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McBride H, Evans S, Pinto A, Daly A, Ashmore C, Ilgaz F, Ford S, Buckley S, MacDonald A. Patient and carer perceptions of video, telephone and in-person clinics for Phenylketonuria (PKU). Orphanet J Rare Dis 2024; 19:303. [PMID: 39164733 PMCID: PMC11337755 DOI: 10.1186/s13023-024-03295-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 07/24/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND In phenylketonuria (PKU), attending multidisciplinary clinic reviews is an important aspect of life-long care. Since the COVID-19 pandemic, video and telephone clinics are used as alternative methods for people with PKU to have contact with their care team. There is limited research concerning patient preference, experience and perceptions of alternative types of clinic review. Individuals from the UK with PKU and their caregivers were invited to complete an online questionnaire, hosted on the National Society for PKU (NSPKU) website and social media platform. RESULTS Data was available from 203 respondents. Forty one per cent of respondents (n = 49/119) preferred in-person clinics; 41% (n = 49) a hybrid of in-person, video and telephone clinics; 9% (n = 11) video clinics only, 6% (n = 7) telephone only and 3% (n = 3) were unsure. The main respondent obstacles to in-person clinics were costs, travel and time, but this was balanced by the benefits of a physical examination and better patient engagement/motivation. Twenty one per cent (n = 36/169) of respondents were uncomfortable with the number of healthcare professionals (HCPs) in a clinic room. Patients were less likely to consult with a doctor on video (64%, n = 91/143) or phone (50%, n = 59/119) reviews compared to in-person (80%, n = 146/183). Issues with video and telephone reviews included the shorter time length of review, distractions, technical issues and poor patient engagement. CONCLUSIONS Online video and telephone clinic platforms were effective in overcoming the challenging circumstances in management, monitoring and treatment of patients with PKU during the COVID-19 pandemic. However, in-person clinics remain the preferred respondent option. It is important that HCPs are flexible, enabling people with PKU a choice of clinic options according to their individual clinical need and circumstances.
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Affiliation(s)
| | - Sharon Evans
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Alex Pinto
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Anne Daly
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Catherine Ashmore
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Fatma Ilgaz
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, 06100, Turkey
| | - Suzanne Ford
- NSPKU National Society for Phenylketonuria, London, UK
- North Bristol NHS Trust, Bristol, UK
| | - Sharon Buckley
- Department of Psychology, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, 53 Bonsall Street, Manchester, M15 6GX, UK
| | - Anita MacDonald
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
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D'Souza K, Singh S, Westgard CM, Barnhardt S. A qualitative assessment of barriers and facilitators of telemedicine volunteerism during the COVID-19 pandemic in India. HUMAN RESOURCES FOR HEALTH 2024; 22:21. [PMID: 38520012 PMCID: PMC10958920 DOI: 10.1186/s12960-024-00897-x] [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: 08/22/2023] [Accepted: 01/30/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The COVID-19 pandemic further propelled the recent growth of telemedicine in low-resource countries, with new models of telemedicine emerging, including volunteer-based telemedicine networks. By leveraging existing infrastructure and resources to allocate health personnel more efficiently, these volunteer networks eased some of the pandemic burden placed on health systems. However, there is insufficient understanding of volunteer-based telemedicine models, especially on the human resources engagement on such networks. This study aims to understand the motivations and barriers to health practitioner engagement on a volunteer telemedicine network during COVID-19, and the mechanisms that can potentially sustain volunteer engagement to address healthcare demands beyond the pandemic. METHODS In-depth qualitative interviews were conducted with health practitioners volunteering on an Indian, multi-state telemedicine network during the COVID-19 pandemic. Data were analyzed using thematic content analysis methods. RESULTS Most practitioners reported being motivated to volunteer by a sense of duty to serve during the pandemic. Practitioners suggested organizational-level measures to make the process more efficient and facilitate a more rewarding provider-patient interaction. These included screening calls, gathering patient information prior to consultations, and allowing for follow-up calls with patients to close the loop on consultations. Many practitioners stated that non-financial incentives are enough to maintain volunteer engagement. However, practitioners expressed mixed feelings about financial incentives. Some stated that financial incentives are needed to maintain long-term provider engagement, while others stated that financial incentives would devalue the volunteer experience. Most practitioners highlighted that telemedicine could increase access to healthcare, especially to the rural and underserved, even after the pandemic. Practitioners also expressed an interest in continuing to volunteer with the network if the need arose again. CONCLUSION Our study findings suggest that practitioners are highly intrinsically motivated to volunteer during large healthcare emergencies and beyond to address the healthcare needs of the underserved. Following the recommendations presented in the study, telemedicine networks can more successfully engage and maintain volunteer practitioners. Volunteer-based telemedicine networks have the potential to bridge shortages of health personnel in resource-constrained settings both in times of crises and beyond.
