantially at our institution during our initial COVID-19 surge. The same-day emergent referral rate and mortality rate reflect the high acuity represented in this cohort and points to the need for telehealth providers that are trained in triage and emergency medicine with a knowledge of local resource availability.
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Sevcenko K, Lindgren I. The effects of virtual reality training in stroke and Parkinson's disease rehabilitation: a systematic review and a perspective on usability. Eur Rev Aging Phys Act 2022; 19:4. [PMID: 35078401 PMCID: PMC8903585 DOI: 10.1186/s11556-022-00283-3] [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: 08/19/2021] [Accepted: 01/04/2022] [Indexed: 12/18/2022] Open
Abstract
Background Virtual Reality (VR) training is emerging in the neurorehabilitation field. Technological advancement is often faster than clinical implementation. Previous reviews stressed the study design and methodological weaknesses of research in the field of VR for neurorehabilitation. Clinically relevant conclusions on implementation in particular patient groups are needed. The aim was to update the existing knowledge with the recent evidence on the effects of VR training on functional ability of patients with stroke and Parkinson’s Disease (PD). Secondary objective was to analyze the aspects of usability of VR intervention in these populations. Methods Systematic literature search (via PubMed, CENTRAL) was conducted from inception to February 29, 2020 to identify suitable articles for two population subcategories. Randomized controlled trials published from 2016 to 2020, investigating the effectiveness of VR on a variety of outcomes contributing to the functional independence were included. Critical Appraisal Skills Programme (CASP) checklist was used for a methodological quality assessment of the primary studies. Given the heterogeneity in types of VR intervention and outcomes, a descriptive synthesis was conducted. Results A total of 18 randomized controlled trials were included (10 in stroke subcategory, 8 in PD). CASP grading ranged 9–11, suggesting high methodological quality. All studies concluded that overall VR might be as effective as the conventional training, but more motivating. In some studies, VR was found to have a greater effect, taking the high response to treatment and satisfaction into account. Conclusions VR training is suggested as an effective intervention to improve the functional ability in stroke and PD patients. Addition of VR into a rehabilitation program might facilitate patient’s motivation, participation and improvement, as this method was generally well accepted, and the results of trials were promising. The consideration of disorder-specific aspects should take place during the decision-making of VR implementation.
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Affiliation(s)
| | - Ingrid Lindgren
- Department of Health Sciences, Lund University, Lund, Sweden. .,Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden.
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Increasing Telehealth Access to Care for Older Adults During the COVID-19 Pandemic at an Academic Medical Center: Video Visits for Elders Project (VVEP). Jt Comm J Qual Patient Saf 2021; 48:173-179. [PMID: 35027304 PMCID: PMC8645266 DOI: 10.1016/j.jcjq.2021.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/23/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The COVID-19 pandemic led to a significant increase in ambulatory virtual care, threatening access to care for older adults with lower digital literacy. This report describes the Video Visits for Elders Project (VVEP), a quality improvement effort to help older adults access video visits at an academic primary care practice. METHODS We reached out to empaneled older adults (≥ 65 years) who had a scheduled visit between March 30 and June 12, 2020. We assessed patients' readiness to engage in a virtual visit and offered to walk them through accessing the platform if they owned a compatible device. We evaluated outcomes of those phone calls and actual visit completion. RESULTS Between March 26 and June 3, 2020, we called 1,427 patients, reaching 1,025 (71.8%). Of those reached (mean age 75.6 years), 312 (30.4%) were already video-enabled, 192 (18.7%) asked for technical assistance, 185 (18.0%) did not have access to an electronic device, and 336 (32.8%) declined assistance. Of those reached, 40.4% completed their visit by video, 26.5% by telephone, and 1.4% by in-person visit, while 29.6% canceled and 2.1% no-showed. CONCLUSION VVEP successfully innovated to promote equitable access to telemedicine for vulnerable older patients in a time of crisis. Almost half required technical assistance or did not have access to a compatible device to engage in virtual care. As telemedicine will continue to play an important role in access to clinical care even in a postpandemic world, it is imperative for health systems to focus on technological need to promote equitable access to care for all patients.
