1
|
Lin L, Cheng M, Guo Y, Cao X, Tang W, Xu X, Cheng W, Xu Z. Early discharge hospital at home as alternative to routine hospital care for older people: a systematic review and meta-analysis. BMC Med 2024; 22:250. [PMID: 38886793 PMCID: PMC11184809 DOI: 10.1186/s12916-024-03463-3] [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: 11/03/2023] [Accepted: 06/03/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The global population of adults aged 60 and above surpassed 1 billion in 2020, constituting 13.5% of the global populace. Projections indicate a rise to 2.1 billion by 2050. While Hospital-at-Home (HaH) programs have emerged as a promising alternative to traditional routine hospital care, showing initial benefits in metrics such as lower mortality rates, reduced readmission rates, shorter treatment durations, and improved mental and functional status among older individuals, the robustness and magnitude of these effects relative to conventional hospital settings call for further validation through a comprehensive meta-analysis. METHODS A comprehensive literature search was executed during April-June 2023, across PubMed, MEDLINE, Embase, Web of Science, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) to include both RCT and non-RCT HaH studies. Statistical analyses were conducted using Review Manager (version 5.4), with Forest plots and I2 statistics employed to detect inter-study heterogeneity. For I2 > 50%, indicative of substantial heterogeneity among the included studies, we employed the random-effects model to account for the variability. For I2 ≤ 50%, we used the fixed effects model. Subgroup analyses were conducted in patients with different health conditions, including cancer, acute medical conditions, chronic medical conditions, orthopedic issues, and medically complex conditions. RESULTS Fifteen trials were included in this systematic review, including 7 RCTs and 8 non-RCTs. Outcome measures include mortality, readmission rates, treatment duration, functional status (measured by the Barthel index), and mental status (measured by MMSE). Results suggest that early discharge HaH is linked to decreased mortality, albeit supported by low-certainty evidence across 13 studies. It also shortens the length of treatment, corroborated by seven trials. However, its impact on readmission rates and mental status remains inconclusive, supported by nine and two trials respectively. Functional status, gauged by the Barthel index, indicated potential decline with early discharge HaH, according to four trials. Subgroup analyses reveal similar trends. CONCLUSIONS While early discharge HaH shows promise in specific metrics like mortality and treatment duration, its utility is ambiguous in the contexts of readmission, mental status, and functional status, necessitating cautious interpretation of findings.
Collapse
Affiliation(s)
- Lulu Lin
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Mengyuan Cheng
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Yawei Guo
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Xiaowen Cao
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Weiming Tang
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
- Institute of Global Health and Infectious Diseases, University of North Carolina at ChapelHill, Chapel Hill, NC, USA
| | - Xin Xu
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Weibin Cheng
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China.
- School of Data Science, City University of Hong Kong, Hong Kong SAR, China.
- Faculty of Health Sciences, City University of Macau, Macao SAR, China.
| | - Zhongzhi Xu
- School of Public Health, Sun Yat-Sen University, Guangzhou, China.
| |
Collapse
|
2
|
Güneş Öztürk G, Akyıldız D, Karaçam Z. The impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancy: A systematic review and meta-analysis. J Telemed Telecare 2024; 30:607-630. [PMID: 35570738 DOI: 10.1177/1357633x221087867] [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: 11/16/2022]
Abstract
INTRODUCTION Telehealth is an applicable, acceptable, cost-effective, easily accessible, and speedy method for pregnant women. This study aimed to examine the impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancies. METHODS Studies were selected from PubMed, Science Direct, Web of Science, EBSCO, Scopus, and Clinical Key databases according to the inclusion and exclusion criteria from January to February 2021. Cochrane risk-of-bias tools were used in the quality assessment of the studies. RESULTS Four observational and eight randomized controlled studies were included in this meta-analysis (telehealth: 135,875, control: 94,275). It was seen that the number of ultrasound (p < 0.01) and face-to-face visits (p < 0.01), fasting insulin (p < 0.01), hemoglobin A1C before delivery (p < 0.01), and emergency cesarean section rates (p = 0.05) were lower in the telehealth group. In the telehealth group, the women's use of antenatal corticosteroids (p = 0.03) and hypoglycemic medication at delivery (p = 0.03), the total of nursing interventions (p < 0.01), compliance with actual blood glucose measurements (p < 0.01), induction intervention at delivery (p = 0.003), and maternal mortality (p < 0.001) rates were higher. Two groups were similar in terms of the use of medical therapy, total gestational weight gain, health problems related to pregnancy, mode and complications of delivery, maternal intensive care unit admission, fetal-neonatal growth and development, neonatal health problems and mortality, follow-up, and care costs. DISCUSSION Telehealth and routine care yielded similar maternal/neonatal health and cost outcomes. It can be said that telehealth is a safe technique to work with in the management of high-risk pregnancies.
Collapse
Affiliation(s)
- Gizem Güneş Öztürk
- Division of Midwifery, Faculty of Health Science, Aydın Adnan Menderes University, Aydın, Turkey
| | - Deniz Akyıldız
- Division of Midwifery, Faculty of Health Science, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Zekiye Karaçam
- Division of Midwifery, Faculty of Health Science, Aydın Adnan Menderes University, Aydın, Turkey
| |
Collapse
|
3
|
Lavelle F, McKernan C, Shrewsbury V, Wolfson JA, Taylor RM, Duncanson K, Martins CA, Elliott C, Collins CE. An online qualitative study exploring wants and needs for a cooking programme during pregnancy in the UK and Ireland. J Hum Nutr Diet 2024. [PMID: 38606553 DOI: 10.1111/jhn.13307] [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: 08/09/2023] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Optimal maternal nutrition is associated with better pregnancy and infant outcomes. Culinary nutrition programmes have potential to improve diet quality during pregnancy. Therefore, this research aimed to understand the experiences of cooking and the wants and needs of pregnant women regarding a cooking and food skills programme in the United Kingdom (UK) and Republic of Ireland (ROI). METHODS Online focus group discussions with pregnant women and those who had experienced a pregnancy in the UK or ROI were conducted between February and April 2022. Two researchers conducted a thematic analysis. Seven focus groups with ROI participants (n = 24) and six with UK participants (n = 28) were completed. RESULTS Five themes were generated. These were (1) cooking during pregnancy: barriers, motivators and solutions; (2) food safety, stress and guilt; (3) need for cooking and food skills programmes and desired content; (4) programme structure; (5) barriers and facilitators to programme participation. Overall, there was support for a programme focusing on broad food skills, including planning, food storage, using leftovers and to manage pregnancy-specific physiological symptoms such as food aversions. Participants emphasised the importance of inclusivity for a diverse range of people and lifestyles for programme design and content. CONCLUSIONS Current findings support the use of digital technologies for culinary nutrition interventions, potentially combined with in-person sessions using a hybrid structure to enable the development of a support network.
Collapse
Affiliation(s)
- Fiona Lavelle
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, UK
- Department of Nutritional Sciences, School of Life Course & Population Sciences, King's College London, London, UK
| | - Claire McKernan
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - Vanessa Shrewsbury
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Julia A Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Rachael M Taylor
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Kerith Duncanson
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Carla A Martins
- Center for Epidemiological Research in Nutrition and Health, University of Sao Paulo, Sao Paulo, Brazil
- Institute of Food and Nutrition, Federal University of Rio de Janeiro, Macaé, Brazil
| | - Christopher Elliott
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| |
Collapse
|
4
|
Der-Martirosian C, Hou C, Hovsepian S, Diarra Carter M, Heyworth L, Dobalian A, Leung L. Implementation of Video-Based Care in Interdisciplinary Primary Care Settings at the Veterans Health Administration: Qualitative Study. JMIR Form Res 2024; 8:e52830. [PMID: 38592760 PMCID: PMC11040435 DOI: 10.2196/52830] [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: 09/16/2023] [Revised: 02/13/2024] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND With the rapid shift to telehealth, there remains a knowledge gap in how video-based care is implemented in interdisciplinary primary care (PC) settings. OBJECTIVE The objective of this study was to gain an in-depth understanding of how video telehealth services were implemented in PC from the perspectives of patients and interdisciplinary PC team members at the Veterans Health Administration (VHA) 2 years after the onset of the COVID-19 pandemic. METHODS We applied a positive and negative deviance approach and selected the 6% highest (n=8) and the 6% lowest (n=8) video-using PC sites in 2022 from a total of 130 VHA medical centers nationally. A total of 12 VHA sites were included in the study, where 43 PC interdisciplinary team members (August-October 2022) and 25 patients (February-May 2023) were interviewed. The 5 domains from the diffusion of innovation theory and the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework guided the development of the 2 study interview guides (provider and patient). We identified themes that emerged across all interviews that were associated with the implementation of video-based care in interdisciplinary PC settings, using directed-content rapid analysis of the interview transcripts. The analysis was guided by 5 a priori NASSS domains: (1) patient condition or characteristic, (2) technology, (3) adopter system, (4) health care organization, and (5) adaptation over time. RESULTS The study findings include the following common themes and factors, organized by the 5 NASSS domains: (1) patient condition or characteristic-visit type or purpose (eg, follow-up visits that do not require physical examination), health condition (eg, homebound or semihomebound patients), and sociodemographic characteristic (eg, patients who have a long commute time); (2) technology-key features (eg, access to video-enabled devices), knowledge (eg, how to use videoconferencing software), and technical support for patients and providers; (3) adopter system-changes in staff roles and clinical practice (eg, coordination of video-based care), provider and patient preference or comfort to use video-based care, and caregiver's role (eg, participation of caregivers during video visits); (4) health care organization-leadership support and access to resources, scheduling for video visits (eg, schedule or block off digital half or full days), and training and telehealth champions (eg, hands-on or on-site training for staff, patients, or caregivers); (5) adaptation over time-capacity to improve all aspects of video-based care and provide continued access to resources (eg, effective communication about updates). CONCLUSIONS This study identified key factors associated with the implementation of video-based services in interdisciplinary PC settings at the VHA from the perspectives of PC team members and patients. The identified multifaceted factors may inform recommendations on how to sustain and improve the provision of video-based care in VHA PC settings as well as non-VHA patient-centered medical homes.
Collapse
Affiliation(s)
- Claudia Der-Martirosian
- Veterans Affairs Greater Los Angeles Healthcare System Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, United States
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA, United States
| | - Cynthia Hou
- Veterans Affairs Greater Los Angeles Healthcare System Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, United States
| | - Sona Hovsepian
- Veterans Affairs Greater Los Angeles Healthcare System Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, United States
| | - Maia Diarra Carter
- Office of Primary Care/Patient Care Services, Veterans Health Administration, Washington, DC, United States
| | - Leonie Heyworth
- Office of Connected Care/Telehealth Services, Veterans Health Administration, Washington, DC, United States
- Department of Medicine, University of California San Diego School of Medicine, San Diego, CA, United States
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA, United States
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, United States
| | - Lucinda Leung
- Veterans Affairs Greater Los Angeles Healthcare System Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, United States
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Agneles, CA, United States
| |
Collapse
|
5
|
Yakubu AO, Olalude O, Salami M, Amuta AC, Amusa A, Salaudeen HA, Awoyemi AJ. Telemedicine and Neurology: A Survey of Neurology Patients in a Nigerian Tertiary Hospital. Cureus 2024; 16:e57916. [PMID: 38725763 PMCID: PMC11081517 DOI: 10.7759/cureus.57916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Background Telemedicine has been recognized as a viable solution for addressing the shortage of medical professionals in developing countries such as Nigeria. Tele-neurology has the potential to provide remote consultations and care for patients with neurological conditions, thereby reducing the burden of travel and improving access to medical care. Despite its growing popularity, there is a lack of research on patient's views on this mode of care delivery in Nigeria. This study was conducted to investigate patient's perspectives on the use of tele-neurology in Nigeria. Methodology A descriptive cross-sectional study was conducted among 398 neurology patients at Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria. The data obtained were analyzed using descriptive statistics and a chi-square test using p < 0.05. Results Only 3% of our respondents had previously used telemedicine, with 78.1% of the respondents open to using telemedicine as a means of consultation. The disadvantages of telemedicine noted include limitations in assessing neurological status (94.7%), difficulty in explaining health conditions (84.4%), and lack of technical support (14.6%). The majority of respondents (96.5%) believed telemedicine will help in saving time. There was a statistically significant association between propensity to use telemedicine and time spent in the hospital (0.045) and time off work (<0.001). The propensity to use telemedicine was statistically significant to the use of email (0.001) and type of email address (0.001). Conclusion The findings suggested that there is a need for healthcare providers and policymakers to invest in developing telemedicine to improve access to care.
