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Adler-Milstein J, Gopalan A, Huang J, Toretsky C, Reed M. Patterns of Telemedicine Use in Primary Care for People with Dementia in the Post-pandemic Period. J Gen Intern Med 2024:10.1007/s11606-024-08836-1. [PMID: 39046633 DOI: 10.1007/s11606-024-08836-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/21/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND The pandemic rapidly expanded telemedicine, which has persisted as a widely available primary care modality. The uptake of telemedicine among people with dementia specifically in the primary care setting, who have more complex care needs but also benefit from more accessible primary care, is unknown. OBJECTIVE Among people with dementia, assess uptake of telemedicine-based primary care in the post-pandemic period and determine associations with key socio-demographic characteristics. DESIGN Retrospective observational study. SUBJECTS People with dementia at UCSF and Kaiser Permanente Northern CA (KPNC) with at least one primary care encounter in pre- (3/1/2019-2/29/2020) or post-COVID (3/1/2021-2/28/2022) periods, post-COVID sample: N= 419 individuals (UCSF), N=18,037 (KPNC). MAIN MEASURES Encounter modality: in-person, video telemedicine, or telephone telemedicine. Focal socio-demographic characteristics: age, limited English proficiency, socioeconomic status, driving distance to clinic, and caregiver at encounter. KEY RESULTS There was a large increase in telemedicine among people with dementia in the post-pandemic period at both sites. At KPNC, those with only in-person primary care visits shrunk from 60.47% (pre) to 26.95% (post). At UCSF, the change was even greater: 98.99% to 35.08%. Across both sites, the only measure significantly associated with use of telemedicine was greater driving distance from home to clinic. At KPNC, those over age 90 were most likely to use telemedicine while patients with limited English proficiency and those with a caregiver at the encounter used telemedicine at lower levels. The relationships were similar at UCSF but not statistically significant. CONCLUSIONS Telemedicine use is high for people with dementia in the primary care setting in the post-pandemic period. Those with longer drives to clinic and the oldest patients were most likely to use telemedicine, likely due to challenges traveling to appointments. Still, not all people with dementia used telemedicine equally-particularly those with limited English proficiency.
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Affiliation(s)
- Julia Adler-Milstein
- Center for Clinical Informatics and Improvement Research, Department of Medicine, University of California, San Francisco, CA, USA.
| | - Anjali Gopalan
- Kaiser Permanente Northern California (KPNC) Division of Research, Oakland, CA, USA
| | - Jie Huang
- Kaiser Permanente Northern California (KPNC) Division of Research, Oakland, CA, USA
| | - Christopher Toretsky
- Center for Clinical Informatics and Improvement Research, Department of Medicine, University of California, San Francisco, CA, USA
| | - Mary Reed
- Kaiser Permanente Northern California (KPNC) Division of Research, Oakland, CA, USA
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Toapanta N, Sánchez-Gavilan E, Guirao C, Leon Román J, Ramos N, Vergara A, Azancot M, Agraz I, Bermejo S, Montiel E, Molina C, Ribó M, Soler MJ. Pilot monitoring study in patients with diabetic kidney disease using NORA application. Nefrologia 2024:S2013-2514(24)00132-9. [PMID: 39013756 DOI: 10.1016/j.nefroe.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Diabetic Kidney Disease (DKD) is the most common cause of end-stage chronic kidney disease (CKD), conditioning these patients to a worse renal prognosis and higher cardiovascular mortality and/or requirement for renal replacement therapy. The use of novel information and communication technologies (ICTs) focused on the field of health, may facilitates a better quality of life and disease control in these patients. Our objective is to evaluate the effect of monitoring DKD patients using NORA-app. MATERIAL AND METHODS Prospective feasibility/validation study of NORA-app in patients with DKD stage G3bA3 or higher, followed in outpatient clinics of a tertiary care hospital. NORA-app is an application for smartphones designed to control risk factors, share educational medical information, communicate via chat with health professionals, increase treatment compliance (Morisky-Green), and collect patient reported outcomes such as anxiety and depression using HADs scale. Clinical-laboratory variables were collected at 3 months and compared to control patients who declined using NORA-app. RESULTS From 01/01/2021 to 03/03/2022 the use of NORA-app was offered to 118 patients, 82 accepted and 36 declined (controls). After a mean follow-up period of 6,04 months and at the time of data extraction 71 (86.6%) NORA-app patients remain active users, 2 have completed the follow-up at one year and 9 are inactive (3 due to death and 6 due to non-locatable). There were no differences in baseline characteristics including Creatinine [2.1 (1.6-2.4) vs. 1.9 (1.5-2.5)] mg/dL and alb/creat [962 (475-1784) vs. 1036 (560-2183)] mg/gr between Nora and control patients respectively. The therapeutic compliance rate in the NORA-app group was 77%, improving at 90 days to 91%. Patients in the NORA-group showed significantly lower levels of alb/creat than controls (768(411-1971) mg/g Vs 2039 (974-3214) p = 0.047) at 90-day follow-up. CONCLUSIONS In patients with DKD the use of NORA-app was maintained in the long-term, leading to high levels of treatment compliance, and achieving a better disease control. Our study suggests that the generalized use of ICTs may help in the personalized monitoring of these patients to delay the progression of kidney disease.
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Affiliation(s)
- Néstor Toapanta
- Serivicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | | | - Cristina Guirao
- Serivicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Juan Leon Román
- Serivicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Natalia Ramos
- Serivicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Ander Vergara
- Serivicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - María Azancot
- Serivicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Irene Agraz
- Serivicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Sheila Bermejo
- Serivicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Estefanía Montiel
- Serivicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Carlos Molina
- Serivicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Marc Ribó
- Serivicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - María José Soler
- Serivicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
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Chua M, Lau XK, Ignacio J. Facilitators and barriers to implementation of telemedicine in nursing homes: A qualitative systematic review and meta-aggregation. Worldviews Evid Based Nurs 2024; 21:318-329. [PMID: 38340069 DOI: 10.1111/wvn.12711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/31/2023] [Accepted: 01/14/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Telemedicine is an effective way to provide nursing home residents ease of access to consultations with healthcare professionals. It is safe, effective, and time- and cost-efficient, and can be used when there are movement restrictions, such as during the COVID-19 pandemic. This literature focuses only on healthcare professionals' experiences and perspectives on the use of telemedicine in long-term care facilities. OBJECTIVES This review concentrated on telemedicine programs that did not involve remote monitoring. It aimed to comprehensively appraise existing literature examining the facilitators and barriers in implementing telemedicine services in nursing homes. METHODS A systematic qualitative review was conducted with content analysis. Database searching was conducted in PubMed, Embase, Cochrane, Scopus, and CINAHL. Hand searching for gray literature and reference lists of included papers was also performed. Qualitative studies or mixed-method studies with a qualitative analysis addressing implementation of telemedicine in any long-term care facilities were included. The Critical Appraisal Skills Programme qualitative checklist was used to assess the quality of the included studies. The data were extracted and cross-checked between two reviewers. A third reviewer was consulted for any disagreements. Meta-aggregation was used to synthesize the results. RESULTS Eighty-one findings were extracted, which informed 16 categories and 13 synthesized findings. The synthesized findings were related to the innovation domain, infrastructure, work processes, individuals, and implementation processes. LINKING EVIDENCE TO ACTION This review highlighted factors that affect the successful implementation of a telemedicine service in nursing homes. These findings provide evidence to support the future utilization of this service in the nursing home setting. Further research should explore the best approach to address these barriers and facilitators.
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Affiliation(s)
- Min Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xue Kee Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jeanette Ignacio
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Neumann A, König HH, Hajek A. Determinants of Telemedicine Service Use Among Middle-Aged and Older Adults in Germany During the COVID-19 Pandemic: Cross-Sectional Survey Study. JMIR Aging 2024; 7:e50938. [PMID: 38654578 PMCID: PMC11063582 DOI: 10.2196/50938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 04/26/2024] Open
Abstract
Background The occurrence of the COVID-19 pandemic demanded fast changes in the delivery of health care. As a result, significant growth in the use of telemedicine services occurred. Research, especially from nationally representative German samples, is needed to better understand determinants of telemedicine use. Objective The purpose of this study was to identify determinants of telemedicine service use among middle-aged and older adults during the COVID-19 pandemic in Germany. Methods Cross-sectional, nationally representative data were taken from the German sample of the Survey of Health, Ageing and Retirement in Europe (SHARE). The German Corona Survey 2 (n=2039), which was conducted between June and August 2021, was used for this study. Reporting experience with remote medical consultations during the COVID-19 pandemic served as the outcome measure. Associations with socioeconomic, psychological, social, health-related, and COVID-19-related determinants were examined using multiple Firth logistic regressions. Results Psychological factors including feeling nervous, anxious, or on edge (odds ratio [OR] 1.61, 95% CI 1.04-2.50; P=.03), feeling sad or depressed (OR 1.62, 95% CI 1.05-2.51; P=.03) and feelings of loneliness (OR 1.66, 95% CI 1.07-2.58; P=.02) were positively associated with telemedicine use. Moreover, forgoing medical treatment because of being afraid of being infected by SARS-CoV-2 (OR 1.81, 95% CI 1.10-2.97; P=.02) and describing limitations because of a health problem as severe were positively associated with the outcome (OR 2.11, 95% CI 1.12-4.00; P=.02). Socioeconomic and social factors were not significantly associated with telemedicine use in our sample. Conclusions Middle-aged and older individuals in Germany seem to use telemedicine services according to psychological needs and health limitations. Especially when psychological symptoms are experienced, telemedicine seems to be a promising service option in this age group. Future research is needed to confirm these initial findings in postpandemic circumstances.
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Affiliation(s)
- Ariana Neumann
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Leighton C, Cooper A, Porter A, Edwards A, Joseph-Williams N. Effectiveness and safety of asynchronous telemedicine consultations in general practice: a systematic review. BJGP Open 2024; 8:BJGPO.2023.0177. [PMID: 37783479 PMCID: PMC11169987 DOI: 10.3399/bjgpo.2023.0177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND There is a focus on increasing asynchronous telemedicine use, which allows medical data to be transmitted, stored, and interpreted later; however, limited evidence of the quality of care it allows in general practice hinders its use. AIM To investigate uses and effectiveness of asynchronous telemedicine in general practice, according to the domains of healthcare quality, and describe how the COVID-19 pandemic changed its use. DESIGN & SETTING Systematic review in general practice. METHOD A systematic search was carried out across four databases using terms related to general practice, asynchronous telemedicine, uses, and effectiveness, and supported by citation searching. This was followed by screening according to pre-defined criteria, data extraction, and critical appraisal. Narrative synthesis was then undertaken guided by the six domains of healthcare quality and exploring differences in use before and following the COVID-19 pandemic. RESULTS Searches yielded 6864 reports; 27 reports from 23 studies were included. Asynchronous telemedicine is used by a range of staff and patients across many countries. Safety and equity are poorly reported but there were no major safety concerns. Evidence from other domains of healthcare quality show effectiveness in making diagnoses, prescribing medications, replacing other consultations, providing timely care, and increased convenience for patients. Efficiency is impacted by negative effects on workflow, through poor implementation and patient non-adherence, limiting usability and requiring new administrative approaches from healthcare staff. Asynchronous telemedicine use increased rapidly from March 2020, following the COVID-19 pandemic outbreak. CONCLUSION Asynchronous telemedicine provides quality care for patients but is limited by reports of increased workload and inefficient workflow compared with face-to-face consultations. Limits of evidence include heterogeneity and small-scale studies. Further research into cost-effectiveness, equity, safety, and sustained implementation will influence future policy and practice.
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Affiliation(s)
| | - Alison Cooper
- Division of Population Medicine Cardiff University, Cardiff, UK
| | | | - Adrian Edwards
- Division of Population Medicine Cardiff University, Cardiff, UK
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Dawson R, Oliveira JS, Kwok WS, Bratland M, Rajendran IM, Srinivasan A, Chu CY, Pinheiro MB, Hassett L, Sherrington C. Exercise Interventions Delivered Through Telehealth to Improve Physical Functioning for Older Adults with Frailty, Cognitive, or Mobility Disability: A Systematic Review and Meta-Analysis. Telemed J E Health 2024; 30:940-950. [PMID: 37975811 PMCID: PMC11035924 DOI: 10.1089/tmj.2023.0177] [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: 04/06/2023] [Revised: 08/17/2023] [Accepted: 09/01/2023] [Indexed: 11/19/2023] Open
Abstract
Introductions: This study assessed the effects of telehealth-delivered exercise interventions on physical functioning for older adults and explored implementation measures related to program delivery. Methods: We conducted a systematic review of studies investigating effects of exercise interventions delivered through telehealth in adults 60+ years of age with frailty, mobility, or cognitive disability on mobility, strength, balance, falls, and quality of life (QoL). Electronic databases (MEDLINE, CINAHL, SPORTSDiscus, and Physiotherapy Evidence Database) were searched from inception until May 2022. Evidence certainty was assessed with Grading of Recommendations, Assessment, Development, and Evaluation and meta-analysis summarized study effects. Results: A total of 11 studies were included, 5 randomized controlled trials, 2 pilot studies, and 4 feasibility studies. The overall certainty of evidence was rated as "low" or "very low." Pooled between-group differences were not statistically significant, but effect sizes suggested that telehealth produced a moderate improvement on mobility (n = 5 studies; standardized mean difference [SMD] = 0.63; 95% confidence interval [CI] = -0.25 to 1.51; p = 0.000, I2 = 86%) and strength (n = 4; SMD = 0.73; 95% CI = -0.10 to 1.56; p = 0.000, I2 = 84%), a small improvement on balance (n = 3; SMD = 0.40; 95% CI = -035 to 1.15; p = 0.012, I2 = 78%), and no effect on QoL. Analysis of implementation measures suggested telehealth to be feasible in this population, given high rates of acceptability and adherence with minimal safety concerns. Discussion: Telehealth may provide small to moderate benefits on a range of physical outcomes and appears to be well received in aged care populations.
