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McCoy HC, Allison MK, Hernandez M, Ali MM, Stokes M, Bogulski CA, Eswaran H. Assessment of Pregnancy-Related Telehealth Interventions in the United States: A 10-Year Scoping Review. Telemed J E Health 2024; 30:36-46. [PMID: 37256707 DOI: 10.1089/tmj.2023.0176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Introduction: Telehealth use in obstetrics has been demonstrated to improve efficiency, access to care, and pregnancy outcomes. Despite reported successful implementation of these programs, information regarding the program variations and its impact on health care costs and outcomes are scarce. Methods: This is a scoping review of pregnancy-related telehealth studies to understand the current landscape of pregnancy-related telehealth interventions as well as to subset those that are used in high-risk pregnancies. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework to guide this review. Results: A total of 70 articles were included in this scoping review. Of those, 53 (75.7%) studies included a pregnant population and 17 (24.3%) studies focused on a rural and/or urban population. Most studies (n = 56; 80%) included some form of synchronous interaction between provider and participant. Patient outcomes included maternal/infant health outcomes (n = 41; 44.1%), patient satisfaction (n = 9; 9.7%), and attendance/compliance (n = 5; 5.4%). Provider-level outcomes included knowledge change (n = 11; 11.8%) and self-efficacy (n = 3; 3.2%). Other outcomes included assessment of costs and patient/provider feasibility and acceptability of the intervention. Overall, there has been a growing trend in articles published on pregnancy-related telehealth studies since 2011, with 2018 having the most publications in a single year. Conclusion: This review suggests a steadily growing body of literature on pregnancy-related telehealth interventions; however, more research is needed to better understand outcomes of telehealth for pregnancy-related care, especially related to patient satisfaction, health disparities, and cost-benefit.
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Affiliation(s)
- Hannah C McCoy
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mary Kathryn Allison
- Department of Health Behavior and Health Education, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Michelle Hernandez
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mir M Ali
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Melony Stokes
- Southcentral Telehealth Resource Center, Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Cari A Bogulski
- Department of Biomedical Informatics and College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hari Eswaran
- Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Mackie AS, Bravo-Jaimes K, Keir M, Sillman C, Kovacs AH. Access to Specialized Care Across the Lifespan in Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:267-282. [PMID: 38161668 PMCID: PMC10755796 DOI: 10.1016/j.cjcpc.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/05/2023] [Indexed: 01/03/2024]
Abstract
Individuals living with tetralogy of Fallot require lifelong specialized congenital heart disease care to monitor for and manage potential late complications. However, access to cardiology care remains a challenge for many patients, as does access to mental health services, dental care, obstetrical care, and other specialties required by this population. Inequities in health care access were highlighted by the COVID-19 pandemic and continue to exist. Paradoxically, many social factors influence an individual's need for care, yet inadvertently restrict access to it. These include sex and gender, being a member of a racial or ethnic historically excluded group, lower educational attainment, lower socioeconomic status, living remotely from tertiary care centres, transportation difficulties, inadequate health insurance, occupational instability, and prior experiences with discrimination in the health care setting. These factors may coexist and have compounding effects. In addition, many patients believe that they are cured and unaware of the need for specialized follow-up. For these reasons, lapses in care are common, particularly around the time of transfer from paediatric to adult care. The lack of trained health care professionals for adults with congenital heart disease presents an additional barrier, even in higher income countries. This review summarizes challenges regarding access to multiple domains of specialized care for individuals with tetralogy of Fallot, with a focus on the impact of social determinants of health. Specific recommendations to improve access to care within Canadian and American systems are offered.
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Affiliation(s)
- Andrew S. Mackie
- Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Michelle Keir
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Christina Sillman
- Adult Congenital Heart Disease Program, Sutter Heart and Vascular Institute, Sacramento, California, USA
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Stremmel C, Breitschwerdt R. Digital Transformation in the Diagnostics and Therapy of Cardiovascular Diseases: Comprehensive Literature Review. JMIR Cardio 2023; 7:e44983. [PMID: 37647103 PMCID: PMC10500361 DOI: 10.2196/44983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 06/12/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The digital transformation of our health care system has experienced a clear shift in the last few years due to political, medical, and technical innovations and reorganization. In particular, the cardiovascular field has undergone a significant change, with new broad perspectives in terms of optimized treatment strategies for patients nowadays. OBJECTIVE After a short historical introduction, this comprehensive literature review aimed to provide a detailed overview of the scientific evidence regarding digitalization in the diagnostics and therapy of cardiovascular diseases (CVDs). METHODS We performed an extensive literature search of the PubMed database and included all related articles that were published as of March 2022. Of the 3021 studies identified, 1639 (54.25%) studies were selected for a structured analysis and presentation (original articles: n=1273, 77.67%; reviews or comments: n=366, 22.33%). In addition to studies on CVDs in general, 829 studies could be assigned to a specific CVD with a diagnostic and therapeutic approach. For data presentation, all 829 publications were grouped into 6 categories of CVDs. RESULTS Evidence-based innovations in the cardiovascular field cover a wide medical spectrum, starting from the diagnosis of congenital heart diseases or arrhythmias and overoptimized workflows in the emergency care setting of acute myocardial infarction to telemedical care for patients having chronic diseases such as heart failure, coronary artery disease, or hypertension. The use of smartphones and wearables as well as the integration of artificial intelligence provides important tools for location-independent medical care and the prevention of adverse events. CONCLUSIONS Digital transformation has opened up multiple new perspectives in the cardiovascular field, with rapidly expanding scientific evidence. Beyond important improvements in terms of patient care, these innovations are also capable of reducing costs for our health care system. In the next few years, digital transformation will continue to revolutionize the field of cardiovascular medicine and broaden our medical and scientific horizons.