Collapse
Affiliation(s)
- Aliu O Yakubu
- Department of Old Age Psychiatry, University Hospital Wishaw NHS Trust, Wishaw, GBR
| | - Oluwakemi Olalude
- Department of Internal Medicine, Lagos State University Teaching Hospital, Lagos, NGA
| | - Mayowa Salami
- Department of Paediatrics, Princess Royal Maternity Hospital NHS Trust, Glasgow, GBR
| | - Augustine C Amuta
- Department of Health and Wellness, Prince George's County Health Department, Upper Marlboro, USA
| | - Abeedat Amusa
- Department of Medicine and Surgery, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Ago Iwoye, NGA
| | - Hasanat A Salaudeen
- Department of Medicine and Surgery, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Ago Iwoye, NGA
| | - Ayodeji J Awoyemi
- Department of Medicine and Surgery, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Ago Iwoye, NGA
| |
Collapse
|
6
|
Ting CY, Abdul Halim NH, Ling JN, Tiong IK, Ahmad Shauki NIHJ, Lee YF, Osman NA, Chai GW, Ung SH, Ang M. The use of a multi-disciplinary geriatric telemedicine service (TELEG) and its acceptance at a tertiary care centre in Malaysia. BMC Geriatr 2024; 24:133. [PMID: 38317117 PMCID: PMC10845621 DOI: 10.1186/s12877-024-04676-0] [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: 05/25/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has fueled the widespread adoption of telemedicine in healthcare, particularly in Sarawak, Malaysia. This study investigates the use and acceptance of Sarawak's inaugural multidisciplinary geriatric telemedicine service, TELEG. METHODS This cross-sectional study took place at the Sarawak Heart Centre's geriatric department from July 1, 2021, to April 30, 2022. Convenient sampling included all TELEG-enrolled patients during this period, to achieve minimum sample size of 148. TELEG's utilization was assessed in terms of medication therapy and treatment plan optimization, as well as enhanced healthcare accessibility. Participants' acceptance of TELEG was measured using the Service User Technology Acceptability Questionnaire (SUTAQ) administered through Google Forms. Descriptive statistics percentages illustrated the proportion of participants who found TELEG moderately to highly acceptable. Associations between baseline characteristics and overall acceptance were explored through bivariate analyses, including Pearson's correlation test, independent t-test, and ANOVA. The influence of six SUTAQ dimensions on overall acceptance, multivariable linear regression using enter method was employed. Statistical significance was determined by p-values less than 0.5. RESULTS Among 180 geriatric patients enrolled in TELEG during the study period, 149 agreed to participate. TELEG led to medication therapy optimization for 88.6% of participants, primarily involving dose adjustment (44.7%), de-prescribing (31.8%), and prescribing (15.9%). Additionally, 53.8% received treatment plan optimization, predominantly in the form of self-care education (56.3%), referrals for further treatment (33.8%), additional laboratory investigations (29.6%), and increased monitoring (26.8%). Among those educated in self-care (n = 40), dietary intake (27.5%), lower limb exercise (25.0%), and COVID-19 vaccination (12.5%) were the most common topics. All participants expressed moderate to high acceptance of TELEG (mean = 4.9, SD = 0.65, on a scale of 1 to 6). Notably, care personnel concern (B = 0.256; p < 0.001) had the most significant impact on overall acceptance. CONCLUSION This pioneering study evaluates the utilization and user acceptance of a geriatric telemedicine service in the region, providing valuable insights to support its expansion. Follow-up surveys or interviews to gain insights into users' experiences are crucial to further enhance acceptance.
Collapse
Affiliation(s)
- Chuo Yew Ting
- Pharmaceutical Services Division, Sarawak State Health Department, Ministry of Health, Jalan Diplomatik, Off Jalan Bako, Kuching, 93350, Malaysia.
| | - Nur Hidayati Abdul Halim
- Institute for Health Systems Research, National Institute of Health, Ministry of Health, Shah Alam, Malaysia
| | - Jia Nee Ling
- Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
| | | | - Nor Izzah H J Ahmad Shauki
- Institute for Health Systems Research, National Institute of Health, Ministry of Health, Shah Alam, Malaysia
| | - Yew Fong Lee
- Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
- School of Medical and Life Sciences, Sunway University, Selangor, Malaysia
| | - Nor Anizah Osman
- Pharmaceutical Services Division, Sarawak State Health Department, Ministry of Health, Jalan Diplomatik, Off Jalan Bako, Kuching, 93350, Malaysia
| | - Gin Wei Chai
- Sarawak Heart Centre, Ministry of Health, Kota Samarahan, Malaysia
| | - Shin Han Ung
- Sarawak Heart Centre, Ministry of Health, Kota Samarahan, Malaysia
| | - Melinda Ang
- Sarawak Heart Centre, Ministry of Health, Kota Samarahan, Malaysia
| |
Collapse
|
7
|
Mohapatra I, Rai VK, Samantaray SR. Impact of telemedicine on antenatal care at a teaching institution in Eastern India: An insight into the future of better India. J Family Med Prim Care 2023; 12:2652-2660. [PMID: 38186769 PMCID: PMC10771158 DOI: 10.4103/jfmpc.jfmpc_995_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 01/09/2024] Open
Abstract
Objectives Telemedicine (TM) emergence has been profound in using technology to address the problems of obstetrics in remote and rural places, especially in low-risk pregnancy. Through this study, we made an effort to assess the satisfaction level and concerns of antenatal and postnatal patients who availed the telemedicine facility during the study period. We also made an effort to facilitate improved access to antenatal and postnatal care, especially the low-risk pregnancies through telemedicine for patients from remote areas of eastern India that do not have the availability of specialists. Materials and Methods Primary data were collected by means of a telephonic survey of all the antenatal patients who used telemedicine services of AIIMS, Kalyani, based on a preformed questionnaire. Results A total of 80 antenatal patients gave consent to participate in the study. Most of the patients were from the upper lower class [43.75%] followed by the lower middle class [35%]. The average gestational age of respondents was 23.95 weeks. Seventy-one out of 80 patients felt that the appointment was made within a reasonable time. Only 12 patients [15.3%] had waiting time greater than 10 min. The average waiting time was 6.93 min. 56.3% of respondents felt that the person who attended their call was very cooperative. 86.3% of respondents strongly agreed that the consultant was able to understand their health issues completely. Eighty percent of the respondents said that they would like to continue using telemedicine in the future. There is a significant difference between those preferring to use telemedicine in the future and those who do not prefer telemedicine in the future. Poor internet facility and privacy were prominent reasons for not opting for telemedicine in the future by some respondents. Conclusion From this study, it was concluded that TM certainly has great potential to make health care accessible to people residing in rural and far-off places.
Collapse
Affiliation(s)
- Ipsita Mohapatra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Vikash K Rai
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Subha Ranjan Samantaray
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| |
Collapse
|
8
|
Altabtabaei R, Alhuwail D. Exploring the Challenges and Opportunities of Adopting and Using Telemedicine for Diabetes Care and Management: Qualitative Semistructured Interview Study Among Health Care Providers and Patients With Diabetes. JMIR Hum Factors 2023; 10:e46324. [PMID: 37676711 PMCID: PMC10514770 DOI: 10.2196/46324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/22/2023] [Accepted: 07/28/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Around the world, over half of the global population experiences noncommunicable diseases, resulting in premature death. Health care providers (HCPs) can deliver medical treatment from a distance by using digital advancements such as telemedicine. However, there is a limited understanding of the difficulties and opportunities of implementing telemedicine solutions in different socioeconomic and cultural environments, including Kuwait. OBJECTIVE The purpose of this study is to (1) examine the obstacles and benefits of telemedicine in the context of diabetes treatment and management, as perceived by both HCPs and patients with diabetes; (2) investigate the nonfunctional requirements for telemedicine applications used in diabetes care and management; and (3) provide suggestions to enhance the integration and adoption of telemedicine in Kuwait's health care system for diabetes care and management. METHODS The research used a qualitative and exploratory design, with semistructured interviews as the main data collection method. Participants were recruited on the internet through social media platforms due to the COVID-19 pandemic. The results were analyzed using thematic analysis and the Framework Method. The "diffusion of innovation" model was used as a perspective to interpret the findings. RESULTS A total of 20 participants were included in this study-10 HCPs and 10 patients with diabetes-all of whom supported telemedicine. The HCPs reported that many diabetes cases could be managed through telemedicine, with only a few requiring in-person visits. Patients with diabetes noted the convenience and time-saving aspect of telemedicine. Both groups recommended the creation of a secure and user-friendly telemedicine system similar to popular social media platforms. Additionally, participants emphasized the importance of telemedicine during the pandemic as a way to prioritize patient safety. CONCLUSIONS The results of this study provide valuable insights into the needs and preferences of both HCPs and patients with diabetes in a resource-rich country like Kuwait to embrace telemedicine. The COVID-19 pandemic has changed the way medical care is provided and has pushed both groups to consider digital solutions for ongoing diabetes management and treatment.
Collapse
Affiliation(s)
- Rabab Altabtabaei
- Information Science Department, Kuwait University, Kuwait City, Kuwait
| | - Dari Alhuwail
- Information Science Department, Kuwait University, Kuwait City, Kuwait
- Health Informatics Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
| |
Collapse
|
9
|
Araújo MDSD, Albuquerque ACD, Felisberto E, Samico I, Rodrigues ÁS. [Assessment of the implementation of an care teleregulation project in a Brazilian capital city]. CAD SAUDE PUBLICA 2023; 39:e00009623. [PMID: 37466552 PMCID: PMC10494686 DOI: 10.1590/0102-311xpt009623] [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: 01/27/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 07/20/2023] Open
Abstract
This study evaluates the degree of implementation (DI) of the Regulates+ Brazil project and analyzes to what extent the variations in implementation influence the results observed in access to specialized appointments in Recife, Pernambuco, Brazil. This is an evaluative research of implementation analysis. A logic model and an analysis and judgment matrix with indicators for evaluating the degree of implementation and the results of the Project were developed and submitted to expert consensus. The data collection was conducted via a semi-structured questionnaire applied to key informants and secondary data extracted from the official documents from Regulates+ Brazil and Brazilian National Regulation System (SISREG), referring to the period from May/2020 to May/2021, which were consolidated and compared with values defined in the matrix. The degree of implementation of the Regulates+ Brazil project in Recife was considered to be implemented (83.7%), as well as the Structure (81.7%) and Methods (84.6%) dimensions. However, most effect indicators underperformed, which, when confronted, were consistent with bottlenecks observed in some components and subcomponents of the Project, such as the performance of professionals in basic health units, which was indicated as incipient, especially regarding follow-up of returned requests. The results suggest that any intervention in Telehealth requires, for its proper implementation, the adequacy of teams and work processes, practices of Continuing Education, as well as a continuous evaluation process, to achieve the expected results, or else it will become another bureaucratization and barrier to access.
Collapse
Affiliation(s)
| | | | | | - Isabella Samico
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brasil
| | | |
Collapse
|
10
|
Alzahrani HS, Alharbi SA, Alsadan YI, Alghosn NS, Almazyad SM, Alotaibi N, Almansour M, Aldossari KK, Demyati E, Abulreesh RY. Awareness and acceptance of teleclinic services during COVID-19 in the general population in Riyadh: Cross-sectional study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:217. [PMID: 37546015 PMCID: PMC10402800 DOI: 10.4103/jehp.jehp_819_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 03/31/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The first COVID-19 case in Saudi Arabia was reported on March 2, 2020. The Saudi government introduced the "937" service number as one of the telemedicine services for COVID-19 information. Telemedicine uses telecommunication and information technologies in the medical field to deliver healthcare services and improve patients' health status. This study aims to estimate the frequency of teleclinics usage during COVID-19, assess awareness of teleclinics, and assess acceptance of teleclinics during COVID-19 in the Saudi population. MATERIALS AND METHODS The cross-sectional study used a convenient sample encompassing the 1,583 Saudi and non-Saudi adult population of Riyadh, Saudi Arabia, and was conducted online between August 2020 and April 2021. A self-administrated online questionnaire was distributed to all participants and data were collected on sociodemographics, knowledge of use of teleclinics, and its acceptance. Analysis of quantitative data by t-test and association of qualitative variables by Chi-square test was conducted. Regression analysis was performed on the significant values of univariate analysis. Data were analyzed by SPSS 25. RESULTS Most (92.5%) participants were female and had a university education (65.9%). The main reason for using teleclinic was experiencing a new complaint (27.3%), next, for medications refill (13.2%), with COVID-19-related issues being the least common reason for using teleclinic (8.2%). The result shows that 77.1% of participants had a good level of acceptance of teleclinic. The regression analysis showed that number of teleclinics utilization, as an advantage it is more convenient, and recommending this service to someone else was significantly associated with acceptance of teleclinics in future. CONCLUSION As per the findings, the experience of using teleclinic positively impacts the level of acceptance of teleclinic among the population. The adoption of telemedicine for healthcare delivery during the COVID-19 pandemic helped limit the spread of the infection and reduce the risk of exposure to COVID-19 for both patients and healthcare providers. In the future, telemedicine can be used as an alternative to minor complaints and follow-up checkups. In this way, the burden of healthcare system can also be overcome.
Collapse
Affiliation(s)
- Hayat S. Alzahrani
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Sarah A. Alharbi
- Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Yara I. Alsadan
- Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Nouf S. Alghosn
- Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | - Nowayer Alotaibi
- Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Mohammed Almansour
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khaled K. Aldossari
- Family and Community Medicine Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Eyad Demyati
- Consultant in Family Medicine and Community Health Services Department, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Razan Y. Abulreesh
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| |
Collapse
|
11
|
Bourdon J. Rethinking telepresence: post- and pre-COVID-19. MEDIA, CULTURE, AND SOCIETY 2023; 45:884-895. [PMID: 38602903 PMCID: PMC10020854 DOI: 10.1177/01634437231159527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Following the marked increase in the use of digital technologies during the recent pandemic, the article reconsiders the concept of social telepresence, in the sense of interpersonal connection at a distance, locating it in the longue durée and within media studies. It reminds the reader that, for centuries, when people were separated from one another by the force of various circumstances, including pandemics, they resorted to technologies at their disposal to experience telepresence, long before the term itself was coined by scholars. Foremost among these has been the epistolary, a vitally important interpersonal media largely overlooked by media and telepresence researchers. Rather than competitively evaluating the performance of various technologies, the article proposes a framework to compare them, along with the practices of social telepresence, in the course of history. This comparative program employs the following criteria: embodiment, synchronicity, the space of the encounter, the ontology of entities other than humans actuated by telepresence and the social preferences for different forms of telepresence.