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Affiliation(s)
- Rik Dawson
- Sydney Musculoskeletal Health, Insititue for Musculoskeletal Health, The University of Sydney, Sydney Local Health District, Gadigal Country, Sydney, Australia
| | - Juliana S. Oliveira
- Sydney Musculoskeletal Health, Insititue for Musculoskeletal Health, The University of Sydney, Sydney Local Health District, Gadigal Country, Sydney, Australia
| | - Wing S. Kwok
- Sydney Musculoskeletal Health, Insititue for Musculoskeletal Health, The University of Sydney, Sydney Local Health District, Gadigal Country, Sydney, Australia
| | - Marte Bratland
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Gadigal Country, Sydney, Australia
| | - Ian Matthew Rajendran
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Gadigal Country, Sydney, Australia
| | - Ajith Srinivasan
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Gadigal Country, Sydney, Australia
| | - Chun Yin Chu
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Gadigal Country, Sydney, Australia
| | - Marina B. Pinheiro
- Sydney Musculoskeletal Health, Insititue for Musculoskeletal Health, The University of Sydney, Sydney Local Health District, Gadigal Country, Sydney, Australia
| | - Leanne Hassett
- Sydney Musculoskeletal Health, Insititue for Musculoskeletal Health, The University of Sydney, Sydney Local Health District, Gadigal Country, Sydney, Australia
| | - Catherine Sherrington
- Sydney Musculoskeletal Health, Insititue for Musculoskeletal Health, The University of Sydney, Sydney Local Health District, Gadigal Country, Sydney, Australia
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Gamble CJ, van Haastregt JCM, van Dam van Isselt EF, Zwakhalen SMG, Schols JMGA. Effectiveness of guided telerehabilitation on functional performance in community-dwelling older adults: A systematic review. Clin Rehabil 2024; 38:457-477. [PMID: 38013415 PMCID: PMC10898211 DOI: 10.1177/02692155231217411] [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: 09/08/2022] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To systematically review the effectiveness of guided telerehabilitation on improving functional performance in community-dwelling older adults. DATA SOURCES Articles published in PubMed, Cochrane Library and Embase (Ovid) from 01 January 2010 up to 17 October 2023. REVIEW METHODS Included studies had (1) a randomised controlled trial design, (2) an average population age of 65 years or older, (3) a home-based setting and (4) evaluated the effectiveness of functional performance outcome measures. The intervention was considered telerehabilitation when guided by a healthcare professional using video, audio and/or text communication technologies with a minimum frequency of once per week. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 statement guideline was followed. Methodological quality was appraised using the revised Cochrane Risk of Bias tool. RESULTS A total of 26 randomised controlled trials were included. Telerehabilitation had superior (N = 15), non-superior (N = 16) or non-inferior (N = 11) effectiveness for improving functional performance outcome measures compared to control interventions. No studies found the control intervention to be superior over telerehabilitation. Between study differences in intervention characteristics contributed to significant clinical heterogeneity. Five studies were found to present an overall 'low' risk of bias, 12 studies to present 'some' risk of bias and 9 studies to present an overall 'high' risk of bias. CONCLUSION The findings suggest that telerehabilitation could be a promising alternative to in-person rehabilitation for improving functional performance in community-dwelling older adults. Additional well-designed studies with minimised bias are needed for a better understanding of effective telerehabilitation intervention strategies.
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Affiliation(s)
- CJ Gamble
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
- Stichting Valkenhof, Valkenswaard, The Netherlands
| | - JCM van Haastregt
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - EF van Dam van Isselt
- University Network for the Care sector Zuid-Holland, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - SMG Zwakhalen
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - JMGA Schols
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
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Dawson R, Gilchrist H, Pinheiro M, Nelson K, Bowes N, Sherrington C, Haynes A. Experiences of Older Adults, Physiotherapists, and Aged Care Staff in the TOP UP Telephysiotherapy Program: Interview Study of the TOP UP Interventions. JMIR Aging 2024; 7:e53010. [PMID: 38324369 PMCID: PMC10882472 DOI: 10.2196/53010] [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: 09/22/2023] [Revised: 11/19/2023] [Accepted: 12/18/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Telehealth provides opportunities for older adults to access health care. However, limited research exists on the use of telehealth within aged care services, particularly regarding physiotherapy-led fall prevention and mobility programs. Understanding the experiences and interactions of older adults, physiotherapists, and aged care service providers is crucial for the scale-up and sustainability of such essential programs. The TOP UP study, a hybrid type 1 effectiveness-implementation randomized controlled trial in aged care, used a supported multidisciplinary telephysiotherapy model to motivate older adults to engage in exercises to improve mobility and reduce falls. OBJECTIVE This qualitative substudy aims to achieve 2 primary objectives: to describe the experiences and acceptability of the TOP UP intervention for older people, physiotherapists, and aged care support workers and managers and to gain an in-depth understanding of program implementation. METHODS A purposive recruitment strategy was used to select 18 older adults who participated in the TOP UP intervention, ensuring variation in age, gender, residential status (home or residential aged care), geographic location, and cognitive levels. In addition, 7 physiotherapists, 8 aged care support workers, and 6 managers from 7 different aged care provider partners participated in this study. Semistructured interviews were conducted to explore stakeholders' experiences with the TOP UP program, gather suggestions for improvement, and obtain insights for the future implementation of similar telephysiotherapy programs. The interview framework and coding processes were informed by behavior changes and implementation frameworks. Data were analyzed using an abductive approach, informed by 2 behavioral change theories (Capability, Opportunity, Motivation, and Behavior Model and Self-Determination Theory) and the Nonadoption, Abandonment and Challenges to the Scale-Up, Spread and Sustainability of Health and Care Technologies framework. RESULTS All participants (n=39) reported high levels of acceptability for the TOP UP program and cited multiple perceived benefits. The thematic analysis generated 6 main themes: telephysiotherapy expands opportunity; tailored physiotherapy care with local support enhances motivation; engaging, older adult-friendly educational resources build capability; flexible reablement approach fosters autonomy; telephysiotherapy is safe, effective, and acceptable for many; and organizational commitment is required to embed telehealth. The motivation to exercise was enhanced by Zoom's convenience, use of tailored web-based exercise resources, and companionable local support. CONCLUSIONS This study highlights the inherent value of telephysiotherapy in aged care, emphasizing the need for investment in staff training, local support, and older adult-friendly resources in future telephysiotherapy iterations. TOP UP represents a convenient and flexible web-based care model that empowers many older adults to receive sustainable, high-quality care precisely when and where they need it. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN 1261000734864; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621000734864.
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Affiliation(s)
- Rik Dawson
- Institute for Musculoskeletal Health, Sydney Musculoskeletal Health, Sydney Local Health District, The University of Sydney, Camperdown, Australia
| | - Heidi Gilchrist
- Institute for Musculoskeletal Health, Sydney Musculoskeletal Health, Sydney Local Health District, The University of Sydney, Camperdown, Australia
| | - Marina Pinheiro
- Institute for Musculoskeletal Health, Sydney Musculoskeletal Health, Sydney Local Health District, The University of Sydney, Camperdown, Australia
| | | | | | - Cathie Sherrington
- Institute for Musculoskeletal Health, Sydney Musculoskeletal Health, Sydney Local Health District, The University of Sydney, Camperdown, Australia
| | - Abby Haynes
- Institute for Musculoskeletal Health, Sydney Musculoskeletal Health, Sydney Local Health District, The University of Sydney, Camperdown, Australia
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Pimentel CB, Dryden EM, Nearing KA, Kernan LM, Kennedy MA, Hung WW, Riley J, Moo LR. The role of Department of Veterans Affairs community-based outpatient clinics in enhancing rural access to geriatrics telemedicine specialty care. J Am Geriatr Soc 2024; 72:520-528. [PMID: 38032320 DOI: 10.1111/jgs.18703] [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: 07/26/2023] [Revised: 10/16/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Half of the 4.7 M veterans who reside in rural communities and rely on U.S. Department of Veterans Affairs (VA) health care are older (≥65). Their rurality presents unique challenges, including a shortage of clinicians skilled in geriatric medicine. Community-based outpatient clinics (CBOCs) help extend VA's geographic reach but are typically located in under-resourced settings. Telemedicine may increase access to care, but little is known about CBOCs' capacity to leverage telemedicine to meet older patients' needs. We identified organizational barriers and facilitators to the use of geriatric telemedicine specialty care from the perspective of rural clinicians and staff. METHODS From February-April 2020, we interviewed CBOC clinicians and staff (N = 50) from 13 rural CBOCs affiliated with four VA Geriatric Research Education and Clinical Centers. Semi-structured interviews addressed patient population characteristics; CBOC location, staffing, and in-house resources; use of VA specialty care services; and telemedicine use. We developed a codebook using an iterative process and Gale's Framework Method thematically organize and analyze data. RESULTS Respondents perceived that their CBOCs serve a predominantly older patient population. Four characteristics enabled CBOCs to offer geriatric telemedicine specialty care: partnerships with larger VA Medical Center teams; social worker/telehealth clinical technician knowledge of geriatrics and telehealth resources; periodic outreach/education from geriatric specialists; and routine use of other telehealth services. Barriers included: constraints on clinic space and unstable internet for telemedicine visits; staffing challenges leading to limited familiarity with telemedicine resources; and clinician and staff perceptions of older veterans' preference for in-person visits. CONCLUSIONS Telemedicine is an important modality to enhance access to care for an increasingly older and medically complex patient population. Although rural CBOCs provide a large portion of care to VA's growing geriatric population, staff are insufficiently trained in geriatrics, work in resource-poor settings, and are largely unaware of VA telemedicine programs designed to support them.
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Affiliation(s)
- Camilla B Pimentel
- New England Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Eileen M Dryden
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Kathryn A Nearing
- Eastern Colorado VA Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Laura M Kernan
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Meaghan A Kennedy
- New England Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - William W Hung
- Bronx Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
- Icahn School of Medicine, Mount Sinai, New York, USA
| | - Jessica Riley
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Lauren R Moo
- New England Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Harvard Medicine School, Boston, Massachusetts, USA
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10
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Dotan E, Lynch SM, Ryan JC, Mitchell EP. Disparities in care of older adults of color with cancer: A narrative review. Cancer Med 2024; 13:e6790. [PMID: 38234214 PMCID: PMC10905558 DOI: 10.1002/cam4.6790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/06/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024] Open
Abstract
This review describes the barriers and challenges faced by older adults of color with cancer and highlights methods to improve their overall care. In the next decade, cancer incidence rates are expected to increase in the United States for people aged ≥65 years. A large proportion will be older adults of color who often have worse outcomes than older White patients. Many issues contribute to racial disparities in older adults, including biological factors and social determinants of health (SDOH) related to healthcare access, socioeconomic concerns, systemic racism, mistrust, and the neighborhood where a person lives. These disparities are exacerbated by age-related challenges often experienced by older adults, such as decreased functional status, impaired cognition, high rates of comorbidities and polypharmacy, poor nutrition, and limited social support. Additionally, underrepresentation of both patients of color and older adults in cancer clinical research results in a lack of adequate data to guide the management of these patients. Use of geriatric assessments (GA) can aid providers in uncovering age-related concerns and personalizing interventions for older patients. Research demonstrates the ability of GA-directed care to result in fewer treatment-related toxicities and improved quality of life, thus supporting the routine incorporation of validated GA into these patients' care. GA can be enhanced by including evaluation of SDOH, which can help healthcare providers understand and address the needs of older adults of color with cancer who face disparities related to their age and race.
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Affiliation(s)
- Efrat Dotan
- Department of Hematology/OncologyFox Chase Cancer CenterPhiladelphiaPennsylvaniaUSA
| | | | | | - Edith P. Mitchell
- Clinical Professor of Medicine and Medical OncologySidney Kimmel Cancer Center at JeffersonPhiladelphiaPennsylvaniaUSA
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11
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Sharma P, Kamath C, Brockman TA, Roche A, Sinicrope P, Jiang R, Decker PA, Pazdernik V, Patten C. Demographics and Social Factors Associated With Persistent Nonuse of Video Appointments at a Multisite Health Care Institution: Cross-Sectional Study. JMIR Form Res 2024; 8:e50572. [PMID: 38265855 PMCID: PMC10851122 DOI: 10.2196/50572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/21/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND During the COVID-19 outbreak, video appointments became a popular method for health care delivery, particularly in the early stages of the pandemic. Although Mayo Clinic aimed to reduce face-to-face (F2F) appointments to prevent the spread of the virus, some patients continued seeing their health care providers in person. In the later stages of the pandemic, many patients became comfortable with video appointments, even if they were initially hesitant. However, a subset of patients continued to avoid video appointments. It is not yet clear what sociodemographic factors may be associated with this group of patients. OBJECTIVE This cross-sectional study aimed to examine demographic and social determinant of health (SDoH) factors associated with persistent nonusers of video appointments among a sample of patients within a multistate health care organization. We also explored patient beliefs about the use of video for health care appointments. METHODS We conducted a 1-time cross-sectional paper survey, mailed between July and December 2022, of patients matching the eligibility criteria: (1) aged ≥18 years as of April 2020, (2) Mayo Clinic Midwest, Florida, or Arizona patient, (3) did not use video appointment services during April-December 2020 but attended F2F appointments in the departments of primary care and psychiatry/psychology. The survey asked patients, "Have you ever had a video appointment with a healthcare provider?" "Yes" respondents were defined as "users" (adapted to video appointments), and "no" respondents were defined as "persistent nonusers" of video appointments. We analyzed demographics, SDoH, and patient beliefs toward video appointments in 2 groups: persistent nonusers of video appointments and users. We used chi-square and 2-tailed t tests for analysis. RESULTS Our findings indicate that patients who were older, lived in rural areas, sought care at Mayo Clinic Midwest, and did not have access to the patient portal system were likely to be persistent nonusers of video appointments. Only 1 SDoH factor (not having a disability, handicap, or chronic disease) was associated with persistent nonuse of video appointments. Persistent nonusers of video appointments held personal beliefs such as discomfort with video communication, difficulty interpreting nonverbal cues, and personal preference for F2F appointments over video. CONCLUSIONS Our study identified demographic (older age and rural residence), sociodemographic factors (not having a disability, handicap, or chronic disease), and personal beliefs associated with patients' decisions to choose between video versus F2F appointments for health care delivery. Health care institutions should assess patients' negative attitudes toward technology prior to introducing them to digital health care services. Failing to do so may result in its restricted usage, negative patient experience, and wasted resources. For patients who hold negative beliefs about technology but are willing to learn, a "digital health coordinator" could be assigned to assist with various digital health solutions.