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Affiliation(s)
- Karishma D'Souza
- Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1101B McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC, 27599, USA.
| | - Saksham Singh
- School of Human Ecology, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Christopher M Westgard
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Sharon Barnhardt
- Centre for Social and Behaviour Change, Ashoka University, Rajiv Gandhi Education City, Sonipat, Haryana, 131029, India
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Gündüz M, Yüksel Güdek Y, Kasapkara ÇS. Out-of-pocket health expenditures in patients living with ınborn errors of metabolism. Orphanet J Rare Dis 2023; 18:179. [PMID: 37415155 DOI: 10.1186/s13023-023-02775-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 06/18/2023] [Indexed: 07/08/2023] Open
Abstract
AIM The implementation of newborn screening programs for inborn errors of metabolism has advanced the diagnosis and management of affected infants and undoubtedly improved their outcomes. We aimed to determine out-of-pocket health expenditures of patients with inborn errors of metabolism during follow-up and treatment processes and to determine the economic burden on the families. MATERIALS AND METHODS A total of 232 patients who voluntarily agreed to participate in the study and were regularly followed up in the Department of Pediatric Metabolism with the diagnosis of Inborn Errors of Metabolism between April 2022 and July 2022 were included. Questionnaires were asked about the demographic characteristics of patients, use of health services, follow-up, treatment procedures, frequency of controls and health expenditures. RESULTS The average out-of-pocket expenditure of the households in the last month was 1039.22 ± 1030.08 (minimum: 20, maximum: 5000) Turkish Liras. When we consider the catastrophic health expenditure rate as expenditure exceeding 40% of household income, we found that 9.9% (23 people) of parents included in the study made catastrophic health expenditures. The rate of catastrophic expenditure of patients with a diagnosis of Amino Acid Metabolism Disorders was found to be higher than that of patients with a diagnosis of Vitamin and Cofactor Metabolism Disorders. Similarly, patients with a diagnosis of lysosomal storage diseases had more expenditures than patients with a diagnosis of vitamin and cofactor metabolism disorders. When we compared the rate of catastrophic health expenditure of the patients with urea cycle disorders and the patients with a diagnosis of vitamin and cofactor metabolism disorders, the former had more expenditure than the latter (p < 0.05). There was no significant difference between other disease groups in terms of catastrophic expenditure. The rate of catastrophic expenditures of the households living as large family type were higher than the families living as nuclear family type (p < 0.01). A statistically significant difference was found between the rates of catastrophic expenditures of the families living in Ankara and those who were admitted from other provinces for follow-up and treatment (p < 0.001). However, there was no difference between the rates of catastrophic expenditure of the patients who received any treatment and those who were followed up without treatment (p > 0.05). CONCLUSION Due to the high rate of consanguineous marriages in our country, the development of newborn screening programs, the increase in awareness about metabolic diseases and the improvement in diagnostic methods, the frequency of metabolic diseases is increasing, and mortality and morbidity rates are significantly reduced with early diagnosis and treatment opportunities. It is necessary to carry out more comprehensive studies to determine and prevent the socioeconomic effects of out-of-pocket health expenditures of patients living with Inborn Errors of Metabolism.
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Affiliation(s)
- Mehmet Gündüz
- Department of Pediatric Metabolism, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Turkey.