Collapse
|
12
|
McLean KA, Knight SR, Diehl TM, Varghese C, Ng N, Potter MA, Zafar SN, Bouamrane MM, Harrison EM. Readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review and clinical innovation network analysis. Lancet Digit Health 2023; 5:e295-e315. [PMID: 37100544 DOI: 10.1016/s2589-7500(23)00026-2] [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: 08/02/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 04/28/2023]
Abstract
An increasing number of digital health interventions (DHIs) for remote postoperative monitoring have been developed and evaluated. This systematic review identifies DHIs for postoperative monitoring and evaluates their readiness for implementation into routine health care. Studies were defined according to idea, development, exploration, assessment, and long-term follow-up (IDEAL) stages of innovation. A novel clinical innovation network analysis used coauthorship and citations to examine collaboration and progression within the field. 126 DHIs were identified, with 101 (80%) being early stage innovations (IDEAL stage 1 and 2a). None of the DHIs identified had large-scale routine implementation. There is little evidence of collaboration, and there are clear omissions in the evaluation of feasibility, accessibility, and the health-care impact. Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality supporting evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.
Collapse
Affiliation(s)
- Kenneth A McLean
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Stephen R Knight
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas M Diehl
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Nathan Ng
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mark A Potter
- Colorectal Unit, Western General Hospital, Edinburgh, UK
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matt-Mouley Bouamrane
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
13
|
Alromaihi D, Asheer S, Hasan M, Faqihi F, Almannaei N, Alkowari S, Janahi D, Hasan M, Abraham A, Verma S. Evaluation of Patients' Satisfaction with the Transition of Internal Medicine Outpatient Clinics to Teleconsultation During COVID-19 Pandemic. Telemed J E Health 2023; 29:270-277. [PMID: 35704029 DOI: 10.1089/tmj.2021.0517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: The utilization of telemedicine has been steadily rising and became more available during the coronavirus disease 2019 (COVID-19) pandemic to ensure the continuity of care and minimize the risk of exposure to the infection. The aim of this study was to evaluate patients' and caregivers' satisfaction to newly developed teleconsultation services at the internal medical outpatient clinics at a tertiary university hospital during the COVID-19 pandemic. Methods: A cross-sectional satisfaction evaluation was conducted between April 2020 and June 2020. Participants included patients or caregivers who were randomly selected to answer a multi-item questionnaire to measure satisfaction with the quality, effectiveness, and convenience of the service. Results: A total of 901 participants completed the satisfaction survey. Most of the patients were in the age group 45-64 years (43.7%). The main teleconsultation method was telephone call (99.2%) and 798 participants (88.6%) were satisfied with the quality of teleconsultation. There was no difference in satisfaction levels across the various specialty clinics or age groups. The service was viewed as convenient by 636 participants (70.5%) and 481 (56.6%) preferred to continue using telemedicine after the COVID-19 pandemic. Conclusion: The study revealed high level of satisfaction among patients and caregivers with the recently introduced teleconsultation services at internal medicine outpatient clinics during the COVID-19 pandemic, which is a relatively new concept in many countries. This opens the door to further utilize telemedicine as an integrated part to improve patient care beyond the pandemic.
Collapse
Affiliation(s)
- Dalal Alromaihi
- Department of Internal Medicine, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain.,Royal College of Surgeons in Ireland-Medical University of Bahrain, Adliya, Kingdom of Bahrain
| | - Shaikha Asheer
- Department of Internal Medicine, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Mariam Hasan
- Department of Internal Medicine, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Fatima Faqihi
- Department of Internal Medicine, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Noora Almannaei
- Department of Internal Medicine, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Shaikha Alkowari
- Department of Internal Medicine, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Duha Janahi
- Department of Internal Medicine, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Mona Hasan
- Quality and Patient Safety Directorate, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Aneena Abraham
- Quality and Patient Safety Directorate, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Seema Verma
- Quality and Patient Safety Directorate, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| |
Collapse
|
14
|
Kerai A, Meda N, Agarwal K, Garg M, Deb B, Singh P, Singla P, Arar T, Darko G, Oluigbo N. The Use of Telemedicine to Improve Hypertension in an Urban Primary Care Clinic and Predictors of Improved Blood Pressure. J Prim Care Community Health 2023; 14:21501319231199014. [PMID: 37740500 PMCID: PMC10517597 DOI: 10.1177/21501319231199014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Meta-analysis of randomized controlled trials have demonstrated the efficacy of telemedicine in blood pressure (BP) management when compared to conventional care. We initiated a hypertension telehealth clinic in our urban primary care clinic and through this study aim to evaluate the strengths and limitations of telemedicine in hypertension (HTN) control. The primary outcome of the study is to identify the proportion of patients with improved HTN. Secondary outcomes included identifying: predictors for lower BP, predictors of missing telehealth appointments, and comorbid conditions that are more likely to necessitate use of more than 1 antihypertensive medication. METHODS AND ANALYSIS Patients seen in the HTN telehealth clinic from May 1st, 2022 to October 31st, 2022 were identified. A retrospective chart review was done to compare the BP during in-person visit prior to first telehealth visit, telehealth visit home BP readings and last recorded in-office BP on chart at end of study period. Descriptive statistical analysis, Chi Square test, and multivariable logistic regression was used to analyze data. RESULTS Of the 234 appointments, 83% were conducted and 154 patients were seen. A remarkable decrease in percentage of patients with BP >140/90 was seen when comparing in-office visit BP to first telehealth visit home BP, 72% versus 45% respectively. No remarkable difference was noted in percentage of patients with BP >140/90 when comparing first telehealth visit home BP to last in-office BP recorded on chart, 45% and 41% respectively. Patients with diabetes had lower odds of missing appointments, adjusted odds ratio (aOR): 0.34 ([0.12-0.91], P = .03). Patients with partners were more likely to have lower BP at the telehealth visit, aOR:3.2 ([1.15-9.86], P = .03) while patients with obstructive sleep apnea (OSA) (aOR 0.27 ([0.08-0.77], P = .02) and CAD, aOR 0.24 ([0.06-0.8], P = .03) were less likely to have lower BP. CONCLUSION The study demonstrated telemedicine as a great tool to prevent overtreatment of hypertension as significant difference between in-office BP and home BP during telehealth visits was noted. We did not see a significant change in blood pressure when comparing home BP at first telehealth visit to the last in-person clinic BP at end of study period.
Collapse
Affiliation(s)
- Ajay Kerai
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Namratha Meda
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Mohil Garg
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Brototo Deb
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Pooja Singh
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Puneet Singla
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Tareq Arar
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Godwin Darko
- MedStar Washington Hospital Center, Washington, DC, USA
| | | |
Collapse
|
15
|
Kasoju N, Remya NS, Sasi R, Sujesh S, Soman B, Kesavadas C, Muraleedharan CV, Varma PRH, Behari S. Digital health: trends, opportunities and challenges in medical devices, pharma and bio-technology. CSI TRANSACTIONS ON ICT 2023; 11:11-30. [PMCID: PMC10089382 DOI: 10.1007/s40012-023-00380-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/27/2023] [Indexed: 04/12/2024]
Abstract
Digital health interventions refer to the use of digital technology and connected devices to improve health outcomes and healthcare delivery. This includes telemedicine, electronic health records, wearable devices, mobile health applications, and other forms of digital health technology. To this end, several research and developmental activities in various fields are gaining momentum. For instance, in the medical devices sector, several smart biomedical materials and medical devices that are digitally enabled are rapidly being developed and introduced into clinical settings. In the pharma and allied sectors, digital health-focused technologies are widely being used through various stages of drug development, viz. computer-aided drug design, computational modeling for predictive toxicology, and big data analytics for clinical trial management. In the biotechnology and bioengineering fields, investigations are rapidly growing focus on digital health, such as omics biology, synthetic biology, systems biology, big data and personalized medicine. Though digital health-focused innovations are expanding the horizons of health in diverse ways, here the development in the fields of medical devices, pharmaceutical technologies and biotech sectors, with emphasis on trends, opportunities and challenges are reviewed. A perspective on the use of digital health in the Indian context is also included.
Collapse
Affiliation(s)
- Naresh Kasoju
- Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 695011 Kerala India
| | - N. S. Remya
- Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 695011 Kerala India
| | - Renjith Sasi
- Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 695011 Kerala India
| | - S. Sujesh
- Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 695011 Kerala India
| | - Biju Soman
- Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 695011 Kerala India
| | - C. Kesavadas
- Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 695011 Kerala India
| | - C. V. Muraleedharan
- Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 695011 Kerala India
| | - P. R. Harikrishna Varma
- Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 695011 Kerala India
| | - Sanjay Behari
- Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 695011 Kerala India
| |
Collapse
|
16
|
Alamri AF, Alomari FK, Danash AM, Aljoudi MT, Almasharqa AI, Almasloot AM, Alwhaibi RM, Hasan MM, Zaidi U. Perception of Healthcare Providers during the COVID-19 Pandemic: A Mixed Method Survey in an Integrated Healthcare Delivery System in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16676. [PMID: 36554560 PMCID: PMC9778948 DOI: 10.3390/ijerph192416676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
During the COVID-19 pandemic, telemedicine was broadly adopted for patient care. Considering this experience, it is crucial to understand the perceptions of teleclinic healthcare professionals. In Saudi Arabia, telemedicine literature was restricted to physicians working in government and private hospitals. This study examined perceptions in relation to telemedicine among physicians and other healthcare professionals practicing in Saudi Arabian military hospitals in the Taif region. During COVID-19, telemedicine was implemented in military hospitals; consequently, this study assists in evaluating introduced practices and the perceptions of health professionals regarding these new practices. A quantitative, descriptive, correlational, and cross-sectional study was undertaken on healthcare professionals (N = 153). Twenty (20) items based on standardized measures were used to collect data using an online questionnaire. The measures contained three subscales: perceived usefulness, perceived ease, and behavioral intention. It was hypothesized that the perception of teleclinic usefulness and ease score by healthcare providers would be significantly correlated with behavioral intention. Descriptive statistics for mean, frequency, and standard deviation, as well as a Pearson correlation coefficient and regression analysis, were conducted to assess the relationship and predictive association between variables. In addition, a focus group discussion was organized to collect information directly from healthcare professionals. Most of the participants were approximately 40 years of age, Saudi Nationals (63%), medical specialists (62%), and were involved in teleclinic practices before the COVID-19 pandemic (60%). The reliability of all three scales was determined to be acceptable (α = 0.75-0.91). Perceived usefulness and perceived ease were shown to be significantly correlated with behavioral intention (r = 0.877, p = 0.05). In addition, the regression analysis indicated that perceived usefulness and perceived ease are predictors of the behavioral intention (R2 = 0.777, F (2,152) = 261.76, p = 0.001) of teleclinic practices among healthcare professionals. The positive perception of telemedicine integration in healthcare systems revealed by this study is a major catalyst for continuous adoption. On the other hand, certified telemedicine platforms, on-the-job training, Internet of things, and a flexible approach are required to find opportunities and enhancements in telemedicine interactions.
Collapse
Affiliation(s)
- Ali Faris Alamri
- King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh 13415, Saudi Arabia
| | | | | | | | | | | | - Reem M. Alwhaibi
- Rehabilitation Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh 13415, Saudi Arabia
| | | | - Uzma Zaidi
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh 13415, Saudi Arabia
| |
Collapse
|
17
|
Sodhi N, Weinstein RS, Stewart K, Doarn CR. Analysis of Telehealth Versus Telemedicine Terminology in the Telemedicine and e-Health Journal Between 2010 and 2020. Telemed J E Health 2022; 28:1861-1865. [PMID: 35417253 DOI: 10.1089/tmj.2022.0073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: The terms "telemedicine" and "telehealth" are similar, yet, carry different meanings and are often defined differently. Methods: A decadal longitudinal study analyzing the usage of these terms in the Telemedicine and e-Health Journal (TMJ) between 2010 and 2020 was conducted. Looking at the keywords assigned to the "Original Research" articles, "telemedicine" (34%) is used almost three times more than telehealth (12%). Although "other" keywords are assigned at a similar frequency as "telemedicine," a similar pattern is followed for the terms within the text. Results: "Telemedicine" and "other" terms are used the most (36%), while articles using both ("telemedicine" and "telehealth") (15%) or "telehealth" (14%) as terms throughout the article are less. This longitudinal study also analyzed the TMJs editorial board between 2010 and 2020. Most of the board is made up of physicians (MD or DO) (42) or PhDs (33), with 25 out the 75 having dual credentialing. Conclusions: Also, while there is international influence within the board (UK, India, France, Canada, etc.), most of the board is associated with an American organization (educational and/or corporate). Most of the board (34/75) has also been present between 10 and 11 years within the study period (a total of 11 years).