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Yu E, Hagens S. Socioeconomic Disparities in the demand for and use of virtual visits among senior adults during the COVID-19 pandemic: A cross-sectional study (Preprint). JMIR Aging 2021; 5:e35221. [PMID: 35134746 PMCID: PMC8942091 DOI: 10.2196/35221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/12/2022] [Accepted: 02/07/2022] [Indexed: 01/31/2023] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Ellie Yu
- Canada Health Infoway, Toronto, ON, Canada
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Aldekhyyel RN, Almulhem JA, Binkheder S. Usability of Telemedicine Mobile Applications during COVID-19 in Saudi Arabia: A Heuristic Evaluation of Patient User Interfaces. Healthcare (Basel) 2021; 9:healthcare9111574. [PMID: 34828620 PMCID: PMC8621959 DOI: 10.3390/healthcare9111574] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has impacted the use of telemedicine application (apps), which has seen an uprise. This study evaluated the usability of the user interface design of telemedicine apps deployed during the COVID-19 pandemic in Saudi Arabia. It also explored changes to the apps’ usability based on the pandemic timeline. Methods: We screened ten mHealth apps published by the National Digital Transformation Unit and selected three telemedicine apps: (1) governmental “Seha”® app, (2) stand-alone “Cura”® app, and (3) private “Dr. Sulaiman Alhabib”®app. We conducted the evaluations in April 2020 and in June 2021 by identifying positive app features, using Nielsen’s ten usability heuristics with a five-point severity rating scale, and documenting redesign recommendations. Results: We identified 54 user interface usability issues during both evaluation periods: 18 issues in “Seha” 14 issues in “Cura”, and 22 issues in “Dr. Sulaiman Alhabib”. The two most heuristic items violated in “Seha”, were “user control and freedom” and “recognition rather than recall”. In “Cura”, the three most heuristic items violated were “consistency and adherence to standards”, “esthetic and minimalist design”, and “help and documentation” In “Dr. Sulaiman Alhabib” the most heuristic item violated was “error prevention”. Ten out of the thirty usability issues identified from our first evaluation were no longer identified during our second evaluation. Conclusions: our findings indicate that all three apps have a room for improving their user interface designs to improve the overall user experience and to ensure the continuity of these services beyond the pandemic.
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Rogers H, Madathil KC, Joseph A, Holmstedt C, Qanungo S, McNeese N, Morris T, Holden RJ, McElligott JT. An exploratory study investigating the barriers, facilitators, and demands affecting caregivers in a telemedicine integrated ambulance-based setting for stroke care. APPLIED ERGONOMICS 2021; 97:103537. [PMID: 34371321 DOI: 10.1016/j.apergo.2021.103537] [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: 09/17/2020] [Revised: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 06/13/2023]
Abstract
Telemedicine implementation in ambulances can reduce time to treatment for stroke patients, which is important as "time is brain" for these patients. Limited research has explored the demands placed on acute stroke caregivers in a telemedicine-integrated ambulance system. This study investigates the impact of telemedicine on workload, teamwork, workflow, and communication of geographically distributed caregivers delivering stroke care in ambulance-based telemedicine and usability of the system. Simulated stroke sessions were conducted with 27 caregivers, who subsequently completed a survey measuring workload, usability, and teamwork. Follow-up interviews with each caregiver ascertained how telemedicine affected workflow and demands which were analyzed for barriers and facilitators to using telemedicine. Caregivers experienced moderate workload and rated team effectiveness and usability high. Barriers included frustration with equipment and with the training of caregivers increasing demands, the loss of personal connection of the neurologists with the patients, and physical constraints in the ambulance. Facilitators were more common with live visual communication increasing teamwork and efficiency, the ease of access to neurologist, increased flexibility, and high overall satisfaction and usability. Future research should focus on eliminating these barriers and supporting the distributed cognition of caregivers.