| | - Yasemin Yüksel Güdek
- Department of Pediatrics, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Turkey
| | - Çiğdem Seher Kasapkara
- Department of Pediatric Metabolism, Ankara Bilkent City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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Mütze U, Gleich F, Barić I, Baumgartner M, Burlina A, Chapman KA, Chien Y, Cortès‐Saladelafont E, De Laet C, Dobbelaere D, Eysken F, Gautschi M, Santer R, Häberle J, Joaquín C, Karall D, Lindner M, Lund AM, Mühlhausen C, Murphy E, Roland D, Ruiz Gomez A, Skouma A, Grünert SC, Wagenmakers M, Garbade SF, Kölker S, Boy N. Impact of the SARS-CoV-2 pandemic on the health of individuals with intoxication-type metabolic diseases-Data from the E-IMD consortium. J Inherit Metab Dis 2023; 46:220-231. [PMID: 36266255 PMCID: PMC9874390 DOI: 10.1002/jimd.12572] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/20/2022] [Accepted: 10/19/2022] [Indexed: 01/27/2023]
Abstract
The SARS-CoV-2 pandemic challenges healthcare systems worldwide. Within inherited metabolic disorders (IMDs) the vulnerable subgroup of intoxication-type IMDs such as organic acidurias (OA) and urea cycle disorders (UCD) show risk for infection-induced morbidity and mortality. This study (observation period February 2020 to December 2021) evaluates impact on medical health care as well as disease course and outcome of SARS-CoV-2 infections in patients with intoxication-type IMDs managed by participants of the European Registry and Network for intoxication type metabolic diseases Consortium (E-IMD). Survey's respondents managing 792 patients (n = 479 pediatric; n = 313 adult) with intoxication-type IMDs (n = 454 OA; n = 338 UCD) in 14 countries reported on 59 (OA: n = 36; UCD: n = 23), SARS-CoV-2 infections (7.4%). Medical services were increasingly requested (95%), mostly alleviated by remote technologies (86%). Problems with medical supply were scarce (5%). Regular follow-up visits were reduced in 41% (range 10%-50%). Most infected individuals (49/59; 83%) showed mild clinical symptoms, while 10 patients (17%; n = 6 OA including four transplanted MMA patients; n = 4 UCD) were hospitalized (metabolic decompensation in 30%). ICU treatment was not reported. Hospitalization rate did not differ for diagnosis or age group (p = 0.778). Survival rate was 100%. Full recovery was reported for 100% in outpatient care and 90% of hospitalized individuals. SARS-CoV-2 impacts health care of individuals with intoxication-type IMDs worldwide. Most infected individuals, however, showed mild symptoms and did not require hospitalization. SARS-CoV-2-induced metabolic decompensations were usually mild without increased risk for ICU treatment. Overall prognosis of infected individuals is very promising and IMD-specific or COVID-19-related complications have not been observed.
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Affiliation(s)
- Ulrike Mütze
- Centre for Child and Adolescent Medicine, Division of Neuropaediatrics and Metabolic Medicine, Department of General PaediatricsUniversity Hospital HeidelbergHeidelbergGermany
| | - Florian Gleich
- Centre for Child and Adolescent Medicine, Division of Neuropaediatrics and Metabolic Medicine, Department of General PaediatricsUniversity Hospital HeidelbergHeidelbergGermany
| | - Ivo Barić
- University of Zagreb, School of Medicine and Department of PediatricsUniversity Hospital Center ZagrebZagrebCroatia
| | - Mathias Baumgartner
- University Children's Hospital and Children's Research Center, University of ZurichZurichSwitzerland
| | - Alberto Burlina
- Division of Inherited Metabolic DiseaseUniversity Hospital PadovaPadovaItaly
| | | | - Yin‐Hsiu Chien
- Department of Medical Genetics and PediatricsNational Taiwan University HospitalTaipeiTaiwan
| | - Elisenda Cortès‐Saladelafont
- University Hospital Germans Trias i Pujol, Department of Paediatrics, Unit of Inherited Metabolic Diseases and NeuropediatricsUniversitat Autònoma de BarcelonaBadalonaSpain
| | - Corinne De Laet
- Hôpital Universitaire des Enfants Reine Fabiola‐Université Libre de BruxellesBrusselsBelgium
| | - Dries Dobbelaere
- Medical Reference Center for Inherited Metabolic DiseasesJeanne de Flandre University Hospital and RADEME Research Team for Rare Metabolic and Developmental Diseases, CHRU LilleLilleFrance
| | - Francois Eysken
- Department of Pediatric Inherited Metabolic DiseasesUniversity Hospital of Antwerp UZAAntwerpBelgium
| | - Matthias Gautschi
- Department of Paediatrics, Division of Paediatric Endocrinology, Diabetology and Metabolism, InselspitalUniversity Hospital BernBernSwitzerland
| | - Rene Santer
- University Children's Hospital, University Medical Centre Hamburg‐EppendorfHamburgGermany
| | - Johannes Häberle
- University Children's Hospital and Children's Research Center, University of ZurichZurichSwitzerland
| | - Clara Joaquín
- Endocrinology and Nutrition DepartmentHospital Universitari Germans Trias i PujolBadalonaSpain
| | - Daniela Karall
- Clinic for PediatricsMedical University of InnsbruckInnsbruckAustria
| | - Martin Lindner
- Goethe University Frankfurt/Main, Uni.‐Children's HospitalFrankfurt/MainGermany
| | - Allan M. Lund
- Centre Inherited Metabolic Diseases, Departments of Paediatrics and Clinical GeneticsCopenhagen University HospitalCopenhagenDenmark