Collapse
Affiliation(s)
- Nandini Sodhi
- Arizona Telemedicine Program, University of Arizona, Tucson, Arizona, USA
| | - Ronald S Weinstein
- Arizona Telemedicine Program, University of Arizona, Tucson, Arizona, USA.,Department of Pathology, University of Arizona, Tucson, Arizona, USA
| | - Kristine Stewart
- Arizona Telemedicine Program, University of Arizona, Tucson, Arizona, USA
| | - Charles R Doarn
- Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| |
Collapse
|
18
|
Muacevic A, Adler JR, Kumar R, Varshney S, Gupta P, Das Munshi B, LNU R, Kumar A, Kumar V. Patients' Satisfaction on Telemedicine Service in Relation to COVID-19 and Non-COVID-19 Problems: A Cross-Sectional Comparative Study. Cureus 2022; 14:e31720. [PMID: 36569721 PMCID: PMC9768663 DOI: 10.7759/cureus.31720] [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] [Accepted: 11/21/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Telemedicine service was historically started for ambulatory and hospice care patients. Since 2020, we have been in the midst of the COVID-19 pandemic. The availability of healthcare facilities became limited due to repeated locked down during the COVID-19 pandemic. Thus, telemedicine service has gained tremendous popularity among healthcare services. Telemedicine service was started at All India Institute of Medical Sciences (AIIMS), Deoghar, as a COVID Helpline facility to provide guidance and care to the home isolated COVID-19 patients during the second wave of COVID-19. But we observed that more than 40% of calls were due to non-COVID-19-related problems, but we managed the non-COVID-19-related calls by discussing with a specialist in conference calls or WhatsApp consultation. Therefore, we planned to compare individual satisfaction with telemedicine services in patients with COVID-19 and non-COVID-19-related problems. METHODS AND MATERIALS This study was a cross-sectional retrospective analysis of the register of telemedicine maintained in AIIMS, Deoghar, callers were grouped into two- COVID-19 and non-COVID-19-related problems. We obtained feedback from the patients and recorded it in a google form, collected data were analyzed in both groups. Telephonic consent was taken for participating in the study. The sample size was calculated to be 252, the COVID-19 group: 126, and the non-COVID-19 group: 126, and simple random sampling was used to choose the participants from the 730 total callers of the first month of telemedicine service. Their response was graded on 4 points Likert scale (1=Poor, 2=fair, 3=Good, 4=Excellent) and outcomes were analyzed by IBM SPSS (version 20.0) software. A p-value of <0.05 was considered statistically significant. OBJECTIVE The primary objective is to estimate the level of satisfaction in both groups and compare their level of satisfaction. The secondary objective is to determine the department-specific telemedicine services requirement for people in need. RESULTS Out of a total of 252 patients, most (54%) callers were 18-45 years old, and 44% were above 45 years old. 64% of patients were male. 90% of callers were from urban or semi-urban districts. 90% of callers had a 10th-grade or more education. 89% of patients were willing to use telemedicine services in the future. An Independent sample t-test was used to compare the means of both the groups showed a significant difference (p < 0.05) in the level of satisfaction in the COVID-19 group to the non-COVID-19 group. It showed that satisfaction in the COVID-19 group was higher than the group with non-COVID-19-related problems. CONCLUSION COVID-19 has changed the whole spectrum of healthcare needs of the community. Our study findings showed that there is a need for separate department-wise telemedicine services to provide satisfactory service for attending to problems related to that department. For example, problems with diabetes should be attended to by an endocrinologist or an internal medicine specialist. This study finding helped us to change the policy and start department-wise telemedicine service.
Collapse
|
19
|
Morris C, Scott RE, Mars M. A Survey of Telemedicine Use by Doctors in District Hospitals in KwaZulu-Natal, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13029. [PMID: 36293608 PMCID: PMC9602563 DOI: 10.3390/ijerph192013029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
There is anecdotal evidence of informal telemedicine activity in KwaZulu-Natal (KZ-N), South Africa. AIM To determine the current extent of telemedicine in district hospitals in KZ-N; the range of clinical activities and technologies used; additional services needed; current knowledge and practice regarding legal, ethical, and regulatory issues; and the need to formalise telemedicine activities. METHOD A cross-sectional survey of telemedicine use by 143 doctors working at 22 District hospitals in KZ-N. RESULTS Most doctors (96%) participated in some form of telemedicine across a spectrum of disciplines, but more than half did not consider their activities to constitute telemedicine. To meet their needs, doctors have started their own informal services with colleagues, using mostly instant messaging and chat groups (WhatsApp). Some doctors indicated the need to formalise these services and establish additional services. Few doctors were aware of the national telemedicine guidelines and the required written informed consent for telemedicine was seldom obtained. This could have serious legal, regulatory, and ethical implications. CONCLUSIONS Practical clinical and technical guidelines and standard operating procedures need to be developed with the active participation of the clinical workforce. These should encourage innovation and greater use of telemedicine, including the use of instant messaging apps.
Collapse
Affiliation(s)
- Christopher Morris
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Richard E. Scott
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Maurice Mars
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Digital Health Systems, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia
| |
Collapse
|
20
|
Solomon DA, Larrabee S, Ellis J, Erfani P, Johnson SF, Rich KM, Sandoval RS, Osman NY. A student-led interprofessional virtual outreach program for people with HIV during the Covid-19 pandemic: a pilot program at an academic medical center in Boston. BMC MEDICAL EDUCATION 2022; 22:657. [PMID: 36056337 PMCID: PMC9438880 DOI: 10.1186/s12909-022-03716-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The Coronavirus disease 2019 (Covid-19) pandemic caused an abrupt disruption in clinical care and medical education, putting patients at increased risk for social stressors and displacing medical students from traditional clerkships. The pandemic also exposed the need for virtual tools to supplement clinical care and an opportunity to create meaningful roles for learners. METHODS An interdisciplinary group designed a student-led virtual outreach program for patients with HIV whose care was limited by the pandemic. Patients were identified by clinicians and social workers using a clinic-based registry. Students called patients to conduct needs assessments, provide Covid-19 education, and to facilitate connection to services. Students participated in case-based didactics and workshops on motivational interviewing and patient engagement using virtual tools. Facilitated team meetings were held weekly during which themes of calls were identified. RESULTS During a three-month period, five students participated in the outreach program. Two hundred sixteen patients were identified for outreach calls, of which 174 (75.9%) were successfully reached by telephone. Rate of completed phone call did not differ by age or gender. Sixty patients had a preferred language other than English of which 95.6% were reached in their preferred language. CONCLUSIONS Virtual proactive outreach can be used as a tool to support patients and engage students in clinical care when access to in-person care is limited. This model of care could be adapted to other ambulatory practices and integrated into pre-clerkship curriculum as an introduction to the social history and structural drivers of health (SDOH) (245/350).
Collapse
Affiliation(s)
- Daniel A Solomon
- Division of Infectious Diseases, Brigham and Women's Hospital, 75 Francis Street PBB-4A, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
- Department of Medicine, Brigham and Women's Hospital, 75 Francis Street PBB-4A, Boston, MA, 02115, USA.
| | - Susan Larrabee
- Division of Infectious Diseases, Brigham and Women's Hospital, 75 Francis Street PBB-4A, Boston, MA, 02115, USA
| | | | | | | | | | | | - Nora Y Osman
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, 75 Francis Street PBB-4A, Boston, MA, 02115, USA
| |
Collapse
|
21
|
Mackwood M, Butcher R, Vaclavik D, Alford-Teaster JA, Curtis KM, Lowry M, Tosteson TD, Zhao W, Tosteson ANA. Adoption of Telemedicine in a Rural US Cancer Center Amid the COVID-19 Pandemic: Qualitative Study. JMIR Cancer 2022; 8:e33768. [PMID: 35895904 PMCID: PMC9384858 DOI: 10.2196/33768] [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: 09/29/2021] [Revised: 06/28/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic necessitated a rapid shift to telemedicine to minimize patient and provider exposure risks. While telemedicine has been used in a variety of primary and specialty care settings for many years, it has been slow to be adopted in oncology care. Health care provider and administrator perspectives on factors affecting telemedicine use in oncology settings are not well understood, and the conditions associated with the COVID-19 pandemic offered the opportunity to study the adoption of telemedicine and the resulting provider and staff perspectives on its use. Objective The aim of this paper is to study the factors that influenced telemedicine uptake and sustained use in outpatient oncology clinics at a US cancer center to inform future telemedicine practices. Methods We used purposive sampling to recruit a mix of oncology specialty providers, practice managers, as well as nursing and administrative staff representing 5 outpatient oncology clinics affiliated with the Dartmouth Cancer Center, a large regional cancer center in the northeast of United States, to participate in semistructured interviews conducted over 6 weeks in spring 2021. The interview guide was informed by the 5 domains of the Consolidated Framework for Implementation Research, which include inner and outer setting factors, characteristics of the intervention (ie, telemedicine modality), individual-level factors (eg, provider and patient characteristics), and implementation processes. In total, 11 providers, 3 leaders, and 6 staff participated following verbal consent, and thematic saturation was reached across the full sample. We used a mixed deductive and inductive qualitative analysis approach to study the main influences on telemedicine uptake, implementation, and sustainability during the first year of the COVID-19 pandemic across the 5 settings. Results The predominant influencers of telemedicine adoption in this study were individual provider experiences and assumptions about patient preference and accessibility. Providers’ early telemedicine experiences, especially if negative, influenced preferences for telephone over video and affected sustained use. Telemedicine was most favorably viewed for lower-acuity cancer care, visits less dependent on physical exam, and for patient and caregiver education. A lack of clinical champions, leadership guidance, and vision hindered the implementation of standardized practices and were cited as essential for telemedicine sustainability. Respondents expressed anxiety about sustaining telemedicine use if reimbursements for telephonic visits diminished or ceased. Opportunities to enhance future efforts include a need to provide additional guidance supporting telemedicine use cases and evidence of effectiveness in oncology care and to address provider concerns with communication quality. Conclusions In a setting of decentralized care processes, early challenges in telemedicine implementation had an outsized impact on the nature and amount of sustained use. Proactively designed telemedicine care processes with attention to patient needs will be essential to support a sustained role for telemedicine in cancer care.
Collapse
Affiliation(s)
- Matthew Mackwood
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,Connected Care, Dartmouth Health, Lebanon, NH, United States
| | - Rebecca Butcher
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,Center for Program Design and Evaluation, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Danielle Vaclavik
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,Center for Program Design and Evaluation, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | | | - Kevin M Curtis
- Connected Care, Dartmouth Health, Lebanon, NH, United States
| | - Mary Lowry
- Connected Care, Dartmouth Health, Lebanon, NH, United States
| | - Tor D Tosteson
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, United States.,Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Wenyan Zhao
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Anna N A Tosteson
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, United States.,Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| |
Collapse
|
22
|
Singh I, Bista NR, Maleku K, Adhikari P, Hyanmikha A, Pradhan S, Kharel R. Establishment of a Rapid Phone Consultation Service for COVID-19 Public Health Support in Nepal. Cureus 2022; 14:e27977. [PMID: 36120230 PMCID: PMC9468515 DOI: 10.7759/cureus.27977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/05/2022] Open
|
23
|
Melian C, Kieser D, Frampton C, C Wyatt M. Teleconsultation in orthopaedic surgery: A systematic review and meta-analysis of patient and physician experiences. J Telemed Telecare 2022; 28:471-480. [PMID: 32873138 DOI: 10.1177/1357633x20950995] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The primary purpose of this review was to evaluate patient and physician preference and satisfaction for teleconsultation in orthopaedic surgery compared to traditional face-to-face consultation. In addition, we evaluated the effects of teleconsultation on patient length of visit, healthcare costs, range of motion (ROM), pain, quality of life (QOL), and ongoing management plans. METHODS A systematic review of MEDLINE, Embase, Web of Science, and Cochrane Library was conducted according to PRISMA guidelines. Randomised control trials and case control studies comparing teleconsultation with traditional, face-to-face consultation in the management of orthopaedic conditions were included. The primary outcome measures were patient and physician preference and satisfaction. Secondary outcomes included patient length of visit, healthcare costs, ROM, pain, QOL, and ongoing management plans. RESULTS A total of 13 articles meeting the eligibility criteria were included for systematic review and 8 for meta-analysis. There was no significant difference in patient satisfaction, length of visit, or time spent with the physician between the telemedicine and in-office control group. The mean difference of patient preference for telemedicine was significantly higher in the telemedicine group compared to the in-office visit group (OR 1.44, 95% CI 1.12-1.87, p = 0.005). DISCUSSION Telemedicine was not inferior to face-to-face office visits in regard to patient and physician preference and satisfaction. Therefore, it would be an effective adjunct to face-to-face office visits, serving as a mechanism of triage and long-term continuity of care.
Collapse
Affiliation(s)
| | - David Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, New Zealand
| | - Christopher Frampton
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, New Zealand
| | - Michael C Wyatt
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, New Zealand
| |
Collapse
|
24
|
Mackwood MB, Tosteson TD, Alford-Teaster JA, Curtis KM, Lowry ML, Snide JA, Zhao W, Tosteson AN. Factors Influencing Telemedicine Use at a Northern New England Cancer Center During the COVID-19 Pandemic. JCO Oncol Pract 2022; 18:e1141-e1153. [PMID: 35446680 PMCID: PMC9287286 DOI: 10.1200/op.21.00750] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/13/2022] [Accepted: 02/18/2022] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To characterize the use of telemedicine for oncology care over the course of the COVID-19 pandemic in Northern New England with a focus on factors affecting trends. METHODS We performed a retrospective observational study using patient visit data from electronic health records from hematology-oncology and radiation-oncology service lines spanning the local onset of the pandemic from March 18, 2020, through March 31, 2021. This period was subdivided into four phases designated as lockdown, transition, stabilization, and second wave. Generalized linear mixed regression models were used to estimate the effects of patient characteristics on trends for rates of telemedicine use across phases and the effects of visit type on patient satisfaction and postvisit ER or hospital admissions within 2 weeks. RESULTS A total of 19,280 patients with 102,349 visits (13.1% audio-only and 1.4% video) were studied. Patient age (increased use in age < 45 and 85 years and older) and urban residence were associated with higher use of telemedicine, especially after initial lockdown. Recent cancer therapy, ER use, and hospital admissions in the past year were all associated with lower telemedicine utilization across pandemic phases. Provider clinical department corresponded to the largest differences in telemedicine use across all phases. ER and hospital admission rates in the 2 weeks after a telehealth visit were lower than those in in-person visits (0.7% v 1.3% and 1.2% v 2.7% for ER and hospital use, respectively; P < .001). Patient satisfaction did not vary across visit types. CONCLUSION Telemedicine use in oncology during the COVID-19 pandemic varied according to the phase and patient, medical, and health system factors, suggesting opportunities for standardization of care and need for attention to equitable telemedicine access.