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Hughes L, Petrella A, Phillips N, Taylor RM. Virtual care and the impact of COVID-19 on nursing: A single centre evaluation. J Adv Nurs 2021; 78:498-509. [PMID: 34590738 PMCID: PMC8657364 DOI: 10.1111/jan.15050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/12/2021] [Accepted: 09/16/2021] [Indexed: 01/23/2023]
Abstract
Aims The overall aim of this evaluation was to look at the impact of the changes in working practices during the pandemic on nurses. This secondary analysis provided an evaluation of virtual care and being able/required to work from home. Design This was secondary analysis of an evaluation using semi‐structured interviews. Methods Conducted at a single National Health Service (NHS) university hospital in the United Kingdom between May and July 2020. Forty‐eight operational leads and nurses participated in semi‐structured interviews which were digitally recorded, transcribed verbatim and analysed using a framework analysis. Results Two overarching themes emerged relating to the patient experience and nursing experience. There were both positive and negative elements associated with virtual care and remote working related to these themes. However, the majority of nurses found that virtual clinics were useful when proper resources were provided, and managerial strategies were put in place to support them. Participants felt that virtual care could benefit many but not all patient groups moving forward, and that flexibility around working from home would be desirable in the future. Conclusion Virtual care and remote working were implemented to accommodate the restrictions imposed because of the pandemic. The benefits of these changes to nurses and patients support these being business as usual. However, clear policies are needed to ensure that nurses feel supported when working remotely and there are robust assessments in place to ensure virtual care is provided to patients who have access to the necessary technology. Impact This was a study of the move to virtual care and remote working during the COVID‐19 pandemic. Telemedicine and flexible working were not common in the NHS prior to the pandemic but the current evaluation supports the role out of these as standard care with policies in place to ensure that nurses and patients are appropriately supported.
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Affiliation(s)
- Luke Hughes
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Anika Petrella
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK
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Johnson AE, Routh S, Taylor CN, Leopold M, Beatty K, McNamara DM, Davis EM. Developing and Implementing a Mobile Health Heart Failure Self-Care Program to Reduce Readmissions: A Patient-Centered Outcomes Research Randomized Controlled Trial (Preprint). JMIR Cardio 2021; 6:e33286. [PMID: 35311679 PMCID: PMC8981015 DOI: 10.2196/33286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/03/2022] [Accepted: 02/16/2022] [Indexed: 12/01/2022] Open
Abstract
Background Patients admitted with decompensated heart failure (HF) are at risk for hospital readmission and poor quality of life during the discharge period. Lifestyle behavior modifications that promote the self-management of chronic cardiac diseases have been associated with an improved quality of life. However, whether a mobile health (mHealth) program can assist patients in the self-management of HF during the acute posthospital discharge period is unknown. Objective We aimed to develop an mHealth program designed to enhance patients’ self-management of HF by increasing knowledge, self-efficacy, and symptom detection. We hypothesized that patients hospitalized with HF would be willing to use a feasibly deployed mHealth program after their hospital discharge. Methods We employed a patient-centered outcomes research methodology to design a stakeholder-informed mHealth program. Adult patients with HF admitted to a large academic hospital were enrolled and randomized to receive the mHealth intervention versus usual care. Our feasibility outcomes included ease of program deployment, use of the clinical escalation process, duration of participant recruitment, and participant attrition. Surveys assessing the demographics and clinical characteristics of HF were measured at baseline and at 30 and 90 days after discharge. Results The study period was between July 1, 2019, and April 7, 2020. The mean cohort (N=31) age was 60.4 (range 22-85) years. Over half of the participants were men (n=18, 58%) and 77% (n=24) were White. There were no significant differences in baseline measures. We determined that an educational mHealth program tailored for patients with HF is feasibly deployed and acceptable by patients. Though not significant, we found notable trends including a higher mean quality of life at 30 days posthospitalization among program users and a longer duration before rehospitalization, which are suggestive of better HF prognosis. Conclusions Our mHealth tool should be further assessed in a larger comparative effectiveness trial. Our pilot intervention offers promise as an innovative means to help HF patients lead healthy, independent lives. These preliminary data suggest that patient-centered mHealth tools can enable high-risk patients to play a role in the management of their HF after discharge. Trial Registration ClinicalTrials.gov NCT03982017; https://clinicaltrials.gov/ct2/show/NCT03982017
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Affiliation(s)
- Amber E Johnson
- Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- UPMC Heart and Vascular Institute, Pittsburgh, PA, United States