| | - Chris Mühlhausen
- Universitätsmedizin Göttingen, Georg‐August‐UniversitätGöttingenGermany
| | - Elaine Murphy
- National Hospital for Neurology and Neurosurgery, Charles Dent Metabolic UnitLondonUK
| | - Dominique Roland
- Institute of Pathology and Human Genetics (IPG)CharleroisBelgium
| | | | - Anastasia Skouma
- Institouto Ygeias Tou Paidiou, Institute of Child HealthAthensGreece
| | - Sarah C. Grünert
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical CentreUniversity of Freiburg, Faculty of MedicineFreiburgGermany
| | | | - Sven F. Garbade
- Centre for Child and Adolescent Medicine, Division of Neuropaediatrics and Metabolic Medicine, Department of General PaediatricsUniversity Hospital HeidelbergHeidelbergGermany
| | - Stefan Kölker
- Centre for Child and Adolescent Medicine, Division of Neuropaediatrics and Metabolic Medicine, Department of General PaediatricsUniversity Hospital HeidelbergHeidelbergGermany
| | - Nikolas Boy
- Centre for Child and Adolescent Medicine, Division of Neuropaediatrics and Metabolic Medicine, Department of General PaediatricsUniversity Hospital HeidelbergHeidelbergGermany
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Scheffer M, Cassenote A, de Britto E Alves MTSS, Russo G. The multiple uses of telemedicine during the pandemic: the evidence from a cross-sectional survey of medical doctors in Brazil. Global Health 2022; 18:81. [PMID: 36123696 PMCID: PMC9483882 DOI: 10.1186/s12992-022-00875-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of telemedicine, or the provision of healthcare and communication services through distance-based technologies, has increased substantially since the 2019 novel coronavirus (COVID-19) pandemic. However, it is still unclear what are the innovative features of the widespread use of such modality, its forms of employment and the context in which it is used across pluralist health systems, particularly in low- and middle-income settings. We have sought to provide empirical evidence on the above issues by analysing the responses of medical doctors in a representative cross-sectional survey in two states in Brazil: São Paulo and Maranhão. METHODS We analysed the responses of 1,183 physicians to a survey on the impact of COVID-19 on their livelihood and working practice. Two independent samples per state were calculated based on a total of 152,511 active medical registries in São Paulo and Maranhão. Proportional stratified sampling was performed and the distributions for gender, age, state and location of address (capital or countryside) were preserved. The survey contained questions on the frequency of physicians' employment of telemedicine services; the specific activities where these were employed, and; the forms in which the pandemic had influenced the adoption or consolidation of this technology. We performed descriptive and univariate analysis based on the chi-square test or Fisher's exact test for the qualitative data, and the Mann-Whitney test in the quantitative cases. Data were shown as absolute frequency and proportion with a 95% confidence interval. RESULTS In our sample of physicians, telemedicine was employed as a form of clinical collaboration by most doctors (76.0%, 95 CI 73.6-78.5), but only less than a third of them (30.6%, 95 CI 28.0-33.3) used it as a modality to provide healthcare services. During the pandemic, telemedicine was used predominantly in COVID-19-related areas, particularly for hospital-based in-patient services, and in private clinics and ambulatory settings. Male, younger doctors used it the most. Doctors in São Paulo employed telemedicine more frequently than in Maranhão (p < 0.001), in urban settings more than in rural areas (p < 0.001). Approximately three-quarters of doctors in large hospitals reported using telemedicine services (78.3%, 95 CI 75.9-80.6), followed by doctors working for smaller private clinics (66.4%, 95 CI 63.7-69.1), and by a smaller proportion of primary care doctors (58.4%, 95 CI 55.6-61.2). CONCLUSIONS Our study suggests that telemedicine may have helped ensure and expand the range of communication and healthcare services in low- and middle-income settings during the COVID-19 pandemic. However, the modality appears to lend itself to be disproportionally used by doctors working in specific, priviledged sections of pluralistic health systems, and presumably by patients seeking care there. Regulation and incentives will be required to support the use of the technology across health systems in low- and middle-income countries in order to increase access to services for less disadvantaged populations.
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Affiliation(s)
- Mário Scheffer
- Department of Preventive Medicine, University of São, Paulo. Avenida Dr. Arnaldo, 455, 2º andar, sala 2166, São Paulo (, SP, CEP: 01246-903, Brazil
| | - Alex Cassenote
- Department of Preventive Medicine, University of São, Paulo. Avenida Dr. Arnaldo, 455, 2º andar, sala 2166, São Paulo (, SP, CEP: 01246-903, Brazil
| | | | - Giuliano Russo
- Wolfson Institute of Population Health, Queen Mary University of London, 58 Turner street, London, E1 2AB, UK.
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