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Affiliation(s)
- Pravesh Sharma
- Psychiatry and Psychology, Mayo Clinic Health System, Eau Claire, WI, United States
| | - Celia Kamath
- Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Tabetha A Brockman
- Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, United States
| | - Anne Roche
- Psychology, Mayo Clinic, Rochester, MN, United States
| | - Pamela Sinicrope
- Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Ruoxiang Jiang
- Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Paul A Decker
- Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Vanessa Pazdernik
- Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Christi Patten
- Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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12
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Abel B, Bongartz M, Rapp K, Roigk P, Peiter J, Metz B, Finger B, Büchele G, Wensing M, Roth C, Schmidberger O, König HH, Gottschalk S, Dams J, Deuster O, Immel D, Micol W, Bauer JM, Benzinger P. Multimodal home-based rehabilitation intervention after discharge from inpatient geriatric rehabilitation (GeRas): study protocol for a multicenter randomized controlled trial. BMC Geriatr 2024; 24:69. [PMID: 38233746 PMCID: PMC10795216 DOI: 10.1186/s12877-023-04634-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/22/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Geriatric rehabilitation aims to maintain the functional reserves of older adults in order to optimize social participation and prevent disability. After discharge from inpatient geriatric rehabilitation, patients are at high risk for decreased physical capacity, increased vulnerability, and limitations in mobility. As a result, ageing in place becomes uncertain for a plethora of patients after discharge from geriatric rehabilitation and effective strategies to prevent physical decline are required. Collaboration between different health-care providers is essential to improve continuity of care after discharge from inpatient geriatric rehabilitation. The aim of this study is to evaluate the effectiveness of a multi-professional home-based intervention program (GeRas) to improve functional capacity and social participation in older persons after discharge from inpatient geriatric rehabilitation. METHODS The study is a multicenter, three-arm, randomized controlled trial with a three-month intervention period. Two hundred and seventy community-dwelling older people receiving inpatient geriatric rehabilitation will be randomized with a 1:1:1 ratio to one of the parallel intervention groups (conventional IG or tablet IG) or the control group (CG). The participants of both IGs will receive a home-based physical exercise program supervised by physical therapists, a nutritional recommendation by a physician, and social counseling by social workers of the health insurance company. The collaboration between the health-care providers and management of participants will be realized within a cloud environment based on a telemedicine platform and supported by multi-professional case conferences. The CG will receive usual care, two short handouts on general health-related topics, and facultative lifestyle counseling with general recommendations for a healthy diet and active ageing. The primary outcomes will be the physical capacity measured by the Short Physical Performance Battery and social participation assessed by the modified Reintegration to Normal Living Index, three months after discharge. DISCUSSION The GeRas program is designed to improve the collaboration between health-care providers in the transition from inpatient geriatric rehabilitation to outpatient settings. Compared to usual care, it is expected to improve physical capacity and participation in geriatric patients after discharge from inpatient geriatric rehabilitation. TRIAL REGISTRATION German Clinical Trials Register (DRKS00029559). Registered on October 05, 2022.
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Grants
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- German Innovation Fund (‘New Forms of Care’) coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- Universitätsklinikum Heidelberg (8914)
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Affiliation(s)
- Bastian Abel
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Martin Bongartz
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Patrick Roigk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Janine Peiter
- Geriatric Center Karlsruhe, ViDia Christian Clinics Karlsruhe, Karlsruhe, Germany
| | - Brigitte Metz
- Geriatric Center Karlsruhe, ViDia Christian Clinics Karlsruhe, Karlsruhe, Germany
| | - Benjamin Finger
- Department of Telemedicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Catharina Roth
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver Schmidberger
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Deuster
- Interdisciplinary Center for Clinical Trials (IZKS) at the University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Désirée Immel
- AOK Baden-Württemberg, Statutory Health Insurance Company, Stuttgart, Germany
| | - William Micol
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen M Bauer
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Petra Benzinger
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany.
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13
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Buawangpong N, Pinyopornpanish K, Pliannuom S, Nantsupawat N, Wiwatkunupakarn N, Angkurawaranon C, Jiraporncharoen W. Designing Telemedicine for Older Adults With Multimorbidity: Content Analysis Study. JMIR Aging 2024; 7:e52031. [PMID: 38198201 PMCID: PMC10809167 DOI: 10.2196/52031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/06/2023] [Accepted: 12/04/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Telemedicine is a potential option for caring for older adults with multimorbidity. There is a need to explore the perceptions about telemedicine among older adults with multimorbidity to tailor it to the needs of older adults with multiple chronic conditions. OBJECTIVE This study aims to explore the perceptions about telemedicine among older patients with multimorbidity. METHODS A qualitative study was conducted using semistructured interviews. The interview questions examined older adults' perspectives about telemedicine, including their expectations regarding telemedicine services and the factors that affect its use. Thematic analysis was performed using NVivo (version 12; Lumivero). The study was reported using the Standards for Reporting Qualitative Research guidelines. RESULTS In total, 29 patients with multimorbidity-21 (72%) female patients and 8 (28%) male patients with a mean age of 69 (SD 10.39) years-were included. Overall, 4 themes and 7 subthemes emerged: theme 1-perceived benefit of telemedicine among older adults with multimorbidities, theme 2-appropriate use of telemedicine for multimorbid care, theme 3-telemedicine system catering to the needs of older patients, and theme 4-respect patients' decision to decline to use telemedicine. CONCLUSIONS Telemedicine for older adults with multimorbidity should focus on those with stable conditions. This can help increase access to care for those requiring continuous condition monitoring. A structured telemedicine program and patient-centered services can help increase patient acceptance of telemedicine. However, health care providers must accept the limitations of older patients that may prevent them from receiving telemedicine services.
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Affiliation(s)
- Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Suphawita Pliannuom
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Nopakoon Nantsupawat
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Nutchar Wiwatkunupakarn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
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14
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Holmes A, Chang YP. Non-pharmacological management of neuropathic pain in older adults: a systematic review. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:47-56. [PMID: 37607003 DOI: 10.1093/pm/pnad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Neuropathic pain encompasses multiple diagnoses with detrimental impacts on quality of life and overall health. In older adults, pharmacological management is limited by adverse effects and drug interactions, while surgical management involves perioperative risk. Prior reviews addressing non-pharmacological interventions for neuropathic pain have not focused on this demographic. Therefore, this systematic review synthesizes the evidence regarding the effectiveness of non-pharmacological interventions in reducing neuropathic pain severity in older adults. METHODS PubMed, CINAHL, Web of Science, and PsycInfo were searched using key terms, with inclusion criteria of age ≥ 65, neuropathic pain, non-pharmacological intervention, pain severity measurement, English language, peer-reviewed, and either randomized controlled trial (RCT) or quasi-experimental design. In total, 2759 records were identified, with an additional 28 records identified by review of reference lists. After removal of duplicates, 2288 records were screened by title and abstract, 404 full-text articles were assessed, and 19 articles were critically reviewed and synthesized. RESULTS Of the 14 RCTs and 5 quasi-experimental studies included in the review, the most common intervention was electric and/or magnetic therapy, followed by acupuncture, mindfulness meditation, exercise, and light therapy. Several studies revealed both statistical and clinical significance, but conclusions were limited by small sample sizes and methodological shortcomings. The interventions were generally safe and acceptable. CONCLUSIONS Results should be interpreted with consideration of clinical vs statistical significance, mediators of pain severity, and individual variations in effectiveness. Further research should address multimodal and novel interventions, newer models of care, and technology-based interventions.
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Affiliation(s)
- Ashleigh Holmes
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY 14214-3079, United States
| | - Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY 14214-3079, United States
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15
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Cecconi M, Spies CD, Moreno R. Economic sustainability of intensive care in Europe. Intensive Care Med 2024; 50:136-140. [PMID: 38054995 DOI: 10.1007/s00134-023-07268-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/03/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy.
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
| | - Claudia D Spies
- Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Rui Moreno
- Faculdade de Ciências Médicas de Lisboa (Nova Medical School), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
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16
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Neumann AV, Gonzalez A, Walter LC, Rivera J. Improving older adults' telehealth through a novel community-academic partnership: Preliminary data. J Am Geriatr Soc 2023; 71:3886-3895. [PMID: 37607098 DOI: 10.1111/jgs.18556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/28/2023] [Accepted: 07/13/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND The COVID-19 pandemic increased the use of telehealth, which posed unique challenges for the provision of care to older adults who face numerous barriers to accessing and using technology. To improve older adults' online health-related abilities, the UCSF Geriatrics Workforce Enhancement Program (UCSF-GWEP) partnered with Little Brothers Friends of the Elderly-San Francisco (LBFE-SF) to develop a model telehealth training intervention. METHODS LBFE-SF recruited older adults from their members with wi-fi and paired each one with a new device and volunteer trainer to cover seven lessons and four key tasks (emailing providers, video visits, accessing health information, and using patient portals). Older adults completed surveys to self-assess their skill level after training, and their confidence before, immediately after, and 3 months post training. A subset of trainees were also interviewed about their program goals and experiences. UCSF-GWEP conducted statistical analyses of survey data, and coded interview transcripts to identify aspects of the model supportive to learning and success. RESULTS Of 43 participants, 31 completed training. Their median age was 75; 48% were non-white; 45% had no more than a high school education; and 63% reported yearly income below U.S. $20,000. Three months after completing the program, more than 50% of trainees reported that they needed little or no help performing all four key tasks, and confidence with video visits, online searches, and patient portals showed significant improvement. Additionally, in interviews participants reported improved health, social benefits, and explained that learning was facilitated by self-pacing, repetition, and longitudinal support from volunteer trainers. CONCLUSIONS Older adults with various barriers to learning technology showed online independence and increased confidence with some telehealth tasks after a novel training intervention. Key characteristics of the model included a tablet device, one-on-one longitudinal support from volunteers, comprehensive learning materials, and community-academic partnership.
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Affiliation(s)
- Alicia V Neumann
- School of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
| | - Andrea Gonzalez
- School of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
| | - Louise C Walter
- School of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
- San Francisco VA Medical Center, San Francisco, California, USA
| | - Josette Rivera
- School of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
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17
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Dawson R, Pinheiro M, Nagathan V, Taylor M, Delbaere K, Olivera J, Haynes A, Rayner J, Hassett L, Sherrington C. Physiotherapy-led telehealth and exercise intervention to improve mobility in older people receiving aged care services (TOP UP): protocol for a randomised controlled type 1 hybrid effectiveness-implementation trial. BMJ Nutr Prev Health 2023; 6:273-281. [PMID: 38618537 PMCID: PMC11009537 DOI: 10.1136/bmjnph-2022-000606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 10/30/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction Deteriorating mobility and falls reduce independence and quality of life for older people receiving aged care services. This trial aims to establish effectiveness on the mobility of older people, and explore cost-effectiveness and implementation of a telehealth physiotherapy programme. Method and analysis This type 1 hybrid effectiveness-implementation randomised controlled trial will involve 240 people aged 65+ years receiving aged care services in community or residential settings. Participants will be randomised to either: (1) the Telehealth Physiotherapy for Older People (TOP UP) Program or (2) a wait-list control group. The 6-month intervention includes 10 physiotherapy sessions delivered by videocall (Zoom). The intervention will include the local support of an aged care worker and online exercise resources. Primary outcome is mobility at 6 months post randomisation measured by the Short Physical Performance Battery. Secondary outcomes include rate of falls, sit-to-stand, quality of life, and goal attainment at 6 months after randomisation. Regression models will assess the effect of group allocation on mobility and the other continuously scored secondary outcomes, adjusting for baseline scores. The number of falls per person over 6 months will be analysed using negative binomial regression models to estimate between-group differences. An economic analysis will explore the cost-effectiveness of the TOP UP programme compared with usual care. Implementation outcomes and determinants relating to the intervention's reach, fidelity, exercise dose delivered, adoption, feasibility, acceptability, barriers and facilitators will be explored using mixed methods. Conclusion This is the first trial to investigate the effectiveness, cost-effectiveness and implementation of a physiotherapy intervention in aged care delivered solely by telehealth internationally. The study has strong aged care co-design and governance and is guided by steering and advisory committees that include staff from aged care service providers and end-users. Trial results will be disseminated via peer-reviewed articles, conference presentations and lay summaries. Trial registration number The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN 12621000734864).
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Affiliation(s)
- Rik Dawson
- Sydney Musculoskeletal Health, Faculty of Health and Medicine, School of Public Health, The University of Sydney Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Marina Pinheiro
- Sydney Musculoskeletal Health, Faculty of Health and Medicine, School of Public Health, The University of Sydney Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Vasikaran Nagathan
- Faculty of Health and Medicine, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Morag Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Juliana Olivera
- Sydney Musculoskeletal Health, Faculty of Health and Medicine, School of Public Health, The University of Sydney Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Abby Haynes
- Sydney Musculoskeletal Health, Faculty of Health and Medicine, School of Public Health, The University of Sydney Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Jenny Rayner
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Leanne Hassett
- Sydney Musculoskeletal Health, Faculty of Health and Medicine, School of Public Health, The University of Sydney Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Catherine Sherrington
- Sydney Musculoskeletal Health, Faculty of Health and Medicine, School of Public Health, The University of Sydney Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
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18
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Kulkarni A, Monu N, Ahsan MD, Orakuwue C, Ma X, McDougale A, Frey MK, Holcomb K, Cantillo E, Chapman-Davis E. Patient and provider perspectives on telemedicine use in an outpatient gynecologic clinic serving a diverse, low-income population. J Telemed Telecare 2023:1357633X231197965. [PMID: 37788366 DOI: 10.1177/1357633x231197965] [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: 10/05/2023]
Abstract
OBJECTIVE To evaluate patient and provider experiences using telemedicine for gynecologic visits among a diverse, low-income population. METHODS Patients attending telemedicine visits at a resident-run gynecology clinic completed a modified Telemedicine Usability Questionnaire and providers completed a survey addressing satisfaction and barriers for each visit. The Telemedicine Usability Questionnaire included six subscales to assess telemedicine usability with 1-5 Likert-scale responses. Statistical analyses included Chi-square, Fisher's exact, Wilcoxon rank sum, Wilcoxon signed-rank, and two-sample t-test. RESULTS Of 192 patients enrolled, 157 (82%) completed the surveys (87% video visits, 13% telephone visits). Most patients were ethnic minorities (non-Hispanic White-16%, Hispanic-32%, Black-28%, Asian-10%), median age was 40 years (range 18-69), and 63% reported income under $40,000. The total mean Telemedicine Usability Questionnaire score was 4.3/5. The reliability subscale score (3.72/5) was lower compared to all other subscales (p < 0.001). Older respondents were more likely to find telemedicine unreliable (mean age >44 vs <39, p = 0.02). Without telemedicine, 54% would have traveled ≥1 h to appointments, with 46% spending over $35 on travel, and 27% missing ≥ 1 workday. Patients preferred telemedicine for follow-up rather than initial visits (81% vs 33%, p < 0.01). Among providers, residents felt less adequately trained in telemedicine compared to nurse practitioners and fellows (54% vs 46%, p = 0.039). CONCLUSION Low-income women utilizing telemedicine for outpatient gynecologic care report positive experiences with improved access to healthcare, cost, and time savings compared to in-person visits. Provider experiences were also positive; however, teaching hospitals must evaluate whether trainee providers feel adequately trained to deliver telemedicine visits.