Collapse
Affiliation(s)
- Matthew B. Mackwood
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
- Connected Care, Dartmouth-Hitchcock Health, Lebanon, NH
| | - Tor D. Tosteson
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH
- Dartmouth Cancer Center, Dartmouth-Hitchcock Health, Lebanon, NH
| | | | - Kevin M. Curtis
- Connected Care, Dartmouth-Hitchcock Health, Lebanon, NH
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Mary L. Lowry
- Connected Care, Dartmouth-Hitchcock Health, Lebanon, NH
| | - Jennifer A. Snide
- Dartmouth Cancer Center, Dartmouth-Hitchcock Health, Lebanon, NH
- Analytics Institute, Dartmouth-Hitchcock Health, Lebanon, NH
| | - Wenyan Zhao
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Anna N.A. Tosteson
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
- Dartmouth Cancer Center, Dartmouth-Hitchcock Health, Lebanon, NH
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH
| |
Collapse
|
25
|
Sobrepera MJ, Lee VG, Garg S, Johnson MJ. Feasibility and Acceptability of Remote Neuromotor Rehabilitation Interactions Using Social Robot Augmented Telepresence: A Case Study. IEEE Int Conf Rehabil Robot 2022; 2022:1-6. [PMID: 36176163 DOI: 10.1109/icorr55369.2022.9896604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
There is a growing need to deliver rehabilitation care to patients remotely. Long term demographic changes, geographic shortages of care providers, and now a global pandemic contribute to this need. Telepresence provides an option for delivering this care. However, telepresence using video and audio alone does not provide an interaction of the same quality as in-person. To bridge this gap, we propose the use of social robot augmented telepresence (SRAT). We have constructed a demonstration SRAT system for upper extremity rehab, in which a humanoid, with a head, body, face, and arms, is attached to a mobile telepresence system, to collaborate with the patient and clinicians as an independent social entity. The humanoid can play games with the patient and demonstrate activities. These activities could be used to perform assessments in support of self-directed rehab and to perform exercises.In this paper, we present a case series with six subjects who completed interactions with the robot, three subjects who have previously suffered a stroke and three pediatric subjects who are typically developing. Subjects performed a Simon Says activity and a target touch activity in person, using classical telepresence (CT), and using SRAT. Subjects were able to effectively work with the social robot guiding interactions and 5 of 6 rated SRAT better than CT. This study demonstrates the feasibility of SRAT and some of its benefits.
Collapse
|
26
|
Abstract
Digital therapeutics refers to the use of evidence-based therapeutic interventions driven by high-quality software programs to treat, manage, or prevent a medical condition. This approach is being increasingly investigated for the management of hypertension, a common condition that is the leading preventable cardiovascular disease risk factor worldwide. Digital interventions can help facilitate uptake of important guideline-recommended lifestyle modifications, reinforce home blood pressure monitoring, decrease therapeutic inertia, and improve medication adherence. However, current studies are only of moderate quality, and are highly heterogeneous in the interventions evaluated, comparator used, and results obtained. Therefore, additional studies are needed, focusing on the development of universally applicable and consistent digital therapeutic strategies designed with health care professional input and evaluation of these interventions in robust clinical trials with objective end points. Hopefully, the momentum for digital therapeutics triggered by the coronavirus disease 2019 pandemic can be utilized to maximize advancements in this field and drive widespread implementation.
Collapse
Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, School of Medicine, Jichi Medical University, Tochigi, Japan
| | - Noriko Harada
- Division of Cardiovascular Medicine, School of Medicine, Jichi Medical University, Tochigi, Japan
| | - Ayako Okura
- Division of Cardiovascular Medicine, School of Medicine, Jichi Medical University, Tochigi, Japan
| |
Collapse
|
27
|
Latest hypertension research to inform clinical practice in Asia. Hypertens Res 2022; 45:555-572. [DOI: 10.1038/s41440-022-00874-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 12/16/2022]
|
28
|
Zhang J, Chua QHA, Shen XM, Viseikumaran JA, Teoh T, Tan NG. A Systematic Implementation of Telemedicine in Singapore's COVID-19 Community Recovery Facilities. Telemed J E Health 2022; 28:1587-1594. [PMID: 35377241 DOI: 10.1089/tmj.2021.0466] [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] [Indexed: 12/30/2022] Open
Abstract
Introduction: This article describes the experience of the Singapore Armed Forces (SAF) implementing telemedicine consultations for COVID-19-positive patients recovering within community recovery facilities (CRFs) in a semi-inpatient setting. Materials and Methods: The SAF adopted a systematic approach to telemedicine implementation and scaling up, with Phase 1 being the deployment of medical teams operating on-site clinics daily at six CRFs and telemedicine only provided for after-hours medical consultations on an ad hoc basis. Subsequently in Phase 2, most clinical consultations in the CRFs were conducted virtually. Results: Phases 1 and 2 recorded 1,902 and 449 clinical consultations, respectively. The mean number of clinical encounters was 33 per 1,000 occupants per day in Phase 1, and 12 per 1,000 occupants per day in Phase 2 (p < 0.001). Acute respiratory illness (52.3% in Phase 1 and 46.7% in Phase 2) was the most common reason for consultations. With full telemedicine in Phase 2, there was reduction in the mean number of clinical encounters per 1,000 occupants per day (p = 0.001), lower man-hours in personal protective equipment (PPE) (p < 0.001), and rise in escalation of care (p < 0.001) but without adverse events reported. Conclusions: Telemedicine for patients was safe, improved medical manpower efficiency, and reduced man-hours in PPE. The increased escalation of care in Phase 2 due to the lack of physical examination capabilities was to be expected to ensure patients' safety. Overall, it is recommended that for stable and mild medical conditions, telemedicine is a viable, safe, and efficient health care delivery tool in crisis situations similar to COVID-19.
Collapse
Affiliation(s)
- Junren Zhang
- Singapore Armed Forces Military Medicine Institute, Singapore, Singapore
| | - Qi Han Aaron Chua
- Republic of Singapore Air Force Medical Service, Singapore, Singapore
| | | | | | - Timothy Teoh
- Singapore Armed Forces Military Medicine Institute, Singapore, Singapore
| | - Nan Guang Tan
- Singapore Armed Forces Army Medical Services, Singapore, Singapore
- Singapore Armed Forces Medical Training Institute, Singapore, Singapore
| |
Collapse
|
29
|
McLean KA, Knight SR, Diehl TM, Zafar SN, Bouamrane M, Harrison EM. Development stage of novel digital health interventions for postoperative monitoring: protocol of a systematic review. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 4:e000104. [PMID: 35321073 PMCID: PMC8900039 DOI: 10.1136/bmjsit-2021-000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/24/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction The postoperative period represents a time where patients are at a high-risk of morbidity, which warrants effective surveillance. While digital health interventions (DHIs) for postoperative monitoring are promising, a coordinated, standardized and evidence-based approach regarding their implementation and evaluation is currently lacking. This study aimed to identify DHIs implemented and evaluated in postoperative care to highlight research gaps and assess the readiness for routine implementation. Methods A systematic review will be conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies describing the implementation and evaluation of DHIs for postoperative monitoring published since 2000 (PROSPERO ID: CRD42021264289). This will encompass the Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Web of Science and ClinicalTrials.gov databases, and manual search of bibliographies for relevant studies and gray literature. Methodological reporting quality will be evaluated using the Idea, Development, Exploration, Assessment and Long-term Follow-up (IDEAL) reporting guideline relevant to the IDEAL stage of the study, and risk of bias will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. Data will be extracted according to the WHO framework for monitoring and evaluating DHIs, and a narrative synthesis will be performed. Discussion This review will assess the readiness for implementation of DHIs for routine postoperative monitoring and will include studies describing best practice from service changes already being piloted out of necessity during the COVID-19 pandemic. This will identify interventions with sufficient evidence to progress to the next IDEAL stage, and promote standardized and comprehensive evaluation of future implementational studies.
Collapse
Affiliation(s)
- Kenneth A McLean
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Stephen R Knight
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Thomas M Diehl
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Matt Bouamrane
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| |
Collapse
|
30
|
A Cross-sectional Study About Nurses' and Physicians' Experience of Disaster Management Preparedness Throughout COVID-19. Disaster Med Public Health Prep 2022; 17:e125. [PMID: 35152935 PMCID: PMC9021579 DOI: 10.1017/dmp.2022.34] [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] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to assess and compare nurses' and physicians' knowledge of disaster management preparedness. An effective health-care system response to various disasters is paramount, and nurses and physicians must be prepared with appropriate competencies to be able to manage the disaster events. METHODS This is a cross-sectional study. A total of 636 nurses and 257 physicians were recruited from 1 hospital in Saudi Arabia. Of them, 608 (95.6%) nurses and 228 (83.2%) physicians completed self-administered, online questionnaires. The questionnaire assessed participants' sociodemographic data, and disaster management knowledge. RESULTS The findings revealed that participants had more knowledge regarding the disaster preparedness stage than mitigation and recovery stages. They also reported a need for advanced disaster training areas. A total of 10.1% of nurses' and 15.6% of physicians' overall knowledge is explained by their demographic and work-related characteristics. CONCLUSIONS Both nurses and physicians had to some extent knowledge regarding the information and practices required for disaster management process. It is proposed that hospital managers must look for opportunities to effectively adopt national standards to manage disasters and include nurses and physicians in major-related learning activities because experience has suggested a somewhat low overall perceived competence in managing disaster situations.
Collapse
|
31
|
Azevedo LB, Stephenson J, Ells L, Adu-Ntiamoah S, DeSmet A, Giles EL, Haste A, O'Malley C, Jones D, Chai LK, Burrows T, Collins CE, van Grieken A, Hudson M. The effectiveness of e-health interventions for the treatment of overweight or obesity in children and adolescents: A systematic review and meta-analysis. Obes Rev 2022; 23:e13373. [PMID: 34747118 DOI: 10.1111/obr.13373] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/20/2021] [Accepted: 09/17/2021] [Indexed: 12/13/2022]
Abstract
The aim of this systematic review and meta-analysis was to examine the effectiveness of e-health interventions for the treatment of children and adolescents with overweight or obesity. Databases were searched up to November 2020. Studies were randomized controlled trials where interventions were delivered via e-health (e.g., computers, tablets, and smartphones, but not phone calls). Studies should target the treatment of overweight or obesity in children or their agent of changes and report body mass index (BMI) or BMI z-score. A meta-analysis using a random-effects model was conducted. Nineteen studies met the inclusion criteria, and 60% were of high quality. The narrative review revealed variation in behavior change strategies and modes of delivery. The pooled mean reduction in BMI or BMI z-score showed evidence for a nonzero effect (standardized mean difference = -0.31, 95% confidence interval -0.49 to -0.13), with moderately high heterogeneity between studies (I2 = 74%, p < 0.001). Subgroup analysis revealed high heterogeneity in studies with a high or unclear risk of bias. E-health interventions can be effective in treating children and adolescents with overweight and obesity and should be considered by practitioners and policymakers. However, an understanding of the most effective and acceptable intervention components, long-term benefits, and sustainability should be further studied.
Collapse
Affiliation(s)
- Liane B Azevedo
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - John Stephenson
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Louisa Ells
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
| | | | - Ann DeSmet
- Faculty of Psychological and Educational Sciences, Université libre de Bruxelles, Brussels, Belgium.,Department of Communication Studies, University of Antwerp, Antwerp, Belgium
| | - Emma L Giles
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Anna Haste
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Claire O'Malley
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Daniel Jones
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Li Kheng Chai
- Health and Wellbeing Queensland, Queensland Government, Brisbane, Queensland, Australia.,School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Tracy Burrows
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia.,Hunter Medical Research Institute, Rankin Park, New South Wales, Australia
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia.,Hunter Medical Research Institute, Rankin Park, New South Wales, Australia
| | - Amy van Grieken
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michelle Hudson
- Middlesbrough 0-19 Service (Healthier Together), Harrogate and District NHS Foundation Trust, Harrogate, UK
| |
Collapse
|
32
|
Luconi F, Montoro R, Lalla L, Teferra M. An Innovative Needs Assessment Approach to Develop Relevant Continuing Professional Development for Psychiatrists. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:106-113. [PMID: 34846721 PMCID: PMC8630991 DOI: 10.1007/s40596-021-01564-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 11/08/2021] [Indexed: 05/07/2023]
Abstract
OBJECTIVES Gaps in psychiatrists' competence can interfere with the delivery of optimal patient care, particularly when these gaps have not been identified. This study aimed to assess the perceived and unperceived continuing professional development needs of psychiatrists practicing in Quebec, Canada. METHODS The authors sent an online cross-sectional survey (2018) to members of the 'Association des médecins psychiatres du Québec' and collected data on unperceived needs via the critical incident method (focused on managing challenging clinical cases/situations). Data were analyzed using descriptive statistics, chi-squared tests, thematic analysis, and triangulation of data. Two coders independently analyzed qualitative data. RESULTS Of 1150 eligible psychiatrists, 187 (16%) completed the survey. Over half were female (58%), caring for adult patients (60%), and practiced in a university hospital (49%). Top perceived and unperceived learning need areas were neurodevelopmental disorders and psychopharmacology. Three hundred forty-three factors influencing the management of reported challenges were classified as case complexity (53%), patient (22%), environment (19%), and lack of knowledge (4%). Consultation with colleagues (49%) was the most frequently accessed resource for approaching challenging cases. During the previous year and across both self-directed and group learning activities, respondents reported engaging more frequently in in-person than online activities. CONCLUSIONS A comprehensive needs assessment integrating perceived and unperceived needs is the cornerstone for planning relevant continuing professional development. The critical incident method is a useful tool to assess psychiatrists' unperceived needs. Critical reflection after solving complex clinical cases might provide an opportunity to optimize psychiatrists' selection of relevant continuing professional development.