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Liberman RF, Heinke D, Lin AE, Nestoridi E, Jalali M, Markenson GR, Sekhavat S, Yazdy MM. Trends in Delayed Diagnosis of Critical Congenital Heart Defects in an Era of Enhanced Screening, 2004-2018. J Pediatr 2023:S0022-3476(23)00125-7. [PMID: 36858148 DOI: 10.1016/j.jpeds.2023.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To describe trends in delayed diagnosis of critical congenital heart defects (CCHDs) with prenatal and postnatal screening advances. STUDY DESIGN We evaluated a retrospective cohort of live births with CCHD delivered between 2004 and 2018 from a statewide, population-based birth defects surveillance system in Massachusetts. Demographic information were obtained from vital records. We estimated timely (prenatal or birth/transfer hospital) and delayed diagnosis (after discharge) proportions by year and time periods coinciding with the transition to mandatory pulse oximetry in 2015. RESULTS We identified 1524 eligible CCHD cases among 1 087 027 live births. By 2018, 92% of cases received a timely diagnosis, most prenatally. From 2004 to 2018, prenatal diagnosis increased from 46% to 76% of cases, while hospital diagnosis decreased from 38% to 17%, and delayed diagnosis declined from 16% to 7%. These trends were consistent across all characteristics evaluated. Among cases without a prenatal diagnosis, the proportion with delayed diagnosis did not change over time, even after implementation of mandatory pulse oximetry screening. Prenatal detection increased the most among severe cases (treated or died in first month of life). Well-appearing newborns without prenatal diagnosis made up 79% of delayed diagnosis cases by 2015-2018. Delayed diagnosis was most common for coarctation. CONCLUSIONS While prenatal diagnosis of CCHD increased dramatically, there was no reduction in delayed diagnosis among postnatally diagnosed infants, even after pulse oximetry screening became mandatory. Pulse oximetry may not reduce delayed diagnosis in settings with high prenatal detection, and other strategies are needed to ensure timely diagnosis of well-appearing newborns.
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Affiliation(s)
| | | | | | | | | | | | | | - Mahsa M Yazdy
- Massachusetts Department of Public Health, Boston, MA
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Golbasi H, Omeroglu I, Bayraktar B, Golbasi C, Adıyaman D, Ekin A. How COVID-19 pandemic is changing the practice of prenatal screening and diagnosis? J Perinat Med 2022; 50:124-131. [PMID: 34881543 DOI: 10.1515/jpm-2021-0343] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/11/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the impact of the COVID-19 pandemic on prenatal screening and diagnostic tests. METHODS We conducted a retrospective study with pregnant women attending to the perinatology department of a tertiary referral center. The pre-COVID-19 period between 11 March 2019 and 10 March 2020 and COVID-19 period between 11 March 2020 and 10 March 2021 were evaluated. Both periods were compared in terms of outpatient visits, ultrasound examinations, prenatal screening and diagnostic tests. The correlation of deaths related to COVID-19 pandemic on these parameters was also assessed. RESULTS A total of 38,918 patients were examined and 28,452 ultrasound examinations, 26,672 prenatal screening tests and 1,471 prenatal diagnostic tests were performed over two years. During COVID-19 pandemic, number of outpatient visits decreased by 25.2%, ultrasound examinations decreased by 44.2%, prenatal screening tests decreased by 36.2% and prenatal diagnostic tests decreased by 30.7%. Statistically significant correlation was not observed between deaths related to COVID-19 and outpatient visits (p=0.210), ultrasound examinations (p=0.265), prenatal screening (p=0.781) and diagnostic tests (p=0.158). Among indications of prenatal diagnostic tests, maternal anxiety was significantly higher in COVID-19 period (p=0.023). There was significant decrease in the detection of fetuses with trisomy 21 (p=0.047) and a significant increase in the detection of fetuses with Turner syndrome (p=0.017) during COVID-19 period. CONCLUSIONS The COVID-19 pandemic has severely impacted antenatal care. Prenatal fetal screening and diagnosis was adversely affected by the pandemic in terms of detecting genetic and structural anomalies.
