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Cummins MR, Tsalatsanis A, Chaphalkar C, Ivanova J, Ong T, Soni H, Barrera JF, Wilczewski H, Welch BM, Bunnell BE. Telemedicine appointments are more likely to be completed than in-person healthcare appointments: a retrospective cohort study. JAMIA Open 2024; 7:ooae059. [PMID: 39006216 PMCID: PMC11245742 DOI: 10.1093/jamiaopen/ooae059] [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: 10/24/2023] [Revised: 04/05/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024] Open
Abstract
Objectives Missed appointments can lead to treatment delays and adverse outcomes. Telemedicine may improve appointment completion because it addresses barriers to in-person visits, such as childcare and transportation. This study compared appointment completion for appointments using telemedicine versus in-person care in a large cohort of patients at an urban academic health sciences center. Materials and Methods We conducted a retrospective cohort study of electronic health record data to determine whether telemedicine appointments have higher odds of completion compared to in-person care appointments, January 1, 2021, and April 30, 2023. The data were obtained from the University of South Florida (USF), a large academic health sciences center serving Tampa, FL, and surrounding communities. We implemented 1:1 propensity score matching based on age, gender, race, visit type, and Charlson Comorbidity Index (CCI). Results The matched cohort included 87 376 appointments, with diverse patient demographics. The percentage of completed telemedicine appointments exceeded that of completed in-person care appointments by 9.2 points (73.4% vs 64.2%, P < .001). The adjusted odds ratio for telemedicine versus in-person care in relation to appointment completion was 1.64 (95% CI, 1.59-1.69, P < .001), indicating that telemedicine appointments are associated with 64% higher odds of completion than in-person care appointments when controlling for other factors. Discussion This cohort study indicated that telemedicine appointments are more likely to be completed than in-person care appointments, regardless of demographics, comorbidity, payment type, or distance. Conclusion Telemedicine appointments are more likely to be completed than in-person healthcare appointments.
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Affiliation(s)
- Mollie R Cummins
- Department of Biomedical Informatics, College of Nursing and Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84112-5880, United States
- Doxy.me Inc., Charleston, SC 29401, United States
| | - Athanasios Tsalatsanis
- Office of Research, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, United States
| | - Chaitanya Chaphalkar
- Office of Research, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, United States
| | | | - Triton Ong
- Doxy.me Inc., Charleston, SC 29401, United States
| | - Hiral Soni
- Doxy.me Inc., Charleston, SC 29401, United States
| | - Janelle F Barrera
- Doxy.me Inc., Charleston, SC 29401, United States
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, United States
| | | | - Brandon M Welch
- Doxy.me Inc., Charleston, SC 29401, United States
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Brian E Bunnell
- Doxy.me Inc., Charleston, SC 29401, United States
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, United States
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Bîlbîie A, Puiu AI, Mihăilă V, Burcea M. Investigating Physicians' Adoption of Telemedicine in Romania Using Technology Acceptance Model (TAM). Healthcare (Basel) 2024; 12:1531. [PMID: 39120234 PMCID: PMC11312213 DOI: 10.3390/healthcare12151531] [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: 07/03/2024] [Revised: 07/24/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024] Open
Abstract
This study investigates Romanian physicians' acceptance of telemedicine using the Technology Acceptance Model. We analyzed 1093 responses to an online survey distributed nationwide to physicians via email by the National Authority of Quality Management in Health, employing the partial least squares algorithm to estimate the relationship between the behavioral intention to adopt telemedicine and its potential determinants. Our findings reveal that the model accounts for 84.6% of the variance in behavioral intention to use telemedicine. Among the two constructs of the TAM model, perceived usefulness is a stronger predictor of behavioral intention than perceived ease of use. Additionally, subjective norms positively and significantly influence physicians' intention to use telemedicine and their perception of its usefulness. Furthermore, perceived incentives and accessibility to medical records also positively impact the behavioral intention to use telemedicine.
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Affiliation(s)
- Abigaela Bîlbîie
- Faculty of Theoretical and Applied Economics, The Academy of Economic Studies, 010552 Bucharest, Romania;
| | - Andreea-Ionela Puiu
- Department of Applied Economics and Quantitative Analysis, Faculty of Business and Administration, University of Bucharest, 030018 Bucharest, Romania
| | - Viorel Mihăilă
- Department of Public Administration, Faculty of Business and Administration, University of Bucharest, 030018 Bucharest, Romania; (V.M.); (M.B.)
| | - Marin Burcea
- Department of Public Administration, Faculty of Business and Administration, University of Bucharest, 030018 Bucharest, Romania; (V.M.); (M.B.)