Collapse
Affiliation(s)
- Francesca Luconi
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
| | - Richard Montoro
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Leonora Lalla
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Meron Teferra
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
33
|
Omboni S, Padwal RS, Alessa T, Benczúr B, Green BB, Hubbard I, Kario K, Khan NA, Konradi A, Logan AG, Lu Y, Mars M, McManus RJ, Melville S, Neumann CL, Parati G, Renna NF, Ryvlin P, Saner H, Schutte AE, Wang J. The worldwide impact of telemedicine during COVID-19: current evidence and recommendations for the future. CONNECTED HEALTH 2022; 1:7-35. [PMID: 35233563 PMCID: PMC7612439 DOI: 10.20517/ch.2021.03] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
During the COVID-19 pandemic, telemedicine has emerged worldwide as an indispensable resource to improve the surveillance of patients, curb the spread of disease, facilitate timely identification and management of ill people, but, most importantly, guarantee the continuity of care of frail patients with multiple chronic diseases. Although during COVID-19 telemedicine has thrived, and its adoption has moved forward in many countries, important gaps still remain. Major issues to be addressed to enable large scale implementation of telemedicine include: (1) establishing adequate policies to legislate telemedicine, license healthcare operators, protect patients' privacy, and implement reimbursement plans; (2) creating and disseminating practical guidelines for the routine clinical use of telemedicine in different contexts; (3) increasing in the level of integration of telemedicine with traditional healthcare services; (4) improving healthcare professionals' and patients' awareness of and willingness to use telemedicine; and (5) overcoming inequalities among countries and population subgroups due to technological, infrastructural, and economic barriers. If all these requirements are met in the near future, remote management of patients will become an indispensable resource for the healthcare systems worldwide and will ultimately improve the management of patients and the quality of care.
Collapse
Affiliation(s)
- Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Solbiate Arno, Varese 21048, Italy
- Department of Cardiology, Sechenov First Moscow State Medical University, Moscow 119991, Russia
| | - Raj S. Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta T6G 2R3, Canada
| | - Tourkiah Alessa
- Biomedical Technology Department, College of Applied Medical Science, King Saud University, Riyadh 11362, Saudi Arabia
| | - Béla Benczúr
- First Department of Internal Medicine (Cardiology-Nephrology), Balassa Janos County Hospital, Szekszard 7100, Hungary
| | - Beverly B. Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, WA 98101, USA
| | - Ilona Hubbard
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne 1011, Switzerland
| | - Kazuomi Kario
- Department of Cardiology, Jichi Medical University School of Medicine, Tochigi 329-0498, Japan
| | - Nadia A. Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Alexandra Konradi
- Almazov National Medical Research Centre, Saint Petersburg 197341, Russia
| | - Alexander G. Logan
- Department of Medicine, University of Toronto, Toronto, Ontario M5S 1A1, Canada
- Sinai Health System, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario M5G 1X5, Canada
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, CT 06510, USA
| | - Maurice Mars
- Department of TeleHealth, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia 5042, Australia
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX1 2JD, UK
| | - Sarah Melville
- Division of Cardiology, Saint John Regional Hospital, Saint John, New Brunswick E2L 4L2, Canada
| | | | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano 20126, Italy
- Istituto Auxologico Italiano, IRCCS San Luca, Milano 20149, Italy
| | - Nicolas F. Renna
- Unit of Hypertension, Hospital Español de Mendoza, School of Medicine, National University of Cuyo, IMBECU-CONICET, Mendoza 5500, Argentina
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne 1011, Switzerland
| | - Hugo Saner
- ARTORG Center for Biomedical Engineering Research and Institute for Social and Preventive Medicine, University of Bern, Bern 3012, Switzerland
| | - Aletta E. Schutte
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney 2042, New South Wales, Australia
- Hypertension in Africa Research Team, South African Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom 2520, South Africa
| | - Jiguang Wang
- The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| |
Collapse
|
34
|
Gannon JM, Brar JS, Zawacki S, Painter T, O'Toole K, Chengappa KNR. From Office-Based Treatment to Telehealth: Comparing Clinical Outcomes and Patient Participation in a Psychiatric Intensive Outpatient Program with a Large Transdiagnostic Sample. Telemed J E Health 2021; 28:1126-1133. [PMID: 34964653 DOI: 10.1089/tmj.2021.0421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction: Patient participation and clinical outcomes of a precoronavirus disease 2019 (COVID-19) office-based transdiagnostic psychiatric intensive outpatient program (IOP) were compared with those of telehealth IOP during COVID-19. Materials and Methods: Weeks of enrollment, Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) assessments, and sociodemographic and clinical factors (including group track and diagnosis) were collected during pre-COVID-19 (n = 191) and during COVID-19 (n = 200). Continuous and categorical measures of GAD-7 and PHQ-9 were analyzed; potential sociodemographic and clinical covariates to scores were also explored. Results: There were no statistically significant differences in participation between time periods. Associations were observed between PHQ-9/GAD-7 score improvement and number of assessments. Significant score reductions occurred in both periods, and differences in change scores were not significant. Sociodemographic and clinical factors were not significantly different between time periods. Patients with commercial insurance had significantly higher improvement in both mean and categorical PHQ-9 scores (t = 2.77, p = 0.006; χ2 = 10.47, df = 1, p = 0.001) and GAD-7 scores (t = 2.29, p = 0.023; χ2 = 8.58, df = 1, p = 0.003) than those with public insurance. Patients with anxiety disorders had significantly greater improvements (F = 4.49, p = 0.004; χ2 = 9.15, df = 3, p = 0.027) in GAD-7 during COVID-19. Discussion: Significant improvements in PHQ-9/GAD-7 scores and measures of participation were not significantly different between telehealth and office-based IOP, nor were they greatly influenced by clinical or sociodemographic factors. Further study is needed of possible care disparities for publicly insured patients. Conclusion: Despite some limitations, telehealth IOP appears to be a clinically appropriate option for a diverse sociodemographic and diagnostically heterogeneous psychiatric population.
Collapse
Affiliation(s)
- Jessica M Gannon
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jaspreet S Brar
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Susanna Zawacki
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tiffany Painter
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kelly O'Toole
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - K N Roy Chengappa
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
35
|
Barochiner J, Marín MJ, Janson JJ, Conti PR, Martínez R, Micali G, Conte IE, Plazzotta F. White Coat Uncontrolled Hypertension in Teleconsultation: A New and Frequent Entity. High Blood Press Cardiovasc Prev 2021; 29:155-161. [PMID: 34905157 PMCID: PMC8669402 DOI: 10.1007/s40292-021-00498-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Cardiovascular risk seems not to be greater in patients with white coat uncontrolled hypertension (WUCH) than in patients with sustained blood pressure (BP) control. Therefore, its detection is important to avoid overtreatment. The COVID-19 pandemic determined a massive migration of hypertension consultations from the face-to-face modality to teleconsultations, and it is unknown whether WUCH exists in this context. Aim We aimed to evaluate the prevalence of WUCH through home BP monitoring (HBPM) in treated hypertensive patients evaluated by teleconsultation. Methods We included treated hypertensive patients that owned a digital BP monitor. During teleconsultation, patients were asked to perform two BP measurements and then a 7-day HBPM, using the same device. Patients were classified as having WUCH if BP was ≥ 140 and/or 90 mmHg in teleconsultation and < 135/85 mmHg on HBPM. The prevalence of WUCH and its 95% confidence interval were estimated. One-way ANOVA, the Chi-square test or Fisher’s exact test were used to compare the characteristics of these patients with the other groups. Results We included 341 patients (45.2% male, mean age 62.3 years). The prevalence of WUCH was 33.1% (95% CI 28.3–38.3%). Significant differences were found in terms of age, the number of antihypertensive drugs and the use of calcium channel blockers, all lower in the WUCH group as compared with the groups with elevated BP on HBPM. Conclusion WUCH exists in teleconsultation and is very frequent. It can be easily detected though HBPM, thus avoiding overmedication, and its potential impact on side-effects and health costs.
Collapse
Affiliation(s)
- Jessica Barochiner
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina. .,Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de triple dependencia CONICET-Instituto Universitario del Hospital Italiano (IUHI)-Hospital Italiano (HIBA), Buenos Aires, Argentina.
| | - Marcos J Marín
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina
| | - Jorge J Janson
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina
| | - Patricia R Conti
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina
| | - Rocío Martínez
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina.,Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de triple dependencia CONICET-Instituto Universitario del Hospital Italiano (IUHI)-Hospital Italiano (HIBA), Buenos Aires, Argentina
| | - Gabriel Micali
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina
| | - Isabel E Conte
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB, Buenos Aires, Argentina
| | - Fernando Plazzotta
- Department of Health Informatics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
36
|
Milos Nymberg V, Ellegård LM, Kjellsson G, Wolff M, Borgström Bolmsjö B, Wallman T, Calling S. Trends in remote health care consumption in Sweden: A comparison before and during the first wave of the Covid-19 pandemic. JMIR Hum Factors 2021; 9:e33034. [PMID: 34846304 PMCID: PMC8812677 DOI: 10.2196/33034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/25/2021] [Accepted: 11/28/2021] [Indexed: 01/30/2023] Open
Abstract
Background Remote assessment of respiratory tract infections (RTIs) has been a controversial topic during the fast development of private telemedicine providers in Swedish primary health care. The possibility to unburden the traditional care has been put against a questionable quality of care as well as risks of increased utilization and costs. The COVID-19 pandemic has contributed to a changed management of patient care to decrease viral spread, with an expected shift in contact types from in-person to remote ones. Objective The main aim of this study was to compare health care consumption and type of contacts (in-person or remote) for RTIs before and during the COVID-19 pandemic. The second aim was to study whether the number of follow-up contacts after an index contact for RTIs changed during the study period, and whether the number of follow-up contacts differed if the index contact was in-person or remote. A third aim was to study whether the pattern of follow-up contacts differed depending on whether the index contact was with a traditional or a private telemedicine provider. Methods The study design was an observational retrospective analysis with a description of all index contacts and follow-up contacts with physicians in primary care and emergency rooms in a Swedish region (Skåne) for RTIs including patients of all ages and comparison for the same periods in 2018, 2019, and 2020. Results Compared with 2018 and 2019, there were fewer index contacts for RTIs per 1000 inhabitants in 2020. By contrast, the number of follow-up contacts, both per 1000 inhabitants and per index contact, was higher in 2020. The composition of both index and follow-up contacts changed as the share of remote contacts, in particular for traditional care providers, increased. Conclusions During the COVID-19 pandemic in 2020, fewer index contacts for RTIs but more follow-up contacts were conducted, compared with 2018-2019. The share of both index and follow-up contacts that were conducted remotely increased. Further studies are needed to study the reasons behind the increase in remote contacts, and if it will last after the pandemic, and more clinical guidelines for remote assessments of RTI are warranted.
Collapse
Affiliation(s)
- Veronica Milos Nymberg
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, SE
| | - Lina Maria Ellegård
- Department of eEconomics, Lund University, Lund, SE.,Department of Business Administration, Kristianstad University, Kristianstad, SE
| | - Gustav Kjellsson
- Department of Economics, University of Gothenburg, Gothenburg, SE
| | - Moa Wolff
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, SE
| | - Beata Borgström Bolmsjö
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, SE
| | - Thorne Wallman
- Public Health & Caring Sciences, Family Medicine & Preventive Medicine Section, Uppsala University, Uppsala, SE
| | - Susanna Calling
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, SE
| |
Collapse
|
37
|
Sulaman H, Akhtar T, Naeem H, Saeed GA, Fazal S. Beyond COVID-19: Prospect of telemedicine for obstetrics patients in Pakistan. Int J Med Inform 2021; 158:104653. [PMID: 34875485 PMCID: PMC8608655 DOI: 10.1016/j.ijmedinf.2021.104653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 11/16/2021] [Accepted: 11/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore obstetrics patients' experiences with telemedicine during COVID-19 and assess their intent for its future use. DESIGN An exploratory design was applied considering that telemedicine was a new phenomenon in Pakistan particularly for antenatal care services during COVID-19. METHOD Primary data was collected through a telephonic survey of 132 respondents randomly selected from the pool of obstetrics patients who used telemedicine services of Shifa International Hospital (SIH) in Islamabad, Pakistan during the pandemic. We changed the survey tool of Medical Group Management Association to the study purpose. Required information included the respondents' socioeconomic and antenatal characteristics and their telemedicine use experience on four parameters, namely, Appointment, Staff Attitude, Communication, and Telemedicine Services. Patients were inquired about their intent to use telemedicine beyond COVID-19 and the reasons supporting their answer. The data was analyzed descriptively and through t-test mean comparisons and binary logistic regression. RESULTS Majority (54%) intend to use telemedicine in future. Average age of respondents was 30 years with gravidity 2.36, parity 1.40 and gestational amenorrhea 27.3 weeks. The respondents average schooling was 9.5 years, marriage duration was 4.5 years and monthly household income was PKR ∼83,000. However, the overall experience of those who were confident in future use of telemedicine was 0.677 points higher and significantly different than those who were not inclined to use it in future. Of those lacking interest in future use of telemedicine, nearly two-third felt in-person visit was more satisfying, 11% needed physical examination, ∼6% experienced long waiting time, 5% each had inadequate access to ICT and online payment facilities, and 6% faced other issues such as excess payments. The binary logistic regression analysis (R2 37.3%) held Medical Consultations and Communications as the most important determinants and could predict nearly two-fifth of variation in respondents' intent for future use of telemedicine. CONCLUSION Uptake of telemedicine for obstetrics patients is one of the positive externalities of COVID-19 and may appear as a cost-effective and culturally acceptable way to ensure universal coverage of antenatal care in Pakistan. However, telemedicine's future beyond COVID-19 for obstetrics hinges upon improving users' experience primarily through consultant and staff trainings and provision of effective communication e.g., in regional languages. Besides, offering physical examination facility and ability to use mobile wallet payment solutions may motivate future use of telemedicine in obstetrics.