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Affiliation(s)
- Hakan Golbasi
- Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ibrahim Omeroglu
- Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Burak Bayraktar
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ceren Golbasi
- Department of Obstetrics and Gynecology, Izmir Tınaztepe University Faculty of Medicine, Izmir, Turkey
| | - Duygu Adıyaman
- Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Atalay Ekin
- Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
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Fremed MA, Niaz T, Hope KD, Altman CA, Levy VY, Glickstein JS, Johnson JN. Adaptations of paediatric cardiology practice during the COVID-19 pandemic. Cardiol Young 2021; 32:1-5. [PMID: 34657645 PMCID: PMC8545844 DOI: 10.1017/s1047951121004364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/10/2021] [Accepted: 10/06/2021] [Indexed: 11/25/2022]
Abstract
During the initial surge of the COVID-19 pandemic in the spring and summer of 2020, paediatric heart centres were forced to rapidly alter the way patient care was provided to minimise interruption to patient care as well as exposure to the virus. In this survey-based descriptive study, we characterise changes that occurred within paediatric cardiology practices across the United States and described provider experience and attitudes towards these changes during the pandemic. Common changes that were implemented included decreased numbers of procedures, limiting visitors and shifting towards telemedicine encounters. The information obtained from this survey may be useful in guiding and standardising responses to future public health crises.
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Affiliation(s)
- Michael A. Fremed
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Talha Niaz
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kyle D. Hope
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Carolyn A. Altman
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Victor Y. Levy
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Julie S. Glickstein
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Jonathan N. Johnson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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Kovacevic A, Bär S, Starystach S, Elsässer M, van der Locht T, Mohammadi Motlagh A, Ostermayer E, Oberhoffer-Fritz R, Ewert P, Gorenflo M, Wacker-Gussmann A. Fetal Cardiac Services during the COVID-19 Pandemic: How Does It Affect Parental Counseling? J Clin Med 2021; 10:3423. [PMID: 34362206 PMCID: PMC8347932 DOI: 10.3390/jcm10153423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022] Open
Abstract
The COVID-19 pandemic impacts health care providers in multiple ways, even specialties that do not seem to be affected primarily, such as fetal cardiac services. We aimed to assess the effects on parental counseling for fetal congenital heart disease (CHD). In this multicenter study, we used a validated questionnaire. Parents were recruited from four national tertiary medical care centers (n = 226); n = 169 had been counseled before and n = 57 during the pandemic. Overall counseling success including its dimensions did not differ between the two groups (p = n.s.). However, by applying the sorrow scale, we could demonstrate that parents counseled during the pandemic were significantly more concerned (p = 0.025) and unsure (p = 0.044) about their child's diagnosis, therapy and outcome. Furthermore, parents expressed a significantly increased need for written and/or online information on fetal heart disease (p = 0.034). Other modifiers did not affect counseling success (p = n.s.). We demonstrate that the COVID-19 pandemic impacts effectiveness of parental counseling for fetal CHD, possibly by altering parental perceptions. This needs to be taken into consideration when counseling. Implementing alternative and innovative approaches (e.g., online conference or virtual reality tools) may aid in facilitating high-quality services in critical times such as in the present pandemic.
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Affiliation(s)
- Alexander Kovacevic
- Department of Pediatric and Congenital Cardiology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (T.v.d.L.); (M.G.)
| | - Stefan Bär
- Max Weber Institute for Sociology, Ruprecht Karls University Heidelberg, 69115 Heidelberg, Germany; (S.B.); (S.S.)
| | - Sebastian Starystach
- Max Weber Institute for Sociology, Ruprecht Karls University Heidelberg, 69115 Heidelberg, Germany; (S.B.); (S.S.)
- Institute of Medical Sociology and Rehabilitation Science, Charité—University Medicine Berlin, 10117 Berlin, Germany
| | - Michael Elsässer
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, 69120 Heidelberg, Germany;
| | - Thomas van der Locht
- Department of Pediatric and Congenital Cardiology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (T.v.d.L.); (M.G.)
| | - Aida Mohammadi Motlagh
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany; (A.M.M.); (R.O.-F.); (A.W.-G.)
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center Munich, 80636 Munich, Germany;
| | - Eva Ostermayer
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany;
| | - Renate Oberhoffer-Fritz
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany; (A.M.M.); (R.O.-F.); (A.W.-G.)
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center Munich, 80636 Munich, Germany;
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center Munich, 80636 Munich, Germany;
| | - Matthias Gorenflo
- Department of Pediatric and Congenital Cardiology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (T.v.d.L.); (M.G.)
| | - Annette Wacker-Gussmann
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany; (A.M.M.); (R.O.-F.); (A.W.-G.)
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center Munich, 80636 Munich, Germany;
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