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Mansfield BS, Mohamed F, Larouche M, Raal FJ. The Hurdle of Access to Emerging Therapies and Potential Solutions in the Management of Dyslipidemias. J Clin Med 2024; 13:4160. [PMID: 39064199 PMCID: PMC11277596 DOI: 10.3390/jcm13144160] [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: 06/12/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
This review explores the many barriers to accessing lipid-lowering therapies (LLTs) for the prevention and management of atherosclerotic cardiovascular disease (ASCVD). Geographical, knowledge, and regulatory barriers significantly impede access to LLTs, exacerbating disparities in healthcare infrastructure and affordability. We highlight the importance of policy reforms, including pricing regulations and reimbursement policies, for enhancing affordability and streamlining regulatory processes. Innovative funding models, such as value-based pricing and outcome-based payment arrangements, have been recommended to make novel LLTs more accessible. Public health interventions, including community-based programs and telemedicine, can be utilized to reach underserved populations and improve medication adherence. Education and advocacy initiatives led by patient advocacy groups and healthcare providers play a crucial role in raising awareness and empowering patients. Despite the barriers to access, novel LLTs present a big opportunity to reduce the burden of ASCVD, emphasizing the need for collaborative efforts among policymakers, healthcare providers, industry stakeholders, and patient advocacy groups to address these barriers to improve access to LLTs globally.
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Affiliation(s)
- Brett S. Mansfield
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg 2193, South Africa; (B.S.M.); (F.M.)
- Carbohydrate & Lipid Metabolism Research Unit, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Farzahna Mohamed
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg 2193, South Africa; (B.S.M.); (F.M.)
- Carbohydrate & Lipid Metabolism Research Unit, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Miriam Larouche
- Département de Médecine, Université de Montréal and ECOGENE-21, Montreal, QC H3T 1J4, Canada;
| | - Frederick J. Raal
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg 2193, South Africa; (B.S.M.); (F.M.)
- Carbohydrate & Lipid Metabolism Research Unit, University of the Witwatersrand, Johannesburg 2193, South Africa
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4
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Ezeamii VC, Okobi OE, Wambai-Sani H, Perera GS, Zaynieva S, Okonkwo CC, Ohaiba MM, William-Enemali PC, Obodo OR, Obiefuna NG. Revolutionizing Healthcare: How Telemedicine Is Improving Patient Outcomes and Expanding Access to Care. Cureus 2024; 16:e63881. [PMID: 39099901 PMCID: PMC11298029 DOI: 10.7759/cureus.63881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 08/06/2024] Open
Abstract
Telemedicine uses digital technologies to provide healthcare services remotely, greatly improving patient access, especially during crises like the COVID-19 pandemic. This systematic review investigates telemedicine's effects on patient outcomes, access to care, and its role in the evolving healthcare landscape. Relevant studies were identified using MeSH terms and keywords through electronic databases and manual reference list screenings. The selected empirical studies, both quantitative and qualitative, examined telemedicine across various patient populations. The review categorized findings into themes related to patient outcomes and access to care. Telemedicine was found to be a transformative tool in chronic disease management, particularly in diabetes care. Significant improvements in patient health outcomes and cost savings were reported with telemedicine interventions. For example, telehealth platforms enhance diabetes management by increasing patient engagement and improving clinical metrics such as HbA1c levels. Additionally, telehealth services for diabetes-related foot disease (DFD) overcome geographical barriers, providing specialized care and improving patient access and satisfaction. In conclusion, telemedicine significantly improves patient outcomes, access, and satisfaction in chronic disease management, especially diabetes care. By overcoming geographical barriers and enhancing patient engagement, telehealth platforms have the potential to transform global healthcare delivery. Implementing these insights into practice can improve the accessibility and effectiveness of diabetes care worldwide, ensuring equitable and patient-centered healthcare solutions.