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Affiliation(s)
| | - Ngozi Monu
- Weill Cornell Medical College, New York, USA
| | | | | | - Xiaoyue Ma
- Weill Cornell Medical College, New York, USA
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19
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Dillon J, Wick JY. Telehealth: Moving Older People Along the Adoption Trajectory. Sr Care Pharm 2023; 38:416-422. [PMID: 37771053 DOI: 10.4140/tcp.n.2023.415] [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: 09/30/2023]
Abstract
Although the concept of telehealth has been in development for many years, the global pandemic galvanized its growth and utility. In general, people adopt technological advancements at different velocities that, when plotted in a chart, resemble a bell-shaped curve. People who are quick to adopt new technologies are designated innovators, while those who are the very last to adopt new technologies are dubbed laggards. Often, older people fall into the laggard category for several reasons including physical, mental, and emotional barriers. In some cases, they lack the technology or experience with various programs that would make such programs accessible. Regardless, telehealth has proven its worth as a way to deliver care in areas distant to the health care provider when physical examination is unnecessary. It can reduce the likelihood of exposure to contagious disease. Telehealth also has the potential to reduce unnecessary emergency department visits, and long-term care facilities that have used telehealth have demonstrated cost savings. Little study has been conducted to determine how pharmacists are using telehealth, but after examining available research on telehealth, pharmacists can identify pitfalls and implement steps that reduce barriers for older people.
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Affiliation(s)
- Jessica Dillon
- University of Connecticut, School of Pharmacy, Storrs, Connecticut
| | - Jeannette Y Wick
- University of Connecticut, School of Pharmacy, Storrs, Connecticut
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20
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Loizos M, Baim-Lance A, Ornstein KA, Lubetsky S, Salas-Belkin L, Chavez S, Zhang M, DeCherrie LV, Gliatto PM. If You Give Them Away, It Still May Not Work: Challenges to Video Telehealth Device Use Among the Urban Homebound. J Appl Gerontol 2023; 42:1896-1902. [PMID: 37070328 PMCID: PMC10524114 DOI: 10.1177/07334648231170144] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
The growing homebound population may particularly benefit from video telehealth. However, some patients do not have the ability or resources to successfully use this modality. This report presents the experience of a large urban home-based primary care program disseminating cellular-enabled tablets with basic instruction to a subset of its patients who would not otherwise have had the ability to engage in video telehealth. Program goals included: increasing the number of patients able to engage in video encounters and leveraging technology to help achieve greater equity. While 123 homebound patients received devices for telehealth, only one-third successfully utilized them. We identified multiple barriers to telehealth utilization beyond physical access to a device, including a lack of skill. Efforts to increase video encounters among patient groups who are less experienced with technology cannot simply rely on device provision or basic instruction but must include reinforced learning strategies combined with ongoing technical assistance.
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Affiliation(s)
- Maria Loizos
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Abigail Baim-Lance
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J. Peters VA Medical Center, Bronx, NY, USA
| | | | - Sara Lubetsky
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Silvia Chavez
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meng Zhang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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21
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Chenhuichen C, González-Senac NM. Technology enabled care and older adults: Where are we at? Rev Esp Geriatr Gerontol 2023; 58:101384. [PMID: 37481840 DOI: 10.1016/j.regg.2023.101384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Chenhui Chenhuichen
- Geriatrics Department, Hospital Universitario de Navarra (HUN), Pamplona, Navarra, Spain.
| | - Nicolás M González-Senac
- Geriatrics Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Instituto de Investigación Sanitaria Hospital General Universitario Gregorio Marañón, Madrid, Spain
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22
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Campbell K, Greenfield G, Li E, O'Brien N, Hayhoe B, Beaney T, Majeed A, Neves AL. The Impact of Virtual Consultations on the Quality of Primary Care: Systematic Review. J Med Internet Res 2023; 25:e48920. [PMID: 37647117 PMCID: PMC10500356 DOI: 10.2196/48920] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The adoption of virtual consultations, catalyzed by the COVID-19 pandemic, has transformed the delivery of primary care services. Owing to their rapid global proliferation, there is a need to comprehensively evaluate the impact of virtual consultations on all aspects of care quality. OBJECTIVE This study aims to evaluate the impact of virtual consultations on the quality of primary care. METHODS A total of 6 databases were searched. Studies that evaluated the impact of virtual consultations, for any disease, were included. Title and abstract screening and full-text screening were performed by 2 pairs of investigators. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis of the results was performed. RESULTS In total, 30 studies (5,469,333 participants) were included in this review. Our findings suggest that virtual consultations are equally effective to or more effective than face-to-face care for the management of certain conditions, including mental illness, excessive smoking, and alcohol consumption. Overall, 4 studies indicated positive impacts on some aspects of patient-centeredness; however, a negative impact was noted on patients' perceived autonomy support (ie, the degree to which people perceive those in positions of authority to be autonomy supportive). Virtual consultations may reduce waiting times, lower patient costs, and reduce rates of follow-up in secondary and tertiary care settings. Evidence for the impact on clinical safety is extremely limited. Evidence regarding equity was considerably mixed. Overall, it appears that virtual care is more likely to be used by younger, female patients, with disparities among other subgroups depending on contextual factors. CONCLUSIONS Our systematic review demonstrated that virtual consultations may be as effective as face-to-face care and have a potentially positive impact on the efficiency and timeliness of care; however, there is a considerable lack of evidence on the impacts on patient safety, equity, and patient-centeredness, highlighting areas where future research efforts should be devoted. Capitalizing on real-world data, as well as clinical trials, is crucial to ensure that the use of virtual consultations is tailored according to patient needs and is inclusive of the intended end users. Data collection methods that are bespoke to the primary care context and account for patient characteristics are necessary to generate a stronger evidence base to inform future virtual care policies.
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Affiliation(s)
- Kate Campbell
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Geva Greenfield
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Edmond Li
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Niki O'Brien
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Benedict Hayhoe
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Ana Luísa Neves
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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23
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Tak HJ, Cozad M, Horner RD. A National Perspective of Telemedicine Use and Direct Medical Costs: Who Uses It and How Much It Costs. Med Care 2023; 61:495-504. [PMID: 37068023 DOI: 10.1097/mlr.0000000000001856] [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: 04/18/2023]
Abstract
BACKGROUND Telemedicine has the potential to reduce medical costs among health systems. However, there is a limited understanding of the use of telemedicine and its association with direct medical costs. OBJECTIVES Using nationally representative data, we investigated telemedicine use and the associated direct medical costs among respondents overall and stratified by medical provider type and patient insurance status. RESEARCH DESIGN, SUBJECTS, AND MEASURES We used the 2020 Medical Expenditure Panel Survey full-year consolidated file, and outpatient department (OP) and office-based (OB) medical provider event files. Outcomes included total and out-of-pocket costs per visit for OP and OB. The primary independent variable was a binary variable indicating visits made through any telemedicine modality. We used multivariable generalized linear models and 2-part models, adjusting for types of providers and care, patient characteristics, and survey design. RESULTS Among total OP (n = 2938) and OB (n = 20,204) visits, 47.6% and 24.7% of visits, respectively were made through telemedicine. For OP, telemedicine visits were associated with lower total costs (average marginal effect: -$228; 95% confidence interval -$362, -$95) and out-of-pocket costs for all visits and for visits to specialists and to nurse practitioners or physicians assistants. For OB, telemedicine visits were associated with lower total costs, but not with lower out-of-pocket costs, for visits to primary care physicians or nurse practitioners or physician assistants, and for visits by Medicare patients. CONCLUSION Telemedicine was associated with lower direct medical costs. Its potential for cost curbing should be proactively identified and integrated into clinical practice and health policy design.
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Affiliation(s)
- Hyo Jung Tak
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE
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24
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Ilali M, Le Berre M, Vedel I, Khanassov V. Telemedicine in the primary care of older adults: a systematic mixed studies review. BMC PRIMARY CARE 2023; 24:152. [PMID: 37468871 PMCID: PMC10357882 DOI: 10.1186/s12875-023-02085-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 06/19/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Family physicians had to deliver care remotely during the COVID-19 pandemic. Their efforts highlighted the importance of developing a primary care telemedicine (TM) model. TM has the potential to provide a high-quality option for primary care delivery. However, it poses unique challenges for older adults. Our aim was therefore to explore the effects of TM and the determinants of its use in primary care for older adults. METHODS In this systematic mixed studies review, MEDLINE, PsycINFO, EMBASE, CINHAL, AgeLine, DARE, Cochrane Library, and clinical trials research registers were searched for articles in English, French or Russian. Two reviewers performed study selection, data extraction and assessment of study quality. TM's effects were reported through the tabulation of key variables. TM use determinants were interpreted using thematic analysis based on Chang's framework. All data were integrated using a joint display matrix. RESULTS From 3,328 references identified, 20 studies were included. They used either phone (n = 8), videoconference (n = 9) or both (n = 3). Among studies reporting positive outcomes in TM experience, 'user habit or preferences' was the most cited barrier and 'location and travel time' was the most cited facilitator. Only one study reported negative outcomes in TM experience and reported 'comfort with patient communication' and 'user interface, intended use or usability' as barriers, and 'technology skills and knowledge' and 'location and travel time' as facilitators. Among studies reporting positive outcomes in service use and usability, no barrier or facilitator was cited more than once. Only one study reported a positive outcome in health-related and behavioural outcomes. CONCLUSIONS TM in older adults' primary care generally led to positive experiences, high satisfaction and generated an interest towards alternative healthcare delivery model. Future research should explore its efficacy on clinical, health-related and healthcare services use.
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Affiliation(s)
- Marwa Ilali
- Department of Family Medicine, McGill University, 5858 Côte-Des-Neiges Road, 3Rd Floor, Montreal, Québec, H3S 1Z1, Canada
| | - Mélanie Le Berre
- Department of Family Medicine, McGill University, 5858 Côte-Des-Neiges Road, 3Rd Floor, Montreal, Québec, H3S 1Z1, Canada
- School of Rehabilitation Science, Université de Montréal, Montreal, Canada
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, 5858 Côte-Des-Neiges Road, 3Rd Floor, Montreal, Québec, H3S 1Z1, Canada
| | - Vladimir Khanassov
- Department of Family Medicine, McGill University, 5858 Côte-Des-Neiges Road, 3Rd Floor, Montreal, Québec, H3S 1Z1, Canada.
- Goldman Herzl Family Practice Centre, Jewish General Hospital, Montreal, Canada.
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25
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Buck AN, Vincent HK, Newman CB, Batsis JA, Abbate LM, Huffman KF, Bodley J, Vos N, Callahan LF, Shultz SP. Evidence-Based Dietary Practices to Improve Osteoarthritis Symptoms: An Umbrella Review. Nutrients 2023; 15:3050. [PMID: 37447376 PMCID: PMC10347206 DOI: 10.3390/nu15133050] [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: 05/18/2023] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
While there is some research investigating whole foods or diets that are easily understood and accessible to patients with osteoarthritis, specific nutrients or nutraceuticals are more commonly identified. Unfortunately, guidelines and evidence surrounding individual nutrients, extracts, and nutraceuticals are conflicting and are more difficult to interpret and implement for patients with osteoarthritis. The purpose of this umbrella review is to provide a comprehensive understanding of the existing evidence of whole foods and dietary patterns effects on osteoarthritis-related outcomes to inform evidence-based recommendations for healthcare professionals and identify areas where more research is warranted. A literature search identified relevant systematic reviews/meta-analyses using five databases from inception to May 2022. Five systematic reviews/meta-analyses were included in the current umbrella review. Most evidence supported the Mediterranean diet improving osteoarthritis-related outcomes (e.g., pain, stiffness, inflammation, biomarkers of cartilage degeneration). There was little to no evidence supporting the effects of fruits and herbs on osteoarthritis-related outcomes; however, there was some suggestion that specific foods could potentiate symptom improvement through antioxidative mechanisms. The overall lack of homogeneity between the studies limits the conclusions that can be made and highlights the need for quality research that can identify consumer-accessible foods to improve osteoarthritis-related symptoms.
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Affiliation(s)
- Ashley N. Buck
- Kinesiology Department, Seattle University, Seattle, WA 98122, USA;
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC 27402, USA
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
| | - Heather K. Vincent
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, FL 33865, USA
| | - Connie B. Newman
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - John A. Batsis
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- Division of Geriatric Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27402, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27402, USA
| | - Lauren M. Abbate
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- VA Eastern Colorado Geriatric Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO 80045, USA
| | - Katie F. Huffman
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Jennifer Bodley
- Lemieux Library, Seattle University, Seattle, WA 98122, USA;
| | - Natasha Vos
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- North Carolina Center for Health and Wellness, University of North Carolina, Asheville, NC 28804, USA
| | - Leigh F. Callahan
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC 27599, USA
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Sarah P. Shultz
- Kinesiology Department, Seattle University, Seattle, WA 98122, USA;
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- School of Nursing and Health Studies, Monmouth University, West Long Branch, NJ 07764, USA
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Chen X. The impact of older adult care policy mixes on the construction of senior centers. Front Public Health 2023; 11:1193070. [PMID: 37397747 PMCID: PMC10311490 DOI: 10.3389/fpubh.2023.1193070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
The problem of an aging population is becoming increasingly serious, and the establishment of senior centers helps to promote the physical health and mental health of the older adult, a key factor in achieving the high-quality development of the old-age security industry. The government has issued a number of policies to promote the establishment and development of senior centers. However, more and more older adult care policy mixes have gradually shown the phenomenon of poor policy connection, confusing standards, and even mutually exclusive content, resulting in many problems in the construction of policy-driven senior centers. Therefore, based on the overall perspective of the older adult care policy mix, this paper uses the GMM method to explore the impact of the comprehensiveness, balance, and consistency of older adult care policy tool portfolios issued by Chinese government agencies on the construction of senior centers in China. The empirical analysis results show that a comprehensive and consistent policy mix can promote the establishment of senior centers, while the balance of the policy mix will inhibit the establishment of senior centers. This paper analyzes the impact of older adult care policy on the construction of senior centers from the perspective of the policy mix, which helps to clarify the different policy effects produced by different policy mix characteristics and provides feasible policy suggestions for the government to formulate more reasonable and effective policies.