| | - Shuvodra Routh
- Department of Internal Medicine, UPMC, Pittsburgh, PA, United States
| | - Christy N Taylor
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Meagan Leopold
- UPMC Community Provider Services, Pittsburgh, PA, United States
| | - Kathryn Beatty
- Innovative Homecare Solutions of UPMC, Pittsburgh, PA, United States
| | - Dennis M McNamara
- Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- UPMC Heart and Vascular Institute, Pittsburgh, PA, United States
| | - Esa M Davis
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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Nies S, Patel S, Shafer M, Longman L, Sharif I, Pina P. Understanding Physicians' Preferences for Telemedicine During the COVID-19 Pandemic: Cross-sectional Study. JMIR Form Res 2021; 5:e26565. [PMID: 34227993 PMCID: PMC8366754 DOI: 10.2196/26565] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/30/2021] [Accepted: 05/31/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In contrast to the current broad dissemination of telemedicine across medical specialties, previous research focused on the effectiveness of telemedicine in special populations and for behavioral health encounters, demonstrating that both physician and patient factors impact the efficacious use of telemedicine. OBJECTIVE We aim to evaluate physician perceptions of the appropriateness of telemedicine for patients attending the primary care practices of a federally qualified health center in New York City. METHODS We used an anonymous cross-sectional survey including closed- and open-ended questions. We used chi-square to test whether providers from certain specialties were more likely to state they would use telemedicine in the future. We used t tests to compare age between those who would versus would not use telemedicine. We then used logistic regression to test whether age and specialty were both correlated with the desire to use telemedicine in the future. We used thematic content analysis to describe the reasons providers felt they would not want to use telemedicine in the future and to describe the situations for which they felt telemedicine would be appropriate. RESULTS Of 272 health care providers who were sent the electronic survey, 157 (58%) responded within the 2-week survey time frame. The mean age of providers was 45 (range 28-75) years. Overall, 80% (126/157) stated they would use telemedicine in the future. Compared to the family medicine, internal medicine, behavioral health, dental, and obstetrics and gynecology specialties, providers from pediatrics, med-peds, subspecialties, and surgery (protelemedicine specialties) were more likely to believe telemedicine would be useful post pandemic (61/67 [91%] vs 65/90 [72%]; P<.001). Providers who reported they would use telemedicine in the future were younger (mean age 44, range 42-46 years vs mean age 50, range 46-55 years; P=.048). In the regression analysis, both protelemedicine specialties and age were significantly associated with odds of reporting they would use telemedicine in the future (prospecialties: odds ratio 5.2, 95% CI 1.7-16.2; younger age: odds ratio 1.05, 95% CI 1.01-1.08). Providers who did not want to use telemedicine in the future cited concerns about inadequate patient care, lack of physical patient interaction, technology issues, and lack of necessity. Providers who felt telemedicine would be useful cited the following situations: follow-up visits, medication refills, urgent care, patient convenience, and specific conditions such as behavioral health, dermatology visits, and chronic care management. CONCLUSIONS The majority of health providers in this resource-limited setting in a federally qualified health center believed that telemedicine would be useful for providing care after the pandemic is over.
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Affiliation(s)
- Sarah Nies
- Family Health Centers at New York University Langone, Brooklyn, NY, United States
| | - Shae Patel
- Family Health Centers at New York University Langone, Brooklyn, NY, United States
| | - Melissa Shafer
- Family Health Centers at New York University Langone, Brooklyn, NY, United States
| | - Laura Longman
- Family Health Centers at New York University Langone, Brooklyn, NY, United States
| | - Iman Sharif
- Family Health Centers at New York University Langone, Brooklyn, NY, United States
| | - Paulo Pina
- Family Health Centers at New York University Langone, Brooklyn, NY, United States
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Li L, Childs AW. Using a Patient Safety/Quality Improvement Model to Assess Telehealth for Psychiatry and Behavioral Health Services Among Special Populations During COVID-19 and Beyond. J Psychiatr Pract 2021; 27:245-253. [PMID: 34398574 PMCID: PMC8318385 DOI: 10.1097/pra.0000000000000555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Telehealth has been rapidly deployed in the environment of the Coronavirus 2019 (COVID-19) pandemic to help meet critical mental health needs. As systems of care use telehealth during the pandemic and evaluate the future of telehealth services beyond the crisis, a quality and safety framework may be useful in weighing important considerations for using telehealth to provide psychiatric and behavioral health services within special populations. Examining access to care, privacy, diversity, inclusivity, and sustainability of telehealth to meet behavioral and psychiatric care needs in geriatric and disadvantaged youth populations can help highlight key considerations for health care organizations in an increasingly electronic health care landscape.