Collapse
Affiliation(s)
- Hira Sulaman
- United Medical and Dental College (UMDC), Korangi Creek Road, Karachi 74900, Pakistan.
| | - Tasneem Akhtar
- Shifa Tameer-e-Millat University - (STMU), Sector H-8/4, Islamabad 44000, Pakistan
| | - Humera Naeem
- Shifa Tameer-e-Millat University - (STMU), Sector H-8/4, Islamabad 44000, Pakistan
| | - Gulshan Ara Saeed
- Shifa Tameer-e-Millat University - (STMU), Sector H-8/4, Islamabad 44000, Pakistan
| | - Shamin Fazal
- Shifa International Hospital, Sector H-8/4, Islamabad 44000, Pakistan
| |
Collapse
|
38
|
Remote diagnosis of surgical-site infection using a mobile digital intervention: a randomised controlled trial in emergency surgery patients. NPJ Digit Med 2021; 4:160. [PMID: 34795398 PMCID: PMC8602321 DOI: 10.1038/s41746-021-00526-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/27/2021] [Indexed: 02/03/2023] Open
Abstract
Surgical site infections (SSI) cause substantial morbidity and pose a burden to acute healthcare services after surgery. We aimed to investigate whether a smartphone-delivered wound assessment tool can expedite diagnosis and treatment of SSI after emergency abdominal surgery. This single-blinded randomised control trial (NCT02704897) enroled adult emergency abdominal surgery patients in two tertiary care hospitals. Patients were randomised (1:1) to routine postoperative care or additional access to a smartphone-delivered wound assessment tool for 30-days postoperatively. Patient-reported SSI symptoms and wound photographs were requested on postoperative days 3, 7, and 15. The primary outcome was time-to-diagnosis of SSI (Centers for Disease Control definition). 492 patients were randomised (smartphone intervention: 223; routine care: 269). There was no significant difference in the 30-day SSI rate between trial arms: 21 (9.4%) in smartphone vs 20 (7.4%, p = 0.513) in routine care. Among the smartphone group, 32.3% (n = 72) did not utilise the tool. There was no significant difference in time-to-diagnosis of SSI for patients receiving the intervention (-2.5 days, 95% CI: -6.6-1.6, p = 0.225). However, patients in the smartphone group had 3.7-times higher odds of diagnosis within 7 postoperative days (95% CI: 1.02-13.51, p = 0.043). The smartphone group had significantly reduced community care attendance (OR: 0.57, 95% CI: 0.34-0.94, p = 0.030), similar hospital attendance (OR: 0.76, 95% CI: 0.28-1.96, p = 0.577), and significantly better experiences in accessing care (OR: 2.02, 95% CI: 1.17-3.53, p = 0.013). Smartphone-delivered wound follow-up is feasible following emergency abdominal surgery. This can facilitate triage to the appropriate level of assessment required, allowing earlier postoperative diagnosis of SSI.
Collapse
|
39
|
Oshni Alvandi A, Bain C, Burstein F. Understanding digital health ecosystem from Australian citizens' perspective: A scoping review. PLoS One 2021; 16:e0260058. [PMID: 34780547 PMCID: PMC8592460 DOI: 10.1371/journal.pone.0260058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/30/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Digital health (DH) and the benefits of related services are fairly well understood. However, it still is critical to map the digital health care landscape including the key elements that define it as an ecosystem. Particularly, knowing the perspectives of citizens on this digital transformation is an important angle to capture. In this review we aim to analyze the relevant studies to identify how DH is understood and experienced by Australian citizens and what they may require from DH platforms. MATERIALS AND METHODS A scoping literature review was conducted across several electronic databases (ACM Digital Library, OVID, PubMed, Scopus, IEEE, Science Direct, SAGE), as well as grey literature. Additionally, citation mining was conducted to identify further relevant studies. Identified studies were subjected to eligibility criteria and the final set of articles was independently reviewed, analyzed, discussed and interpreted by three reviewers. RESULTS Of 3811 articles, 98 articles met the inclusion criteria with research-based articles-as opposed to review articles or white papers- comprising the largest proportion (72%) of the selected literature. The qualitative analysis of the literature revealed five key elements that capture the essence of the digital health ecosystem interventions from the viewpoint of the Australian citizens. The identified elements were "consumer/user", "health care", "technology", "use and usability", "data and information". These elements were further found to be associated with 127 subcategories. CONCLUSIONS This study is the first of its kind to analyze and synthesize the relevant literature on DH ecosystems from the citizens' perspective. Through the lens of two research questions, this study defines the key components that were found crucial to understanding citizens' experiences with DH. This understanding lays a strong foundation for designing and fostering DH ecosystem. The results provide a solid ground for empirical testing.
Collapse
Affiliation(s)
| | - Chris Bain
- Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| | - Frada Burstein
- Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
40
|
Kim HS, Kim B, Lee SG, Jang SY, Kim TH. COVID-19 Case Surge and Telemedicine Utilization in a Tertiary Hospital in Korea. Telemed J E Health 2021; 28:666-674. [PMID: 34757827 DOI: 10.1089/tmj.2021.0157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background: Faced with the coronavirus disease 2019 (COVID-19) pandemic, Korea has allowed telemedicine use for a limited time. This study examined whether the surge in COVID-19 cases led to increased telemedicine use and the associated factors. Methods: Data from the electronic medical records of 929,753 outpatient episodes between March 4 and September 4, 2020, in a tertiary hospital in Korea were used. A comparison group was chosen by matching, adjusting for age and sex because only a small portion (1.0%) of the sample used telemedicine. The final sample comprised 57,972 episodes. Multivariable logistic regression analyses were performed to examine the association of independent variables with the dichotomous dependent variable (i.e., telemedicine visit/in-person visit). Results: The surge in confirmed COVID-19 cases led to significantly increased telemedicine use (101-300 new cases odds ratio [OR]: 3.00; 301-500 new cases OR: 5.82; and ≥501 new cases OR: 42.18; all p < 0.0001). Telemedicine use was also statistically associated with sex (female patients OR: 2.08), age ˃19 years, distance from the hospital (Incheon, Gyeonggi, region, OR: 1.30; and other regions, OR: 4.33), and the number of days from diagnosis (3-6 months OR: 1.21; 6-12 months OR: 1.56; 12-36 months OR: 1.98; and ≥36 months OR: 2.49). Medical Aid patients (OR: 0.83) were less likely to use telemedicine than those with National Health Insurance. Conclusions: Telemedicine can be effective in delivering health services during an outbreak. Policymakers and health care organizations are encouraged to use the results of this study to tailor telemedicine to meet the needs of patients.
Collapse
Affiliation(s)
- Hye Sun Kim
- Severance Children's Hospital, Yonsei University Health System, Seoul, Korea
| | - Bomgyeol Kim
- Department of Public Health, Yonsei University, Seoul, Korea
| | - Sang Gyu Lee
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Tae Hyun Kim
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| |
Collapse
|
41
|
Gachabayov M, Latifi LA, Parsikia A, Latifi R. The Role of Telemedicine in Surgical Specialties During the COVID-19 Pandemic: A Scoping Review. World J Surg 2021; 46:10-18. [PMID: 34743242 PMCID: PMC8572066 DOI: 10.1007/s00268-021-06348-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 12/27/2022]
Abstract
Background The objective of this study was to evaluate the current body of evidence on the use of telemedicine in surgical subspecialties during the COVID-19 pandemic. Methods This was a scoping review conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). MEDLINE via Ovid, PubMed, and EMBASE were systematically searched for any reports discussing telemedicine use in surgery and surgical specialties during the first period (February 2020–August 8, 2020) and second 6-month period (August 9–March 4, 2021) of the COVID-19 pandemic. Results Of 466 articles screened through full text, 277 articles were included for possible qualitative and/or quantitative data synthesis. The majority of publications in the first 6 months were in orthopedic surgery, followed by general surgery and neurosurgery, whereas in the second 6 months of COVID-19 pandemic, urology and neurosurgery were the most productive, followed by transplant and plastic surgery. Most publications in the first 6 months were opinion papers (80%), which decreased to 33% in the second 6 months. The role of telemedicine in different aspects of surgical care and surgical education was summarized stratifying by specialty. Conclusion Telemedicine has increased access to care of surgical patients during the COVID-19 pandemic, but whether this practice will continue post-pandemic remains unknown. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-021-06348-1.
Collapse
Affiliation(s)
- Mahir Gachabayov
- Department of Surgery, Westchester Medical Center Health, New York Medical College, School of Medicine, Taylor Pavilion, Suite D334, 100 Woods Road, Valhalla, NY, 10595, USA.,Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Lulejeta A Latifi
- Department of Surgery, Westchester Medical Center Health, New York Medical College, School of Medicine, Taylor Pavilion, Suite D334, 100 Woods Road, Valhalla, NY, 10595, USA.,University of Arizona, Tucson, AZ, USA.,Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Afshin Parsikia
- Department of Surgery, Westchester Medical Center Health, New York Medical College, School of Medicine, Taylor Pavilion, Suite D334, 100 Woods Road, Valhalla, NY, 10595, USA.,Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center Health, New York Medical College, School of Medicine, Taylor Pavilion, Suite D334, 100 Woods Road, Valhalla, NY, 10595, USA. .,Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
| |
Collapse
|
42
|
Alford-Teaster J, Wang F, Tosteson ANA, Onega T. Incorporating broadband durability in measuring geographic access to health care in the era of telehealth: A case example of the 2-step virtual catchment area (2SVCA) Method. J Am Med Inform Assoc 2021; 28:2526-2530. [PMID: 34414437 DOI: 10.1093/jamia/ocab149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 01/13/2023] Open
Abstract
The COVID-19 (coronavirus disease 2019) pandemic has expanded telehealth utilization in unprecedented ways and has important implications for measuring geographic access to healthcare services. Established measures of geographic access to care have focused on the spatial impedance of patients in seeking health care that pertains to specific transportation modes and do not account for the underlying broadband network that supports telemedicine and e-health. To be able to measure the impact of telehealth on healthcare access, we created a pilot augmentation of existing methods to incorporate measures of broadband accessibility to measure geographic access to telehealth. A reliable measure of telehealth accessibility is important to enable policy analysts to assess whether the increasing prevalence of telehealth may help alleviate the disparities in healthcare access in rural areas and for disadvantaged populations, or exacerbate the existing gaps as they experience "double burdens."
Collapse
Affiliation(s)
- Jennifer Alford-Teaster
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Fahui Wang
- Department of Geography and Anthropology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Anna N A Tosteson
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Tracy Onega
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
43
|
Alami H, Lehoux P, Attieh R, Fortin JP, Fleet R, Niang M, Offredo K, Rouquet R, Ag Ahmed MA, Ly BA. A “Not So Quiet” Revolution: Systemic Benefits and Challenges of Telehealth in the Context of COVID-19 in Quebec (Canada). Front Digit Health 2021. [DOI: 10.3389/fdgth.2021.721898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The COVID-19 pandemic has had a major impact on health and social service systems (HSSS) worldwide. It has put tremendous pressure on these systems, threatening access, continuity, and the quality of patient care and services. In Quebec (Canada), the delivery of care and services has radically changed in a short period of time. During the pandemic, telehealth has been widely deployed and used, notwithstanding the decades-long challenges of integrating this service modality into the Quebec HSSS. Adopting a narrative-integrative approach, this article describes and discusses Quebec's experience with the deployment and utilization of telehealth in the context of COVID-19. Firstly, we introduced the achievements and benefits made with the use of telehealth. Secondly, we discussed the challenges and concerns that were revealed or accentuated by the sanitary crisis, such as: (1) training and information; (2) professional and organizational issues; (3) quality of services and patient satisfaction; (4) cost, remuneration, and funding; (5) technology and infrastructure; (6) the emergence of private telehealth platforms in a public HSSS; (7) digital divide and equity; and (8) legal and regulatory issues. Finally, the article presents recommendations to guide future research, policies and actions for a successful integration of telehealth in the Quebec HSSS as well as in jurisdictions and countries facing comparable challenges.
Collapse
|
44
|
Escobar MF, Henao JF, Prieto D, Echavarria MP, Gallego JC, Nasner D, Martínez-Ruíz DM, Velasco JE, Alarcón J. Teleconsultation for outpatient care of patients during the Covid-19 pandemic at a University Hospital in Colombia. Int J Med Inform 2021; 155:104589. [PMID: 34592540 PMCID: PMC8453779 DOI: 10.1016/j.ijmedinf.2021.104589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/15/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND During the COVID 19 pandemic, direct-to-consumer telehealth (DTC) services allowed patients real-time virtual access to healthcare providers, especially those with an established relationship. In Colombia, this care modality was implemented between 2019 and 2020, under national considerations, it was implemented for outpatient care in a highly complex university hospital in Cali, Colombia. METHODS A descriptive study with prospective information collection was used to describe the implementation of the outpatient teleconsultation care model for patients. We constructed the clinical and process indicators with which we evaluated the model. FINDINGS A total of 56,560 patients from our institution were treated by virtual outpatient consultation during the first nine months of the health emergency declared by COVID 19 in Colombia. The strategy made it possible to achieve coverage more significant than 100% in Cali and the departments of Colombia. Attention by teleconsultation was 19% of the total ambulatory care. The effectiveness in carrying out scheduled teleconsultations had an overall result of 91.5%. The accessibility results demonstrated the need to strengthen connectivity and accessibility to payments and strengthen technology adoption in the institution, health personnel, and patients. INTERPRETATION Implementing an outpatient teleconsultation model allowed the continuity of the management with comprehensive coverage nationwide from a highly complex hospital in southwestern Colombia. The indicators' analysis should help strengthen the policies of access to telemedicine, especially with the consequences of the pandemic in low- and middle-income countries. Latin American evidence is necessary to establish the safety profile of telemedicine and the costs associated with the provision.