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Pietrantonio F, Vinci A, Maurici M, Ciarambino T, Galli B, Signorini A, La Fazia VM, Rosselli F, Fortunato L, Iodice R, Materazzo M, Ciuca A, Cicerchia LCM, Ruggeri M, Manfellotto D, Rosiello F, Moriconi A. Intra- and Extra-Hospitalization Monitoring of Vital Signs-Two Sides of the Same Coin: Perspectives from LIMS and Greenline-HT Study Operators. SENSORS (BASEL, SWITZERLAND) 2023; 23:5408. [PMID: 37420575 DOI: 10.3390/s23125408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND In recent years, due to the epidemiological transition, the burden of very complex patients in hospital wards has increased. Telemedicine usage appears to be a potential high-impact factor in helping with patient management, allowing hospital personnel to assess conditions in out-of-hospital scenarios. METHODS To investigate the management of chronic patients during both hospitalization for disease and discharge, randomized studies (LIMS and Greenline-HT) are ongoing in the Internal Medicine Unit at ASL Roma 6 Castelli Hospital. The study endpoints are clinical outcomes (from a patient's perspective). In this perspective paper, the main findings of these studies, from the operators' point of view, are reported. Operator opinions were collected from structured and unstructured surveys conducted among the staff involved, and their main themes are reported in a narrative manner. RESULTS Telemonitoring appears to be linked to a reduction in side-events and side-effects, which represent some of most commons risk factors for re-hospitalization and for delayed discharge during hospitalization. The main perceived advantages are increased patient safety and the quick response in case of emergency. The main disadvantages are believed to be related to low patient compliance and an infrastructural lack of optimization. CONCLUSIONS The evidence of wireless monitoring studies, combined with the analysis of activity data, suggests the need for a model of patient management that envisages an increase in the territory of structures capable of offering patients subacute care (the possibility of antibiotic treatments, blood transfusions, infusion support, and pain therapy) for the timely management of chronic patients in the terminal phase, for which treatment in acute wards must be guaranteed only for a limited time for the management of the acute phase of their diseases.
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Affiliation(s)
- Filomena Pietrantonio
- Internal Medicine Unit, Castelli Hospital, Asl Roma 6, 00072 Rome, Italy
- Departmental Faculty of Medicine, St. Camillus University of Medicine and Health Sciences, 00131 Rome, Italy
| | - Antonio Vinci
- Local Health Authority Roma 1, 00193 Rome, Italy
- Doctoral School in Nursing Science and Public Health, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Massimo Maurici
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Tiziana Ciarambino
- Department of Internal Medicine, Luigi Vanvitelli University, 81100 Caserta, Italy
| | - Barbara Galli
- Casa Circondariale Rebibbia, Nuovo Complesso Prison, 00185 Rome, Italy
| | - Alessandro Signorini
- Departmental Faculty of Medicine, St. Camillus University of Medicine and Health Sciences, 00131 Rome, Italy
| | - Vincenzo Mirco La Fazia
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX 78705, USA
- Department of Systems Medicine, Division of Cardiology, Tor Vergata University, 00133 Rome, Italy
| | - Francescantonio Rosselli
- Cardiology and Coronary Intensive Therapy Unit, San Francesco di Paola Hospital, 87027 Paola, Italy
| | | | | | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, 00100 Rome, Italy
- PhD Program in Applied Medical-Surgical Sciences, Breast Oncoplastic Surgery, University of Rome Tor Vergata, 00100 Rome, Italy
| | - Alessandro Ciuca
- Department of Infectious Disease and Public Health, Sapienza University of Rome, 00185 Roma, Italy
| | | | - Matteo Ruggeri
- Departmental Faculty of Medicine, St. Camillus University of Medicine and Health Sciences, 00131 Rome, Italy
- National Centre for Health Technology Assessment, National Health Institute, 00153 Rome, Italy
| | - Dario Manfellotto
- UOC Medicina Interna, Fatebenefratelli Isola Tiberina-Gemelli Hospital, 00186 Rome, Italy
- "Centro Studi" FADOI, 20123 Milan, Italy
| | - Francesco Rosiello
- Internal Medicine Unit, Castelli Hospital, Asl Roma 6, 00072 Rome, Italy
- Departmental Faculty of Medicine, St. Camillus University of Medicine and Health Sciences, 00131 Rome, Italy
- Department of Infectious Disease and Public Health, Sapienza University of Rome, 00185 Roma, Italy
- Department of Hystological, Anatomical Sciences and Legal Medicine, Sapienza-University of Rome, 00196 Rome, Italy
| | - Andrea Moriconi
- Department of Business and Management, LUISS University, 00197 Rome, Italy
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Haimi M. The tragic paradoxical effect of telemedicine on healthcare disparities- a time for redemption: a narrative review. BMC Med Inform Decis Mak 2023; 23:95. [PMID: 37193960 DOI: 10.1186/s12911-023-02194-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 05/09/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Telemedicine has become more convenient and advantageous due to the rapid development of the internet and telecommunications. A growing number of patients are turning to telemedicine for health consultations and health-related information. Telemedicine can increase access to medical care by removing geographical and other barriers. In most nations, the COVID-19 pandemic imposed social isolation. This has accelerated the transition to telemedicine, which has become the most commonly utilized method of outpatient care in many places. Telehealth can assist resolve gaps in access to healthcare services and health outcomes, in addition to its primary function of boosting accessibility to remote health services. However, as the benefits of telemedicine become more apparent, so do the limitations of serving vulnerable groups. Some populations may lack digital literacy or internet access. Homeless persons, the elderly, and people with inadequate language skills are also affected. In such circumstances, telemedicine has the potential to exacerbate health inequities. AIM AND METHODS In this narrative review (using the PubMed and Google scholar database), the different benefits and drawbacks of telemedicine are discussed, both globally and in Israel, with particular focus paid to special populations and to the telehealth usage during the Covid-19 period. FINDINGS The contradiction and paradox of using telemedicine to address health inequities yet sometimes making them worse is highlighted. The effectiveness of telemedicine in bridging access to healthcare inequities is explored along with a number of potential solutions. CONCLUSIONS Policy makers should identify barriers among special populations to using telemedicine. They should initiate interventions to overcome these barriers, while adapting them to the needs of these groups.
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Affiliation(s)
- Motti Haimi
- Clalit Health Services, Tel Aviv, Israel.
- Rappaport Faculty of Medicine, Technion, Haifa, Israel.
- School of Public Health, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel.
- Health Disparities Working Group, International Society for Telemedicine and E-Health (ISfTeH), Basel, Switzerland.
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Hoerold M, Heytens H, Debbeler CM, Ehrentreich S, Rauwolf T, Schmeißer A, Gottschalk M, Bitzer EM, Braun-Dullaeus RC, Apfelbacher CJ. An evidence map of systematic reviews on models of outpatient care for patients with chronic heart diseases. Syst Rev 2023; 12:80. [PMID: 37149625 PMCID: PMC10163805 DOI: 10.1186/s13643-023-02227-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 03/30/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Chronic heart disease affects millions of people worldwide and the prevalence is increasing. By now, there is an extensive literature on outpatient care of people with chronic heart disease. We aimed to systematically identify and map models of outpatient care for people with chronic heart disease in terms of the interventions included and the outcomes measured and reported to determine areas in need of further research. METHODS We created an evidence map of published systematic reviews. PubMed, Cochrane Library (Wiley), Web of Science, and Scopus were searched to identify all relevant articles from January 2000 to June 2021 published in English or German language. From each included systematic review, we abstracted search dates, number and type of included studies, objectives, populations, interventions, and outcomes. Models of care were categorised into six approaches: cardiac rehabilitation, chronic disease management, home-based care, outpatient clinic, telemedicine, and transitional care. Intervention categories were developed inductively. Outcomes were mapped onto the taxonomy developed by the COMET initiative. RESULTS The systematic literature search identified 8043 potentially relevant publications on models of outpatient care for patients with chronic heart diseases. Finally, 47 systematic reviews met the inclusion criteria, covering 1206 primary studies (including double counting). We identified six different models of care and described which interventions were used and what outcomes were included to measure their effectiveness. Education-related and telemedicine interventions were described in more than 50% of the models of outpatient care. The most frequently used outcome domains were death and life impact. CONCLUSION Evidence on outpatient care for people with chronic heart diseases is broad. However, comparability is limited due to differences in interventions and outcome measures. Outpatient care for people with coronary heart disease and atrial fibrillation is a less well-studied area compared to heart failure. Our evidence mapping demonstrates the need for a core outcome set and further studies to examine the effects of models of outpatient care or different interventions with adjusted outcome parameters. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42020166330).
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Affiliation(s)
- Madlen Hoerold
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany.
| | - Heike Heytens
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Carla Maria Debbeler
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Saskia Ehrentreich
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Thomas Rauwolf
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Alexander Schmeißer
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Marc Gottschalk
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Eva Maria Bitzer
- Department of Public Health and Health Education, University of Education Freiburg, Kunzenweg 21, Freiburg, Baden-Würtemberg, 79117, Germany
| | - Ruediger C Braun-Dullaeus
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Christian J Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
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A comparative analysis of outpatient nutrition clinic scheduling outcomes based on in-person and telehealth patient care delivery modalities ☆. HEALTHCARE ANALYTICS (NEW YORK, N.Y.) 2023; 3:100163. [PMID: 36999092 PMCID: PMC10032049 DOI: 10.1016/j.health.2023.100163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/08/2023] [Accepted: 03/20/2023] [Indexed: 03/24/2023]
Abstract
During the start of the global COVID-19 pandemic in March 2020, patient care modalities changed from in-person to telehealth to comply with physical distancing guidelines. Our study uniquely examines operations data from three distinct periods: before the transition to telehealth, early transition from in-person care to telehealth, and the eventual adoption of telehealth. We present a comparative analysis of outpatient nutrition clinic scheduling outcomes based on care delivery modality. We used descriptive statistics to report means and variance and frequencies. We used inferential statistics to make comparisons: categorical data were compared using chi- square analysis with post-hoc comparisons using a z-test with alpha at 0.05. Means of continuous variables were compared using ANOVA with Tukey HSD post-hoc analysis. We found patient demographics remained widely unchanged across the three distinct periods as the demand for telehealth visits increased, with a notable rise in return patient visits, signaling both adaptability across the patient population and acceptance of the telehealth modality. These analyses along with evidence from the included literature review point to many the benefits of telehealth, thus telehealth as a healthcare delivery modality is here to stay. Our work serves as a foundation for future studies in this field, provides information for decision-makers in telehealth-related strategic planning, and can be utilized in advocacy for the extension of telehealth coverage.
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Yu J, Yun H, Unruh MA, O'Donnell EM, Katz PR, Ancker JS, Jung HY. Perspectives of Physicians with Experience in Nursing Home Care on Telehealth Use During the COVID-19 Public Health Emergency. J Gen Intern Med 2023; 38:1722-1728. [PMID: 36913142 PMCID: PMC10010241 DOI: 10.1007/s11606-023-08087-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/07/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Despite expanded access to telehealth services for Medicare beneficiaries in nursing homes (NHs) during the COVID-19 public health emergency, information on physicians' perspectives on the feasibility and challenges of telehealth provision for NH residents is lacking. OBJECTIVE To examine physicians' perspectives on the appropriateness and challenges of providing telehealth in NHs. PARTICIPANTS Medical directors or attending physicians in NHs. APPROACH We conducted 35 semistructured interviews with members of the American Medical Directors Association from January 18 through January 29, 2021. Outcomes of the thematic analysis reflected perspectives of physicians experienced in NH care on telehealth use. MAIN MEASURES The extent to which participants used telehealth in NHs, the perceived value of telehealth for NH residents, and barriers to telehealth provision. KEY RESULTS Participants included 7 (20.0%) internists, 8 (22.9%) family physicians, and 18 (51.4%) geriatricians. Five common themes emerged: (1) direct care is needed to adequately care for residents in NHs; (2) telehealth may allow physicians to reach NH residents more flexibly during offsite hours and other scenarios when physicians cannot easily reach patients; (3) NH staff and other organizational resources are critical to the success of telehealth, but staff time is a major barrier to telehealth provision; (4) appropriateness of telehealth in NHs may be limited to certain resident populations and/or services; (5) conflicting views about whether telehealth use will be sustained over time in NHs. Subthemes included the role of resident-physician relationships in facilitating telehealth and the appropriateness of telehealth for residents with cognitive impairment. CONCLUSIONS Participants had mixed views on the effectiveness of telehealth in NHs. Staff resources to facilitate telehealth and the limitations of telehealth for NH residents were the most raised issues. These findings suggest that physicians in NHs may not view telehealth as a suitable substitute for most in-person services.
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Affiliation(s)
- Jiani Yu
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA.
| | - Hyunkyung Yun
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA
| | - Mark A Unruh
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA
| | - Eloise M O'Donnell
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA
| | - Paul R Katz
- Department of Geriatrics, Florida State University College of Medicine, Tallahassee, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, USA
| | - Hye-Young Jung
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, USA
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Shahid S, Hogeveen S, Sky P, Chandra S, Budhwani S, de Silva R, Bhatia RS, Seto E, Shaw J. Health equity related challenges and experiences during the rapid implementation of virtual care during COVID-19: a multiple case study. Int J Equity Health 2023; 22:44. [PMID: 36906566 PMCID: PMC10007658 DOI: 10.1186/s12939-023-01849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/18/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Virtual care quickly became of crucial importance to health systems around the world during the COVID-19 pandemic. Despite the potential of virtual care to enhance access for some communities, the scale and pace at which services were virtualized did not leave many organizations with sufficient time and resources to ensure optimal and equitable delivery of care for everyone. The objective of this paper is to outline the experiences of health care organizations rapidly implementing virtual care during the first wave of the COVID-19 pandemic and examine whether and how health equity was considered. METHODS We used an exploratory, multiple case study approach involving four health and social service organizations providing virtual care services to structurally marginalized communities in the province of Ontario, Canada. We conducted semi-structured qualitative interviews with providers, managers, and patients to understand the challenges experienced by organizations and the strategies put in place to support health equity during the rapid virtualization of care. Thirty-eight interviews were thematically analyzed using rapid analytic techniques. RESULTS Organizations experienced challenges related to infrastructure availability, digital health literacy, culturally appropriate approaches, capacity for health equity, and virtual care suitability. Strategies to support health equity included the provision of blended models of care, creation of volunteer and staff support teams, participation in community engagement and outreach, and securement of infrastructure for clients. We put our findings into the context of an existing framework conceptualizing access to health care and expand on what this means for equitable access to virtual care for structurally marginalized communities. CONCLUSION This paper highlights the need to pay greater attention to the role of health equity in virtual care delivery and situate that conversation around existing inequitable structures in the health care system that are perpetuated when delivering care virtually. An equitable and sustainable approach to virtual care delivery will require applying an intersectionality lens on the strategies and solutions needed to address existing inequities in the system.