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Affiliation(s)
- Victor C Ezeamii
- Public Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, USA
| | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | | | | | | | | | - Mohamed M Ohaiba
- Industrial Engineering, Louisiana State University, Baton Rouge, USA
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Cely-Andrade L, Cárdenas-Garzón K, Enríquez-Santander LC, Saavedra-Avendano B, Ortiz-Avendano GA, Betancourt-Rojas LA, Guerrero-Conde JG. Effectiveness and safety of medication abortion via telemedicine versus in-person: A cohort of pregnant people in Colombia. Contraception 2024:110514. [PMID: 38879070 DOI: 10.1016/j.contraception.2024.110514] [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: 09/28/2023] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE To compare the effectiveness and safety of medication abortion (MAB) via telemedicine versus in-person in pregnant people with less than 12 gestational weeks in Colombia. STUDY DESIGN A retrospective cohort study was conducted with 23,362 pregnant people who requested MAB service from Profamilia (a Colombian non-governmental organization) in 2021-2022. The outcomes were success and safety of MAB. We performed a descriptive and a multivariate statistical analysis using the binary regression model to obtain an adjusted Odds Ratio (aOR) to identify factors associated with abortion success. RESULTS In comparison to in-person care (n = 20,289), individuals in telemedicine (n = 3073) were predominantly from urban areas, belonged to a lower socioeconomic stratum, single and did not identify with any ethnic group. In-person users tended to have higher levels of education and accessed the service through private insurance (p < 0,05). There were no differences in the odd of a successful abortion based on the modality of care (aOR 1.18; 95% CI=0.87-1.59). The results were also the same with sensitivity analysis stratified: pregnant people who were nine weeks gestation or less (aOR 0.86; 95% CI=0.63-1.17) or more (aOR 0.87; 95% CI=0.28-2.65). CONCLUSION Telemedicine is an effective and safe option for MAB, as in-person care. Telemedicine has the potential to increase abortion access by extending the availability of providers and offering people a new option for obtaining care conveniently and privately, especially for women with disadvantaged socioeconomic and educational background. IMPLICATIONS This study demonstrates that medication abortion (MAB) administered via telemedicine produces outcomes akin to those of in-person care, providing a compelling rationale for its adoption, particularly in underserved regions. This approach can be replicated in other countries in Latin America and the Caribbean.
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Zuccotti G, Marsilio M, Fiori L, Erba P, Destro F, Zamana C, Folgori L, Mandelli A, Braghieri D, Guglielmetti C, Pisarra M, Magnani L, Infante G, Dilillo D, Fabiano V, Carlucci P, Zoia E, Pelizzo G, Calcaterra V. Leveraging User-Friendly Mobile Medical Devices to Facilitate Early Hospital Discharges in a Pediatric Setting: A Randomized Trial Study Protocol. CHILDREN (BASEL, SWITZERLAND) 2024; 11:683. [PMID: 38929262 PMCID: PMC11201467 DOI: 10.3390/children11060683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Mobile technology is increasingly prevalent in healthcare, serving various purposes, including remote health monitoring and patient self-management, which could prove beneficial to early hospital discharges. AIMS This study investigates the transitional care program experience facilitating early discharges in a pediatric setting through the use of an easy-to-use mobile medical device (TytoCare™, TytoCare Ltd., Natanya, Israel). OUTCOMES This study aims to assess the effectiveness of telehomecare in achieving complete resolution of diseases without readmission, compare the length of stay between intervention and standard care groups, and gather user and professional experiences. METHODS A randomized open-label, controlled pilot study enrolled 102 children, randomly assigned to the telehomecare (TELE) group (n = 51, adopting early hospital discharge with continued home monitoring) or the standard-of-care (STAND) group (n = 51). Primary outcomes include complete disease resolution without readmission. Secondary objectives include recording a shorter length of stay in the intervention group. Surveys on user and professional experiences were conducted. A group of 51 children declining telemedicine services (NO-TELE) was also included. RESULTS In the TELE group, 100% of children achieved complete disease resolution without readmission, with a median duration of stay of 4 days, significantly shorter than the 7 days in the STAND group (p = 0.01). The telemedicine system demonstrated efficient performance and high satisfaction levels. The NO-TELE group showed no significant differences in demographics or digital technology competence. Perceived benefits of telemedicine included time and cost savings, reduced hospital stays, and technology utility and usability. CONCLUSIONS This study demonstrates that user-friendly mobile medical devices effectively facilitate early hospital discharges in a pediatric setting. These devices serve as a bridge between home and hospital, optimizing care pathways.
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Affiliation(s)
- Gianvincenzo Zuccotti
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy; (D.B.); (V.F.); (G.P.)