Collapse
Affiliation(s)
- María Fernanda Escobar
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia; Department of Telemedicine, Fundación Valle del Lili, Cali, Colombia.
| | - Juan Fernando Henao
- Department of Information Technology, Fundación Valle del Lili, Cali, Colombia
| | - Diana Prieto
- Department of Outpatient Medical Care, Fundación Valle del Lili, Cali, Colombia
| | | | | | - Daniela Nasner
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | | | | | - Juliana Alarcón
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| |
Collapse
|
45
|
Adams R, Branthwaite H, Chockalingam N. Prevalence of musculoskeletal injury and pain of UK-based podiatrists and the impact of enforced altered working practices. J Foot Ankle Res 2021; 14:53. [PMID: 34470650 PMCID: PMC8409074 DOI: 10.1186/s13047-021-00491-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Occupational musculoskeletal injuries are prevalent in healthcare workers and are reported to be profession-specific. There is, however, a paucity of information around the injuries sustained from working as a podiatrist. This paper looks at the incidence of injury from working as a podiatrist, the aggravating factors to sustain these injuries and whether the changes in workload due to the COVID-19 pandemic altered the incidence. Methods A modified work based musculoskeletal injury questionnaire was distributed in the UK via podiatry led social media platforms. Open and Closed questions explored the demographics of the sample, perceived injury 12 months prior to the COVID-19 pandemic and then 6 months into the lockdown. Pre and post COVID-19 data were analysed for differences and thematic analysis was included to categorise reported experiences. Results 148 podiatrists representing 3 % of HCPC registered practitioners responded to the questionnaire. Employment status altered as a result of the COVID-19 pandemic with a 13 % reduction in those working full time. Environments also changed with domiciliary and telehealth significantly increasing (p > 0.00) and non-clinical roles being extended (p > 0.002). Pain frequency and intensity significantly (p > 0.04) increased as a result of the pandemic with shoulder pain being most frequent before lockdown altering to the neck during the lockdown. Two main themes were identified that were attributed to the causes of pain including physical demands and working in awkward spaces. Conclusions Work-related musculoskeletal pain in podiatrists is common with the shoulder and neck being the most frequently affected. Changes in work practices due to the restrictions enforced from the COVID-19 pandemic increased the frequency and intensity of pain mostly associated with increased domiciliary and telehealth working environments. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-021-00491-7.
Collapse
Affiliation(s)
- Robert Adams
- Centre for Biomechanics and Rehabilitation Technologies, Stoke on Trent, Staffordshire University, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| | - Helen Branthwaite
- Centre for Biomechanics and Rehabilitation Technologies, Stoke on Trent, Staffordshire University, Leek Road, ST4 2DF, Stoke-on-Trent, UK.
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Stoke on Trent, Staffordshire University, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| |
Collapse
|
46
|
Chakawa A, Belzer LT, Perez-Crawford T, Yeh HW. COVID-19, Telehealth, and Pediatric Integrated Primary Care: Disparities in Service Use. J Pediatr Psychol 2021; 46:1063-1075. [PMID: 34343329 PMCID: PMC8385826 DOI: 10.1093/jpepsy/jsab077] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 01/04/2023] Open
Abstract
Objective The coronavirus disease 2019 pandemic (COVID-19) may increase pediatric mental health needs due to its social, economic, and public health threats, especially among Black, Indigenous, and People of Color and those served within disadvantaged communities. COVID-19 protocols have resulted in increased provision of telehealth in integrated primary care (IPC) but little is known about pediatric telehealth IPC utilization during the pandemic for diverse and traditionally underserved groups. Methods A comparative study was conducted to explore variability between in-person (pre-COVID-19; n = 106) and telehealth (mid-COVID-19; n = 120) IPC consultation utilization among children 1–19 years old served through a large, inner-city primary care clinic. Logistic regression modeling was used to examine the association between service delivery modality (i.e., in-person vs. telehealth) and attendance, referral concerns, and several sociodemographic variables. Results Service delivery modality and attendance, referral concerns, and race/ethnicity were significantly associated. The odds of non-attendance were greater for children scheduled for telehealth, the odds of children with internalizing problems being scheduled for telehealth were greater than those with externalizing problems, and the odds of Black children being scheduled for telehealth were less compared to White children. Conclusion Though telehealth has helped provide IPC continuity during COVID-19, findings from this study show troubling preliminary data regarding reduced attendance, increased internalizing concerns, and disparities in scheduling for Black patients. Specific actions to monitor and address these early but alarming indications of telehealth and Covid-19 related behavioral health disparities are discussed.
Collapse
Affiliation(s)
- Ayanda Chakawa
- Division of Developmental and Behavioral Health, Section of Pediatric Psychology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Leslee Throckmorton Belzer
- Division of Developmental and Behavioral Health, Section of Pediatric Psychology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.,The Beacon Program, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Trista Perez-Crawford
- Division of Developmental and Behavioral Health, Section of Pediatric Psychology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Hung-Wen Yeh
- University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.,Division of Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| |
Collapse
|
47
|
Sperling S, Andretta CRDL, Basso J, Batista CEA, Borysow IDC, Cabral FC, de Castro Filho ED, Costa LAV, Gehres LG, Kim KY, Maeyama MA, Mallmann ÉDB, Morbeck RA, Oblonczyk MM, Pachito DV, Rodrigues ÁS, de Souza CF, Toth CPP, Gadenz SD. Telehealth for Supporting Referrals to Specialized Care During COVID-19. Telemed J E Health 2021; 28:544-550. [PMID: 34314637 DOI: 10.1089/tmj.2021.0208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic led to the suspension or postponement of care for non-urgent conditions worldwide. Regula Mais Brasil is an initiative of the Unified Health System (SUS) in Brazil to optimize the management of referrals to specialized care by using telehealth. Objectives: To report the expansion of telehealth activities of Regula Mais Brasil in response to COVID-19 and to assess qualification of referrals in primary health care (PHC) units as well as the added value of teleconsultation in qualifying referral cases. Methods: Descriptive study of the teleconsultations carried out as an additional strategy to the remotely operated referral management system, responsible for navigating cases from PHC units to specialized care in Recife, Brazil, between May 6, 2020 and September 30, 2020. Teleconsultation was implemented as a tool for reducing delays in the access to health care due to COVID-19 and ultimately allowed for reclassification of the referral adequacy and priority. Changes in referral priority ratings and referral decisions after teleconsultation were analyzed. Results: A total of 622 referral cases were analyzed. Approved referrals represented 51.9% of cases. The main reason for approved referrals was the need for diagnostic resources. There was a reduction in priority ratings in 449 cases (72.2%) after teleconsultation. There was a statistically significant association between the change of priority ratings and the decision on referral (Pearson's χ2, p-value <0.0001). Results show that telemedicine had an impact on the prioritization and qualification of cases referred to specialized services. Conclusions: A need was detected to rapidly adapt tools available for telemedicine in Brazil. Our results demonstrate that teleconsultation as an additional strategy to the remotely operated referral management system has contributed toward improving equitable access to specialized services.
Collapse
Affiliation(s)
- Stephan Sperling
- Diretoria de Compromisso Social, Hospital Sírio-Libanês, Sao Paulo, Brazil
| | | | - Josue Basso
- Diretoria de Compromisso Social, Hospital Sírio-Libanês, Sao Paulo, Brazil
| | | | - Igor da Costa Borysow
- Diretoria Executiva de Responsabilidade Social, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | | | | | | | | | - Kevin Yun Kim
- Superintendência de Responsabilidade Social, HCor, Sao Paulo, Brazil
| | - Marcos Aurélio Maeyama
- Diretoria Executiva de Responsabilidade Social, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Silva CRDV, Lopes RH, Júnior ODGB, Fuentealba-Torres M, Arcêncio RA, da Costa Uchôa SA. Telemedicine in primary healthcare for the quality of care in times of COVID-19: a scoping review protocol. BMJ Open 2021; 11:e046227. [PMID: 34253666 PMCID: PMC8277488 DOI: 10.1136/bmjopen-2020-046227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Telemedicine gained strength in primary healthcare (PHC) during the COVID-19 pandemic. Thus, there is a need to know its scope, technologies used and impacts on people's health. This study will map telemedicine use in PHC around the world and its impacts on quality of care in the context of the COVID-19 pandemic. METHODS This is a scoping review protocol developed according to Arksey and O'Malley and Levac et al, based on the Joanna Briggs Institute manual, and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). The records will be mapped in the following multidisciplinary health sciences databases: Virtual Health Library, PubMed, Scopus, Web of Science, CINAHL and Embase. Searches will also be conducted on Google Scholar, preprint repositories and specific COVID-19 databases (grey literature). Quantitative data will be analysed using descriptive statistics, while thematic analysis will be performed for qualitative data. Preliminary findings will be presented to stakeholders to identify missing studies and develop effective dissemination strategies. ETHICS AND DISSEMINATION Results will be disseminated through publication in an open access scientific journal, scientific events, and academic and community newspapers. Ethical approval was obtained due to stakeholder consultation, but will not involve the direct participation of patients. Link to the protocol record in the Open Science Framework (OSF) (osf.io/q94en).
Collapse
Affiliation(s)
| | - Rayssa Horácio Lopes
- Postgraduate in Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | - Ricardo Alexandre Arcêncio
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | | |
Collapse
|
49
|
Assiri AH, Mahnashi NA, Alkhttabi NF, Alqahtani KM, Alqahtani MS, Alhajri MA. The Modality Preferred by Population of Health Services Provided During COVID-19 and Assessment of Satisfaction Among Adults in Kingdom of Saudi Arabia. Cureus 2021; 13:e16190. [PMID: 34367796 PMCID: PMC8336729 DOI: 10.7759/cureus.16190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background During the COVID-19 pandemic, there was a great transition in the modalities of health care services, such as the telemedicine landscape, with some speed. Because of the lack of vaccines or effective therapies, social distancing and quarantine were the only widely accessible precautions, creating a compelling reason for alternatives for in-person care. Many countries applied teleconsultation or provided online applications during the COVID-19 pandemic. However, it is not currently known whether this available service has satisfied the patients' needs during the COVID-19 pandemic. Aim To detect the preferred modality of health services by the Saudi population during COVID-19 and to assess the satisfaction with respect to the provided health services in the Aseer region of Saudi Arabia. Methodology A descriptive cross-sectional approach was used targeting all accessible populations in Saudi Arabia. Data were collected from participants using an electronic pre-structured questionnaire. The tool covered participants' socio-demographic data, participants' medical and family history, COVID-19 infection, health problems during the pandemic, received services, modalities of available services, and their satisfaction regarding the provided health service. Results A total of 2102 participants completed the study questionnaire. Exactly 773 (36.8%) respondents had a health problem during the COVID-19 pandemic. The most-reported modality of health services used was calling the 937 number, which is call center of the Ministry of Health (34.7%), followed by using health applications to get an appointment (33.9%). Also, 447 (88.7%) participants reported that the provided medical services were helpful. Regarding their satisfaction, 156 (31%) were just satisfied with the provided services and 280 (55.6%) were highly satisfied. Conclusions In conclusion, the current study showed a high level of public satisfaction regarding different modalities of health services provided during the COVID-19 pandemic in Saudi Arabia. This satisfaction was moderately high among telehealth users and those who had hospital visits for health care.
Collapse
Affiliation(s)
- Amer H Assiri
- Internal Medicine, King Khalid University, Abha, SAU
| | | | | | | | | | | |
Collapse
|
50
|
Pollack CC, Gilbert-Diamond D, Alford-Teaster JA, Onega T. Language and Sentiment Regarding Telemedicine and COVID-19 on Twitter: Longitudinal Infodemiology Study. J Med Internet Res 2021; 23:e28648. [PMID: 34086591 PMCID: PMC8218898 DOI: 10.2196/28648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background The COVID-19 pandemic has necessitated a rapid shift in how individuals interact with and receive fundamental services, including health care. Although telemedicine is not a novel technology, previous studies have offered mixed opinions surrounding its utilization. However, there exists a dearth of research on how these opinions have evolved over the course of the current pandemic. Objective This study aims to evaluate how the language and sentiment surrounding telemedicine has evolved throughout the COVID-19 pandemic. Methods Tweets published between January 1, 2020, and April 24, 2021, containing at least one telemedicine-related and one COVID-19–related search term (“telemedicine-COVID”) were collected from the Twitter full archive search (N=351,718). A comparator sample containing only COVID-19 terms (“general-COVID”) was collected and sampled based on the daily distribution of telemedicine-COVID tweets. In addition to analyses of retweets and favorites, sentiment analysis was performed on both data sets in aggregate and within a subset of tweets receiving the top 100 most and least retweets. Results Telemedicine gained prominence during the early stages of the pandemic (ie, March through May 2020) before leveling off and reaching a steady state from June 2020 onward. Telemedicine-COVID tweets had a 21% lower average number of retweets than general-COVID tweets (incidence rate ratio 0.79, 95% CI 0.63-0.99; P=.04), but there was no difference in favorites. A majority of telemedicine-COVID tweets (180,295/351,718, 51.3%) were characterized as “positive,” compared to only 38.5% (135,434/351,401) of general-COVID tweets (P<.001). This trend was also true on a monthly level from March 2020 through April 2021. The most retweeted posts in both telemedicine-COVID and general-COVID data sets were authored by journalists and politicians. Whereas the majority of the most retweeted posts within the telemedicine-COVID data set were positive (55/101, 54.5%), a plurality of the most retweeted posts within the general-COVID data set were negative (44/89, 49.4%; P=.01). Conclusions During the COVID-19 pandemic, opinions surrounding telemedicine evolved to become more positive, especially when compared to the larger pool of COVID-19–related tweets. Decision makers should capitalize on these shifting public opinions to invest in telemedicine infrastructure and ensure its accessibility and success in a postpandemic world.
Collapse
Affiliation(s)
- Catherine C Pollack
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States.,Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Diane Gilbert-Diamond
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States.,Department of Pediatrics, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States.,Department of Medicine, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Jennifer A Alford-Teaster
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States.,Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Tracy Onega
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| |
Collapse
|