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Affiliation(s)
- Simone Shahid
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada.
| | - Sophie Hogeveen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Philina Sky
- Waasegiizhig Nanaandawe'iyewigamig, PO Box 320, Keewatin, ON, P0X 1C0, Canada
| | - Shivani Chandra
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - Suman Budhwani
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - Ryan de Silva
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - R Sacha Bhatia
- Peter Munk Cardiac Centre, University Health Network, 585 University Ave, Toronto, ON, M5G 2N2, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 55 College St, Toronto, ON, M5T 3M6, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 55 College St, Toronto, ON, M5T 3M6, Canada.,Centre for Digital Therapeutics, Techna Institute, University Health Network, 90 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - James Shaw
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada.,Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
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Rodríguez Sánchez-Laulhé P, Biscarri-Carbonero Á, Suero-Pineda A, Luque-Romero LG, Barrero García FJ, Blanquero J, Heredia-Rizo AM. The effects of a mobile app-delivered intervention in people with symptomatic hand osteoarthritis: a pragmatic randomized controlled trial. Eur J Phys Rehabil Med 2023; 59:54-64. [PMID: 36633498 PMCID: PMC10035439 DOI: 10.23736/s1973-9087.22.07744-9] [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: 01/13/2023]
Abstract
BACKGROUND Exercise therapy, self-management and education are recommended interventions for hand osteoarthritis (OA), but new delivery systems are needed to solve lack of adherence. AIM To determine the effects on hand function and pain related measures of a mobile app-delivered intervention, compared with usual care, in patients with symptomatic hand OA. DESIGN A pragmatic, multicenter, two-group parallel randomized controlled trial. SETTING Community health centers in rural southern Spain. POPULATION Eighty-three participants with unilateral or bilateral symptomatic hand OA were proposed to participate, and finally 74 were included and randomized. METHODS Participants received a home multimodal treatment (exercise, education, and self-management recommendations) with the CareHand mobile app or usual care (written exercises) over 12 weeks. Monthly telephone calls were performed to monitor adherence. The primary outcome was hand physical function (Australian/Canadian Hand Osteoarthritis Index, AUSCAN) at 3- and 6-months. Secondary measures included hand pain intensity and morning stiffness, upper limb function, hand dexterity, and grip and pinch strength. RESULTS The CareHand group showed significant within-group changes in hand function at 6-months (-3.0, 95% CI -5.1 to -0.9 vs. usual care: -0.9, 95% CI -3.3 to 1.5). Neither group showed improvements in hand function at 3-months (CareHand: -1.5, 95% CI -3.1 to 0.1; usual care: -0.5, 95% CI -2.7 to 1.7). For the secondary outcomes, the CareHand group showed better results on upper limb function both at 3- and 6-months, and on pain both at 1- and 3-months compared to usual care group. Linear regression models indicated that baseline scores of pain intensity, hand status, and upper limb function were associated with a greater improvement in hand pain and physical function. CONCLUSIONS A mobile app-delivered intervention is effective for improving hand function, and better than usual care for upper limb function and pain. Further research is warranted to understand the impact of mobile health (mHealth) in people with hand OA. CLINICAL REHABILITATION IMPACT mHealth interventions are a feasible and secure multimodal delivery approach in older adults with hand OA in rural primary care setting. Baseline pain and upper limb function might predict functional hand outcomes.
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Affiliation(s)
- Pablo Rodríguez Sánchez-Laulhé
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podology, University of Seville, Seville, Spain -
- Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group, University of Seville, Seville, Spain -
| | | | - Alejandro Suero-Pineda
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podology, University of Seville, Seville, Spain
| | - Luis G Luque-Romero
- Research Unit, Aljarafe-Sevilla North Health District, Andalusian Health Service, Seville, Spain
- Department of Normal and Pathological Cytology and Histology, University of Seville, Seville, Spain
| | | | - Jesús Blanquero
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podology, University of Seville, Seville, Spain
| | - Alberto M Heredia-Rizo
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podology, University of Seville, Seville, Spain
- Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group, University of Seville, Seville, Spain
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Peri K, Balmer D, Cheung G. The experiences of carers in supporting a person living with dementia to participate in virtual cognitive stimulation therapy during the COVID-19 pandemic. Aging Ment Health 2023; 27:372-379. [PMID: 35403508 DOI: 10.1080/13607863.2022.2053834] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Cognitive stimulation therapy (CST) is an evidence-based group intervention for people with dementia. In response to the COVID-19 pandemic, many existing CST groups moved virtually and this required carers of people living with dementia to assist with setting up the appropriate technology. This study aimed to explore the roles and experiences of carers in accessing virtual CST (vCST). METHODS This qualitative study used semi-structured individual interviews, via telephone or videoconference, to explore the roles and experiences of carers. Interviews were recorded, transcribed verbatim and thematically analysed. RESULTS Twelve family carers (age: 51-75 years) reported a range of experiences, from novice to expert knowledge in terms of accessing digital devices (mainly laptops and iPads) and connecting to Zoom. Accessing vCST provided carers an immediate application of new knowledge. Carers reported positive responses to vCST that provided their family member living with dementia with social contact and cognitive stimulation during lockdown. CONCLUSION Accessing vCST required carers to have an existing adequate level of technological competence in order to learn and use the Zoom platform. Adult learning principles can be used to improve carers' digital literacy required for vCST and other telehealth initiatives.
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Affiliation(s)
- Kathryn Peri
- School of Nursing, The University of Auckland, New Zealand
| | - Deborah Balmer
- School of Nursing, The University of Auckland, New Zealand
| | - Gary Cheung
- Department of Psychological Medicine, School of Medicine, The University of Auckland, New Zealand
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Dryden EM, Kennedy MA, Conti J, Boudreau JH, Anwar CP, Nearing K, Pimentel CB, Hung WW, Moo LR. Perceived benefits of geriatric specialty telemedicine among rural patients and caregivers. Health Serv Res 2023; 58 Suppl 1:26-35. [PMID: 36054487 PMCID: PMC9843069 DOI: 10.1111/1475-6773.14055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Explore the perceived benefits of a Veterans Health Administration (VHA) geriatric specialty telemedicine service (GRECC Connect) among rural, older patients and caregivers to contribute to an assessment of its quality and value. DATA SOURCES In Spring 2021, we interviewed a geographically diverse sample of rural, older patients and their caregivers who participated in GRECC Connect telemedicine visits. STUDY DESIGN A cross-sectional qualitative study focused on patient and caregiver experiences with telemedicine, including perceived benefits and challenges. DATA COLLECTION We conducted 30 semi-structured qualitative interviews with rural, older (≥65) patients enrolled in the VHA and their caregivers via videoconference or phone. Interviews were recorded, transcribed, and analyzed using a rapid qualitative analysis approach. PRINCIPAL FINDINGS Participants described geriatric specialty telemedicine visits focused on cognitive assessments, tailored physical therapy, medication management, education on disease progression, support for managing multiple comorbidities, and suggestions to improve physical functioning. Participants reported that, in addition to prescribing medications and ordering tests, clinicians expedited referrals, coordinated care, and listened to and validated both patient and caregiver concerns. Perceived benefits included improved patient health; increased patient and caregiver understanding and confidence around symptom management; and greater feelings of empowerment, hopefulness, and support. Challenges included difficulty accessing some recommended programs and services, uncertainty related to instructions or follow-up, and not receiving as much information or treatment as desired. The content of visits was well aligned with the domains of the Age-Friendly Health Systems and Geriatric 5Ms frameworks (Medication, Mentation, Mobility, what Matters most, and Multi-complexity). CONCLUSIONS Alignment of patient and caregiver experiences with widely-used models of comprehensive geriatric care indicates that high-quality geriatric care can be provided through virtual modalities. Additional work is needed to develop strategies to address challenges and optimize and expand access to geriatric specialty telemedicine.
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Affiliation(s)
- Eileen M. Dryden
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Meaghan A. Kennedy
- New England Geriatric Research, Education, and Clinical CenterVA Bedford Healthcare SystemBedfordMassachusettsUSA,Department of Family MedicineBoston University School of MedicineBostonMassachusettsUSA
| | - Jennifer Conti
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Jacqueline H. Boudreau
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Chitra P. Anwar
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Kathryn Nearing
- Eastern Colorado VA Geriatric Research Education and Clinical CenterAuroraColoradoUSA,Division of Geriatric MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Camilla B. Pimentel
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA,New England Geriatric Research, Education, and Clinical CenterVA Bedford Healthcare SystemBedfordMassachusettsUSA,Department of Public Health, Zuckerberg College of Health SciencesUniversity of Massachusetts LowellLowellMassachusettsUSA
| | - William W. Hung
- Bronx Geriatric Research Education and Clinical CenterJames J. Peters VA Medical CenterBronxNew YorkUSA,Department of Geriatrics and Palliative MedicineIcahn School of MedicineNew York CityNew YorkUSA
| | - Lauren R. Moo
- New England Geriatric Research, Education, and Clinical CenterVA Bedford Healthcare SystemBedfordMassachusettsUSA,Department of NeurologyHarvard Medical SchoolBostonMassachusettsUSA
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Kahkoska AR, Freeman NLB, Jones EP, Shirazi D, Browder S, Page A, Sperger J, Zikry TM, Yu F, Busby-Whitehead J, Kosorok MR, Batsis JA. Individualized interventions and precision health: Lessons learned from a systematic review and implications for analytics-driven geriatric research. J Am Geriatr Soc 2023; 71:383-393. [PMID: 36524627 PMCID: PMC10037848 DOI: 10.1111/jgs.18141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/16/2022] [Accepted: 10/22/2022] [Indexed: 12/23/2022]
Abstract
Older adults are characterized by profound clinical heterogeneity. When designing and delivering interventions, there exist multiple approaches to account for heterogeneity. We present the results of a systematic review of data-driven, personalized interventions in older adults, which serves as a use case to distinguish the conceptual and methodologic differences between individualized intervention delivery and precision health-derived interventions. We define individualized interventions as those where all participants received the same parent intervention, modified on a case-by-case basis and using an evidence-based protocol, supplemented by clinical judgment as appropriate, while precision health-derived interventions are those that tailor care to individuals whereby the strategy for how to tailor care was determined through data-driven, precision health analytics. We discuss how their integration may offer new opportunities for analytics-based geriatric medicine that accommodates individual heterogeneity but allows for more flexible and resource-efficient population-level scaling.
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Affiliation(s)
- Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nikki L. B. Freeman
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily P. Jones
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniela Shirazi
- Department of Medicine, California University of Science and Medicine, Colton, California, USA
| | - Sydney Browder
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Annie Page
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John Sperger
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tarek M. Zikry
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Fei Yu
- School of Information and Library Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jan Busby-Whitehead
- Division of Geriatric Medicine, Department of Medicine, Center for Aging and Health, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michael R. Kosorok
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - John A. Batsis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Geriatric Medicine, Department of Medicine, Center for Aging and Health, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Oyeyemi DM, Omer ZB, Brown B, Freimund J, Gummerson C, Rink A, Gallant N, Marottoli RA. Developing an animated COVID-19 e-curriculum for adults with dementia and caregivers: Challenges and solutions. PATIENT EDUCATION AND COUNSELING 2023; 106:180-187. [PMID: 36371243 PMCID: PMC9597565 DOI: 10.1016/j.pec.2022.10.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 10/14/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Effective education and support for adults with dementia and their caregivers around pandemic issues is critical for protecting them. Animation-based learning has shown promise in patient education. We collaborated with educators and support staff at Alzheimer's Association Connecticut (AACT) to conduct a mixed-methods study and develop an animated e-curriculum addressing pandemic related challenges. METHODS We conducted focus groups and surveys with dementia and caregiver educators and support staff at AACT for the initial needs assessment and the later e-curriculum evaluation. An interdisciplinary team of educators followed a step-wise process to transform the needs assessment results into an animation based e-curriculum. RESULTS Participants identified the following pandemic challenges: 1) social isolation, 2) caregiver fatigue, 3) safety, and 4) difficulty navigating the healthcare system. The overall quality and usefulness of the e-curriculum was "very good" or "excellent". CONCLUSIONS An animated e-curriculum addressing pandemic related issues relevant to adults with dementia and caregivers had positive reviews and was associated with improvement in self-reported ability to perform curriculum objectives among community dementia educators. PRACTICE IMPLICATIONS The pandemic challenges identified may facilitate the development of further resources. Additionally, this project may serve as a guide for clinicians interested in incorporating animation into education efforts.
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Affiliation(s)
- Deborah M Oyeyemi
- Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Zehra B Omer
- Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, CT, USA; Department of Geriatrics & Extended Care, VA Connecticut Healthcare System, West Haven, CT, 06516, USA.
| | - Bryan Brown
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer Freimund
- Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Christine Gummerson
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Andrea Rink
- Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Noelle Gallant
- Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Richard A Marottoli
- Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, CT, USA; Department of Geriatrics & Extended Care, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
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Stonsaovapak C, Sangveraphunsiri V, Jitpugdee W, Piravej K. Telerehabilitation in Older Thai Community-Dwelling Adults. Life (Basel) 2022; 12:life12122029. [PMID: 36556393 PMCID: PMC9785691 DOI: 10.3390/life12122029] [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: 11/02/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
To investigate the impact on physical performance and walking abilities associated with fall risk and disability in the senior population, we created a telerehabilitation system. This is a multi-site, community setting, pre−post experimental study. We recruited participants from four rural areas in Thailand. All participants received eight weeks of tele-exercise, three sessions per week, via the telerehabilitation system. After the intervention, all participants underwent the Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) test, and the six-minute walk test (6MWT) using a wearable sensor system. A total of 123 participants participated in the study and 2 participants dropped out while conducting the study, thus 121 participants were included in the analysis. In comparison to the baseline, we discovered a considerable improvement in the SPPB score (0.65 ± 0.22, p < 0.001), TUG (−1.70 ± 0.86, p < 0.001), and 6MWT (10.23 ± 7.33, p = 0.007). Our study demonstrates the benefits of telerehabilitation on SPPB, TUG, and 6MWT related to disabilities and fall risk. This telerehabilitation technology demonstrated its viability in the community environment and demonstrated its capacity to offer fundamental components of remote rehabilitation services within the healthcare system.