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Carotenuto A, Traini E, Fasanaro AM, Battineni G, Amenta F. Tele-Neuropsychological Assessment of Alzheimer's Disease. J Pers Med 2021; 11:jpm11080688. [PMID: 34442332 PMCID: PMC8398333 DOI: 10.3390/jpm11080688] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Because of the new pandemic caused by the novel coronavirus disease (COVID-19), the demand for telemedicine and telemonitoring solutions has been exponentially raised. Because of its special advantage to treat patients in an emergency without physical presence at a hospital via video conferencing, telemedicine has been used to overcome distance barriers and to improve access to special domains like neurology. In these pandemic times, telemedicine has been also employed as a support for the diagnosis and treatment of adult-onset dementia disorders including Alzheimer’s disease. Objective: In this study, we carried out a systematic literature analysis to clarify if the neuropsychological tests traditionally employed in face-to-face (FTF) contexts are reliable via telemedicine. Methods: A systematic literature search for the past 20 years (2001–2020) was carried out through the medical databases PubMed (Medline) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). The quality assessment was conducted by adopting the Newcastle Ottawa Scale (NOS) and only studies with a NOS ≥ 7 were included in this review. Results: The Mini-Mental State Examination (MMSE) results do not differ when tests are administered in the traditional FTF modality or by videoconference, and only negligible minor changes in the scoring system were noticeable. Other neuropsychological tests used to support the diagnosis of AD and dementia such as the Token Test, the Comprehension of Words and Phrases (ACWP), the Controlled Oral Word Association Test showed high reliability between the two modalities considered. No differences in the reliability concerning the living setting or education of the subjects were reported. Conclusions: The MMSE, which is the main screening test for dementia, can be administered via telemedicine with minor adaptation in the scoring system. Telemedicine use for other neuropsychological tests also resulted in general reliability and enough accuracy. Cognitive assessment by videoconference is accepted and appreciated and therefore can be used for dementia diagnosis in case of difficulties to performing FTF assessments. This approach can be useful given a personalized medicine approach for the treatment of adult-onset dementia disorders.
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Affiliation(s)
- Anna Carotenuto
- Centre for Clinical Research, Telemedicine and Telepharmacy, University of Camerino, Via Madonna delle Carceri 9, 62032 Camerino, Italy; (A.C.); (E.T.); (A.M.F.); (F.A.)
| | - Enea Traini
- Centre for Clinical Research, Telemedicine and Telepharmacy, University of Camerino, Via Madonna delle Carceri 9, 62032 Camerino, Italy; (A.C.); (E.T.); (A.M.F.); (F.A.)
| | - Angiola Maria Fasanaro
- Centre for Clinical Research, Telemedicine and Telepharmacy, University of Camerino, Via Madonna delle Carceri 9, 62032 Camerino, Italy; (A.C.); (E.T.); (A.M.F.); (F.A.)
| | - Gopi Battineni
- Centre for Clinical Research, Telemedicine and Telepharmacy, University of Camerino, Via Madonna delle Carceri 9, 62032 Camerino, Italy; (A.C.); (E.T.); (A.M.F.); (F.A.)
- Correspondence: ; Tel.: +39-333-172-8206
| | - Francesco Amenta
- Centre for Clinical Research, Telemedicine and Telepharmacy, University of Camerino, Via Madonna delle Carceri 9, 62032 Camerino, Italy; (A.C.); (E.T.); (A.M.F.); (F.A.)
- Research Department, International Radio Medical Centre (C.I.R.M.), Via dell’Architettura 41, 00144 Roma, Italy
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