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Affiliation(s)
- Chernkhuan Stonsaovapak
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Viboon Sangveraphunsiri
- International School of Engineering Faculty of Engineering, Chulalongkorn University, Bangkok 10330, Thailand
| | - Weerachai Jitpugdee
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Krisna Piravej
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Correspondence: or
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Bhatia R, Gilliam E, Aliberti G, Pinheiro A, Karamourtopoulos M, Davis RB, DesRochers L, Schonberg MA. Older adults' perspectives on primary care telemedicine during the COVID-19 pandemic. J Am Geriatr Soc 2022; 70:3480-3492. [PMID: 36169152 PMCID: PMC9538237 DOI: 10.1111/jgs.18035] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/13/2022] [Accepted: 07/23/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prior to the COVID-19 pandemic there were many barriers to telemedicine primary care for adults ≥65 years including insurance coverage restrictions and having lower digital access and literacy. With the pandemic, insurance coverage broadened and many older adults utilized telemedicine creating an opportunity to learn from their experiences to inform future policy. METHODS Between April 2020 and June 2021, we conducted a cross-sectional multimethod study of English-speaking, cognitively-intact, adults ≥65, who had a phone-only and/or video telemedicine visit with their primary care physician within one large Massachusetts health system (10 different practices) since March 2020. The study questionnaire asked participants their overall satisfaction with telemedicine (7-point scale) and to compare telemedicine with in-person care. We used linear regression to examine the association between participants' demographics, Charlson comorbidity score, and survey completion date with their satisfaction score. The questionnaire also included open-ended questions on perceptions of telemedicine; which were analyzed using qualitative methods. RESULTS Of 278 eligible patients reached, 208 completed the questionnaire; mean age was 74.4 years (±4.4), 61.5% were female, 91.4% were non-Hispanic White, 64.4% had ≥1 comorbidity, and 47.2% had a phone-only visit. Regardless of their age, participants reported being satisfied with telemedicine; median score was 6.0 on the 7-point scale (25th percentile = 5.0 and 75th percentile = 7.0). Non-Whites satisfaction scores were on average 1 point lower than those of non-Hispanic Whites (p = 0.02). Those with comorbidity reported scores that on average were 0.5 points lower than those without comorbidity (p = 0.07). Overall, 39.5% felt their telemedicine visit was worse than in-person care; 4.9% thought it was better. Participants appreciated telemedicine's convenience but described frustrating technical challenges. While participants preferred in-person care, most wanted telemedicine to remain available. CONCLUSIONS Adults ≥65 reported being satisfied with primary care telemedicine during the pandemic's first 14 months and wanted telemedicine to remain available.
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Affiliation(s)
- Roma Bhatia
- Division of General Medicine and Primary Care, Research Section, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
| | - Elizabeth Gilliam
- Division of General Medicine and Primary Care, Research Section, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
| | - Gianna Aliberti
- Division of General Medicine and Primary Care, Research Section, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
| | - Adlin Pinheiro
- Division of General Medicine and Primary Care, Research Section, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
| | - Maria Karamourtopoulos
- Division of General Medicine and Primary Care, Research Section, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
| | - Roger B Davis
- Division of General Medicine and Primary Care, Research Section, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
| | - Laura DesRochers
- Division of General Medicine and Primary Care, Research Section, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
| | - Mara A Schonberg
- Division of General Medicine and Primary Care, Research Section, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
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Rush KL, Singh S, Seaton CL, Burton L, Li E, Jones C, Davis JC, Hasan K, Kern B, Janke R. Telehealth Use for Enhancing the Health of Rural Older Adults: A Systematic Mixed Studies Review. THE GERONTOLOGIST 2022; 62:e564-e577. [PMID: 34661675 DOI: 10.1093/geront/gnab141] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Telehealth holds potential for inclusive and cost-saving health care; however, a better understanding of the use and acceptance of telehealth for health promotion among rural older adults is needed. This systematic review aimed to synthesize evidence for telehealth use among rural-living older adults and to explore cost-effectiveness for health systems and patients. RESEARCH DESIGN AND METHODS This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study designs reporting health promotion telehealth interventions with rural-living adults aged 55 and older were eligible for review. Following screening and inclusion, articles were quality-rated and ranked by level of evidence. Data extraction was guided by the Technology Acceptance Model and organized into outcomes related to ease of use, usefulness, intention to use, and usage behavior along with cost-effectiveness. RESULTS Of 2,247 articles screened, 42 were included. Positive findings for the usefulness of telehealth for promoting rural older adults' health were reported in 37 studies. Evidence for ease of use and usage behavior was mixed. Five studies examined intention to continue to use telehealth and in 4 of these, patients preferred telehealth. Telehealth was cost-effective for health care delivery (as a process) compared to face to face. However, findings were mixed for cost-effectiveness with both reports of savings (e.g., reduced travel) and increased costs (e.g., insurance). DISCUSSION AND IMPLICATIONS Telehealth was useful for promoting health among rural-living older adults. Technological supports are needed to improve telehealth ease of use and adherence. Cost-effectiveness of telehealth needs more study, particularly targeting older adults.
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Affiliation(s)
- Kathy L Rush
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Sarah Singh
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Cherisse L Seaton
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Lindsay Burton
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Eric Li
- Faculty of Management, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Charlotte Jones
- Faculty of Medicine, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Jennifer C Davis
- Faculty of Management, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Khalad Hasan
- Department of Computer Science, Mathematics, Physics and Statistics, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Brodie Kern
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Robert Janke
- Research and Administration, Library Administration, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
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Digitally enabled cardiac rehabilitation following coronary revascularization: results from a single centre feasibility study. Eur Heart J Suppl 2022; 24:H25-H31. [DOI: 10.1093/eurheartjsupp/suac054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Wearable activity monitors, together with smartphone-based health and fitness applications (apps), are becoming more accessible and their widespread use provides an additional opportunity for the recording of cardiovascular metrics in patients with cardiovascular disease. The use of selected metrics by cardiac rehabilitation (CR) programmes allows the facilitation of individualized and tailored positive lifestyle changes to patients and places the patient at the centre of their recovery programme. To investigate the role of such devices on outcomes with patients on a CR programme, a cohort/case–control study was conducted. Patients post-myocardial infarction who were treated with either percutaneous coronary intervention or surgical coronary revascularisation at a single centre were invited to use a physical activity monitor linked to a customized app at their initial assessment for the rehabilitation programme. Those who accepted were allocated to the treatment group. The control group was selected from a larger pool of 400 historical and concurrent patients. Propensity matching was used to associate each case with their closest control. The changes in self-reported physical activity were similar for both groups at the end of the CR programme (EOP). The digitally monitored group tended to achieve greater METS (metabolic equivalent of task - a measure of exercise intensity) at 12 weeks (P < 0.059); however, no difference was observed in the overall change in METS at EOP (P < 0.333). Although no difference was noted in diastolic blood pressure, a statistically significant drop in the systolic blood pressure in the digitally monitored group (P < 0.004) was detected. In this study, the innovative combination of technology and face-to-face CR showed promising results and assisted the individualization of delivered content. This intervention could easily be replicated and expanded. Challenges are the recruitment of the elderly population, those who may be less engaged with or have less access to technology, and the underrepresentation of women in the study sample.
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Vicente MA, Fernández C, Guilabert M, Carrillo I, Martín-Delgado J, Mira JJ. Patient Engagement Using Telemedicine in Primary Care during COVID-19 Pandemic: A Trial Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14682. [PMID: 36429402 PMCID: PMC9690471 DOI: 10.3390/ijerph192214682] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 06/16/2023]
Abstract
The correct treatment of most non-transmissible diseases requires, in addition to adequate medication, adherence to physical activity and diet guidelines, as well as health data monitoring and patient motivation. The restrictions caused by the COVID-19 pandemic made telemedicine tools and mobile apps the best choice for monitoring patient compliance. The objective of this study was to analyze the benefits of an m-Health solution designed specifically for chronic patients during the COVID-19 pandemic. A pragmatic clinical trial with pre-post measurements of a single group was carried out with 70 patients (aged 40+) with one or more chronic conditions. Patients were provided with an ad hoc mobile app and health data measuring devices according to their diseases. The health status of the patients was monitored remotely by health professionals who could also modify the patient's objectives according to their evolution. The results obtained show an average fulfillment of objectives of 77%. Higher fulfillment values: medication adherence (98%) and oxygen saturation (82%); lower fulfillment values: weight (48%), glucose (57%), and distance walked (57%). Globally, the ad hoc app was rated 8.72 points out of 10 (standard deviation 1.10). Concerning the pre-post analysis, there were significant improvements vs. prior apps used by the participants in the following items: improved physical activation and better control of blood pressure, diet, weight, glucose, and oxygen saturation. In conclusion, the telemedicine tool developed was useful in increasing patient engagement and adherence to treatment.
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Affiliation(s)
| | - César Fernández
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain
| | - Mercedes Guilabert
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain
| | - Irene Carrillo
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain
| | - Jimmy Martín-Delgado
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 0313 Alicante, Spain
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil 090603, Ecuador
| | - José Joaquín Mira
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 0313 Alicante, Spain
- Alicante-Sant Joan d’Alacant Health Department, 03013 Alicante, Spain
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Schweiger A, Rodebaugh TL, Lenze EJ, Keenoy K, Hassenstab J, Kloeckner J, Gettinger TR, Nicol GE. Mindfulness Training for Depressed Older Adults Using Smartphone Technology: Protocol for a Fully Remote Precision Clinical Trial. JMIR Res Protoc 2022; 11:e39233. [PMID: 36301604 PMCID: PMC9650569 DOI: 10.2196/39233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Precision medicine, optimized interventions, and access to care are catchphrases for the future of behavioral treatments. Progress has been slow due to the dearth of clinical trials that optimize interventions' benefits, individually tailor interventions to meet individual needs and preferences, and lead to rapid implementation after effectiveness is demonstrated. Two innovations have emerged to meet these challenges: fully remote trials and precision clinical trials. OBJECTIVE This paper provides a detailed description of Mindful MyWay, a study designed to test online mindfulness training in older adults with depression. Consistent with the concept of fully remote trials using a smartphone app, the study requires no in-person contact and can be conducted with participants anywhere in the United States. Based upon the precision medicine framework, the study assesses participants using high-frequency assessments of symptoms, cognitive performance, and patient preferences to both understand the individualized nature of treatment response and help individually tailor the intervention. METHODS Mindful MyWay is an open-label early-phase clinical trial for individuals 65 years and older with current depression. A smartphone app was developed to help coordinate the study, deliver the intervention, and evaluate the acceptability of the intervention, as well as predictors and outcomes of it. The curriculum for the fully remote intervention parallels the mindfulness-based stress reduction curriculum, a protocolized group-based mindfulness training that is typically provided in person. After consent and screening, participants download The Healthy Mind Lab mobile health smartphone app from the Apple App Store, allowing them to complete brief smartphone-based assessments of depressive symptoms and cognitive performance 4 times each day for 4 weeks prior to and after completing the intervention. The intervention consists of an introduction video and 10 weekly mindfulness training sessions, with the expectation to practice mindfulness at home daily. The app collects participant preference data throughout the 10-week intervention period; these high-frequency assessments identify participants' individually dynamic preferences toward the goal of optimizing the intervention in future iterations. RESULTS Participant recruitment and data collection began in March 2019. Final end point assessments will be collected in May 2022. The paper describes lessons learned regarding the critical role of early-phase testing prior to moving to a randomized trial. CONCLUSIONS The Mindful MyWay study is an exemplar of innovative clinical trial designs that use smartphone technology in behavioral and neuropsychiatric conditions. These include fully remote studies that can recruit throughout the United States, including hard-to-access areas, and collect high-frequency data, which is ideal for idiographic assessment and individualized intervention optimization. Our findings will be used to modify our methods and inform future randomized controlled trials within a precision medicine framework. TRIAL REGISTRATION ClinicalTrials.gov NCT03922217; https://clinicaltrials.gov/ct2/show/NCT03922217. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39233.
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Affiliation(s)
- Abigail Schweiger
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, United States
- School of Social Work, Saint Louis University, Saint Louis, MO, United States
| | - Thomas L Rodebaugh
- Department of Psychological and Brain Sciences, Washington University in Saint Louis, Saint Louis, MO, United States
| | - Eric J Lenze
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, United States
- mHealth Research Core, Washington University School of Medicine, Saint Louis, MO, United States
| | - Katie Keenoy
- mHealth Research Core, Washington University School of Medicine, Saint Louis, MO, United States
- Trial Care Unit, Center for Clinical Studies, Washington University School of Medicine, Saint Louis, MO, United States
| | - Jason Hassenstab
- Department of Psychological and Brain Sciences, Washington University in Saint Louis, Saint Louis, MO, United States
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Jeanne Kloeckner
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, United States
| | - Torie R Gettinger
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, United States
- School of Social Work, Saint Louis University, Saint Louis, MO, United States
| | - Ginger E Nicol
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, United States
- mHealth Research Core, Washington University School of Medicine, Saint Louis, MO, United States
- Division of Child and Adolescent Psychiatry, Washington University School of Medicine, Saint Louis, MO, United States
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Valk-Draad MP, Bohnet-Joschko S. Nursing Home-Sensitive Hospitalizations and the Relevance of Telemedicine: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12944. [PMID: 36232255 PMCID: PMC9566431 DOI: 10.3390/ijerph191912944] [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: 08/19/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
The aging of society is increasing the number of hospitalizations of nursing home residents. Telemedicine might help reduce the frequency of these potentially risk-associated hospitalizations. This scoping review looked for evidence of a change in the rate of hospitalization and, if mentioned, any cost savings and/or staff acceptance of the use of telemedicine in a nursing home setting. To identify available evidence, the electronic databases PubMed, Livivo, EBSCO and JSTOR were searched (without time or regional constraints) for comparative primary research studies on this topic in peer-reviewed journals. A total of 1127 articles were retrieved and 923 titles and abstracts were screened, with 16 studies published between 2001 and 2022 being included. Telemedicine consultation reduced the hospitalization of nursing home residents in 14/16 and care costs in 8/11 articles. Staff satisfaction was mentioned positively in five studies. Most studies used telemedicine involving medical diagnostic technologies (10), (electronic) health records (9), specialists (9) and specialized nursing staff (11). Few studies had a higher level of evidence: only one randomized clinical trial was included. There is the need for high credibility studies, using guidelines on protocol and reporting, to better understand the hindering and facilitating factors of telemedicine provision in the healthcare of nursing home residents.
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Zadvinskis IM, Tucker S, Hoying J. Evidence, expertise, and patient/family preferences to maximize health for older adults with implications for evidence-based practice. Worldviews Evid Based Nurs 2022; 19:344-351. [PMID: 36102340 PMCID: PMC9826038 DOI: 10.1111/wvn.12605] [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: 05/19/2022] [Revised: 07/11/2022] [Accepted: 07/25/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND As Americans live longer and with chronic conditions, the healthcare system, researchers, faculty, practicing providers, patients, and families must adapt to changing societal needs and goals. AIMS The aim of this commentary was to offer recommendations that align with the six vital directions to improve the health care and quality of life for older Americans. METHODS This article expands upon the six vital directions from an evidence-based practice (EBP) perspective that values the three legs of the EBP stool: (1) research evidence, (2) clinician expertise, and (3) patient preferences, values, and circumstances. RESULTS The recommendations reflect the scientific literature, our expertise in EBP and research, our nursing roles and expertise, and our experiences in the care of our older parents. By sharing our experiences as nurse scientists and daughters, we offer insight to raise the healthcare bar for older adults through EBP and meaningful, person-centered care. LINKING ACTION TO EVIDENCE Vital directions for improving the health care and quality of life for older Americans include promoting interprofessional education to create an adequately prepared workforce; researching and implementing pathways to minimize the social determinants of health for older adults; disseminating findings that remediate older adult health disparities; innovating approaches for managing chronic health conditions at home; and studying and implementing approaches for allocating resources for end-of-life care that are satisfying for the patients, their family, and clinicians.
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Affiliation(s)
- Inga M. Zadvinskis
- Helene Fuld Health Trust National Institute for Evidence‐based Practice in Nursing and HealthcareColumbusOhioUSA
| | - Sharon Tucker
- Helene Fuld Health Trust National Institute for Evidence‐based Practice in Nursing and HealthcareColumbusOhioUSA,The Ohio State University College of NursingColumbusOhioUSA
| | - Jacqueline Hoying
- Helene Fuld Health Trust National Institute for Evidence‐based Practice in Nursing and HealthcareColumbusOhioUSA,The Ohio State University College of NursingColumbusOhioUSA
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Li S(E, Hossain M, Gilman B, Forrow LV, Lee KM, Brown R. Effects of a nursing home telehealth program on spending and utilization for Medicare residents. Health Serv Res 2022; 57:1191-1200. [PMID: 35043397 PMCID: PMC9441287 DOI: 10.1111/1475-6773.13936] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/09/2021] [Accepted: 01/04/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess the effects of eLongTermCare (eLTC), a telehealth program implemented by an integrated health system in 45 nursing homes across the Midwest, on the use of acute hospital services and total expenditures for Medicare residents. DATA SOURCES Minimum Data Set, Medicare fee-for-service claims, and enrollment data from 2013 to 2018. STUDY DESIGN We used a longitudinal difference-in-differences design to estimate the changes in outcomes for treatment beneficiaries before and after participating in the eLTC program, relative to changes for the matched comparison beneficiaries over the same period. We measured outcomes over a 24-month follow-up period, including total Medicare spending, emergency department (ED) visits, hospitalizations, and the likelihood of readmission. DATA COLLECTION/EXTRACTION METHODS Using administrative data, we identified treatment beneficiaries who stayed at participating nursing facilities during the program period and matched comparison beneficiaries with similar baseline characteristics from non-participating facilities in the same geographic locations. PRINCIPAL FINDINGS For long-term care residents, the eLTC program led to an estimated reduction of 73 ED visits per 1000 beneficiaries (p < 0.01, 8.6% effect) over the two-year follow-up period. The estimated effects for this group were concentrated among beneficiaries who entered the nursing home after program startup, with sizable reductions in hospitalizations, ED visits, and spending. For skilled care residents, the program was associated with an estimated reduction of 85 ED visits per 1000 beneficiaries (p = 0.03, 9.7% effect), but had no discernible effect on their hospitalizations or total Medicare spending. CONCLUSIONS Telehealth can be a valuable tool for nursing homes to enhance care coordination and provide timely access to care, leading to lower spending for nursing home residents. Future research needs to explore payment methods that encourage telehealth expansion in nursing homes.
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Affiliation(s)
| | | | | | | | - Katie M. Lee
- Mathematica Inc.WashingtonDistrict of ColumbiaUSA
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Allen J. Exploring Adult Patients’ Perceptions and Experiences of Telemedicine Consultations in Primary Care: A Qualitative Systematic Review. INTERNATIONAL JOURNAL OF MEDICAL STUDENTS 2022. [DOI: 10.5195/ijms.2022.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The COVID-19 pandemic transformed a gradual uptake of telemedicine, into a sudden worldwide implementation of telemedicine consultations. Primary care is a particular area affected and one where telemedicine consultations are expected to be the future. However, for effective long-term implementation it is vital that patient perceptions and experiences are understood. The aim of this qualitative systematic review was to explore the perceptions and experiences of adults who have used telemedicine consultations in primary care. Studies were identified through a search of four electronic databases (MEDLINE, EMBASE, CINAHL, and CENTRAL) alongside reference list and citation searches. Quality assessment was conducted using the CASP checklist and data was synthesized using a simplified approach to thematic analysis. From 2492 identified records, ten studies met the eligibility criteria all of which were judged as either good or moderate quality. Three themes were identified which were potential benefits, potential barriers, and beneficial prerequisites for telemedicine consultations in primary care. Within these themes, sixteen sub-themes were identified with examples including accessibility and convenience for potential benefits, lack of face-to-face interaction and impersonal consultations for potential barriers, and continuity of care for beneficial prerequisites. Analysing these subthemes, four main recommendations for practice can be made which are to utilise continuity of care, offer both video and telephone consultations, provide adequate support, and that healthcare professionals should demonstrate an explicit understanding of the patient’s health issues. Further research is needed to explore and expand on this topic area and future research should be viewed as a continuous process.
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Ng BP, Park C, Silverman CL, Eckhoff DO, Guest JC, Díaz DA. Accessibility and utilisation of telehealth services among older adults during COVID-19 pandemic in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2657-e2669. [PMID: 34994028 DOI: 10.1111/hsc.13709] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/26/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
The removal of regulatory and reimbursement barriers during the COVID-19 pandemic in the United States presented opportunities to explore the potential of telehealth to improve access to and use of healthcare among underserved populations. Therefore, we examined factors associated with accessibility and utilisation of telehealth among older adults during the COVID-19 pandemic. We analysed the nationally representative Medicare Current Beneficiary Survey COVID-19 Supplement File of community-dwelling Medicare beneficiaries aged ≥65 years (n = 5,189), administered from 5 October 2020, through 15 November 2020. Two survey-weighted multivariable logistic regression models were used to assess the association between factors (i.e., socio-demographics, co-morbidities and digital access/literacy) and whether (1) beneficiaries' regular providers offered telehealth during the COVID-19 pandemic, and (2) those being offered telehealth used it. Furthermore, subgroup analyses by residing area and income status were conducted. Of study beneficiaries, 83.6% reported their regular providers offered telehealth during COVID-19. Disparities in accessibility of telehealth by sociodemographic status were observed [e.g., those living in a non-metro area (versus metro) were 7.1% (marginal effect [ME] = -7.1%; p < 0.01) less likely to report accessibility of telehealth]. Beneficiaries who had no access to internet (ME = -8.2%; p < 0.001) and had not participated in video/voice calls/conferencing prior (versus participated) (ME = -6.6%; p < 0.001) were less likely to report having access to telehealth. Among those being offered telehealth services, 43.0% reported using telehealth services. Hispanic and Non-Hispanic Black beneficiaries (e.g., Black versus White; ME = 11.3%; p < 0.01) and those with co-morbidities (versus 0-1 condition) (e.g., 2-3 co-morbidities, ME = 7.3%; p < 0.01) were more likely to report using telehealth services when offered. Similar results were observed in the subgroup analyses regarding disparities in accessibility and utilisation of telehealth. The accessibility and utilisation of telehealth have increased amidst the pandemic; however, disparities in accessibility of telehealth were observed. A telehealth triage protocol is needed to ensure underserved patients continue to receive appropriate care.
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Affiliation(s)
- Boon Peng Ng
- College of Nursing, University of Central Florida, Orlando, FL, USA
- Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - Chanhyun Park
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Ciara L Silverman
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Dawn O Eckhoff
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Janeen C Guest
- Master of Public Administration, University of Management and Technology, Arlington, VA, USA
| | - Desiree A Díaz
- College of Nursing, University of Central Florida, Orlando, FL, USA
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49
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Gong Y, Zhou J. What are the demands of telegeriatrics medical services for elderly patients during the COVID-19 pandemic. Front Public Health 2022; 10:935684. [PMID: 36003633 PMCID: PMC9394759 DOI: 10.3389/fpubh.2022.935684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/12/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose Elderly patients are associated with a higher risk of nosocomial cross infection during the COVID-19 pandemic. Providing medical services and primary care for elderly patients is a worldwide challenge. A new telegeriatrics system was established to provide medical services and primary care for elderly patients treated by family physicians. This study aimed to describe the operation mechanism of the new system and investigate the demands of telegeriatrics medical services for elderly patients treated by family physicians during the COVID-19 pandemic. Methods A total of 1,353 elderly patients (aged≥60) treated by family physicians were enrolled. The proportion of the top 10 diseases of elderly patients applying the new system was analyzed. Differences in main diseases between elderly patients applying telegeriatrics medical services and outpatients in hospitals were compared. Differences between the new telegeriatrics system in our study and telemedicine systems of other studies in other countries were analyzed. Results Constituent ratios of chronic kidney disease, type 2 diabetes mellitus, and coronary heart disease have the highest rate in elderly patients applying the new telegeriatrics system. Digestive diseases, cardiovascular diseases, and neurology diseases were the top three diseases of elderly outpatients. Conclusion This is the first time that a new telegeriatrics system has been applied to provide medical services for elderly patients treated by family physicians during the COVID-19 pandemic. Chronic kidney disease, Type 2 diabetes mellitus, and coronary heart disease were found to be the top three diseases of elderly patients applying telegeriatrics medical services during the COVID-19 pandemic, which were different from the outpatients in general hospitals. The new telegeriatrics system guarantees elderly patients get equal rights to medical services. Results will provide a basis for the government health administrative department to formulate new telegeriatrics policies for elderly patients.
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Affiliation(s)
- Yu Gong
- Department of Internal Medicine, Telemedicine Center, Shanghai Municipal Eighth People's Hospital, Shanghai, China
- Department of Internal Medicine, Division of Nephrology, Shanghai Municipal Eighth People's Hospital, Shanghai, China
- *Correspondence: Yu Gong
| | - Jianyuan Zhou
- Department of Internal Medicine, Telemedicine Center, Shanghai Municipal Eighth People's Hospital, Shanghai, China
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50
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Chen W, Flanagan A, Nippak PM, Nicin M, Sinha SK. Understanding the Experience of Geriatric Care Professionals in Using Telemedicine to Care for Older Patients in Response to the COVID-19 Pandemic: A Mixed-Methods Study. JMIR Aging 2022; 5:e34952. [PMID: 35830331 PMCID: PMC9369613 DOI: 10.2196/34952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Geriatric care professionals were forced to rapidly adopt the use of telemedicine technologies to ensure the continuity of care for their older patients in response to the COVID-19 pandemic. However, there is little current literature that describes how telemedicine technologies can best be used to meet the needs of geriatric care professionals in providing care to frail older patients, their caregivers, and their families. Objective This study aims to identify the benefits and challenges geriatric care professionals face when using telemedicine technologies with frail older patients, their caregivers, and their families and how to maximize the benefits of this method of providing care. Methods This was a mixed methods study that recruited geriatric care professionals to complete an online survey regarding their personal demographics and experiences with using telemedicine technologies and participate in a semistructured interview. Interview responses were analyzed using the Consolidated Framework for Implementation Research (CFIR). Results Quantitative and qualitative data were obtained from 30 practicing geriatric care professionals (22, 73%, geriatricians, 5, 17%, geriatric psychiatrists, and 3, 10%, geriatric nurse practitioners) recruited from across the Greater Toronto Area. Analysis of interview data identified 5 CFIR contextual barriers (complexity, design quality and packaging, patient needs and resources, readiness for implementation, and culture) and 13 CFIR contextual facilitators (relative advantage, adaptability, tension for change, available resources, access to knowledge, networks and communications, compatibility, knowledge and beliefs, self-efficacy, champions, external agents, executing, and reflecting and evaluating). The CFIR concept of external policy and incentives was found to be a neutral construct. Conclusions This is the first known study to use the CFIR to develop a comprehensive narrative to characterize the experiences of Ontario geriatric care professionals using telemedicine technologies in providing care. Overall, telemedicine can significantly enable most of the geriatric care that is traditionally provided in person but is less useful in providing specific aspects of geriatric care to frail older patients, their caregivers, and their families.
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Affiliation(s)
- Wenwen Chen
- School of Health Services Management, Ted Rogers School of Management, Toronto Metropolitan University, TRS 2-068350 Victoria Street, Toronto, CA
| | - Ashley Flanagan
- National Institute on Ageing, Toronto Metropolitan University, Toronto, CA
| | - Pria Md Nippak
- School of Health Services Management, Ted Rogers School of Management, Toronto Metropolitan University, TRS 2-068350 Victoria Street, Toronto, CA
| | - Michael Nicin
- National Institute on Ageing, Toronto Metropolitan University, Toronto, CA
| | - Samir K Sinha
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, CA.,National Institute on Ageing, Toronto Metropolitan University, Toronto, CA
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