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (L.F.); (P.E.); (L.F.); (D.D.); (P.C.); (V.C.)
| | - Marta Marsilio
- Department of Economics, Management and Quantitative Methods, University of Milan, 20122 Milan, Italy; (M.M.); (C.G.); (M.P.); (L.M.); (G.I.)
| | - Laura Fiori
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (L.F.); (P.E.); (L.F.); (D.D.); (P.C.); (V.C.)
| | - Paola Erba
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (L.F.); (P.E.); (L.F.); (D.D.); (P.C.); (V.C.)
| | - Francesca Destro
- Pediatric Surgery Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (F.D.); (C.Z.)
| | - Costantino Zamana
- Pediatric Surgery Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (F.D.); (C.Z.)
| | - Laura Folgori
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (L.F.); (P.E.); (L.F.); (D.D.); (P.C.); (V.C.)
| | - Anna Mandelli
- Intensive Care Unit, Buzzi Children’s Hospital, 20154 Milan, Italy; (A.M.); (E.Z.)
| | - Davide Braghieri
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy; (D.B.); (V.F.); (G.P.)
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (L.F.); (P.E.); (L.F.); (D.D.); (P.C.); (V.C.)
| | - Chiara Guglielmetti
- Department of Economics, Management and Quantitative Methods, University of Milan, 20122 Milan, Italy; (M.M.); (C.G.); (M.P.); (L.M.); (G.I.)
| | - Martina Pisarra
- Department of Economics, Management and Quantitative Methods, University of Milan, 20122 Milan, Italy; (M.M.); (C.G.); (M.P.); (L.M.); (G.I.)
| | - Letizia Magnani
- Department of Economics, Management and Quantitative Methods, University of Milan, 20122 Milan, Italy; (M.M.); (C.G.); (M.P.); (L.M.); (G.I.)
| | - Gabriele Infante
- Department of Economics, Management and Quantitative Methods, University of Milan, 20122 Milan, Italy; (M.M.); (C.G.); (M.P.); (L.M.); (G.I.)
| | - Dario Dilillo
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (L.F.); (P.E.); (L.F.); (D.D.); (P.C.); (V.C.)
| | - Valentina Fabiano
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy; (D.B.); (V.F.); (G.P.)
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (L.F.); (P.E.); (L.F.); (D.D.); (P.C.); (V.C.)
| | - Patrizia Carlucci
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (L.F.); (P.E.); (L.F.); (D.D.); (P.C.); (V.C.)
| | - Elena Zoia
- Intensive Care Unit, Buzzi Children’s Hospital, 20154 Milan, Italy; (A.M.); (E.Z.)
| | - Gloria Pelizzo
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy; (D.B.); (V.F.); (G.P.)
- Pediatric Surgery Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (F.D.); (C.Z.)
| | - Valeria Calcaterra
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (L.F.); (P.E.); (L.F.); (D.D.); (P.C.); (V.C.)
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
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Borsch AS, Jensen AMB, Vange SS, Jervelund SS. The video window: How video consultation technology reveals and redefines the art of medicine in Danish specialist practice. Soc Sci Med 2024; 351:116965. [PMID: 38762998 DOI: 10.1016/j.socscimed.2024.116965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/05/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
In the contemporary landscape of technologically mediated healthcare, video consultations introduce a dynamic interplay of challenges and opportunities. Taking the notion of 'the art of medicine' as an analytical frame, and drawing on interviews with medical specialists as well as participant observation of video consultations with patients (carried out between February 2022 and January 2023), this article investigates how video consultation technology changes the practices of medical specialists in the Danish healthcare system. Informed by post-phenomenology, we approach video consultations metaphorically as 'windows' between medical specialists and patients, unveiling three pivotal dimensions characterizing these changes. First, the shift from a physical to a virtual consultation room requires a reevaluation of the authoritative nature of the clinic, emphasizing the need for negotiating and staging the clinical space online. Second, while video consultations limit doctors' ability to rely on traditional non-verbal cues such as body language, they offer glimpses into patients' home environments, exposing the influence of social preconceptions on medical evaluations. Third, the adoption of video consultations introduces new conditions for doctors' use of senses, accentuating the importance of reflecting on the roles of different sensory impressions in the art of medicine. Our study illuminates how video consultation technology simultaneously expands and constrains the engagement between medical specialists and patients. Despite their inherent limitations, video consultations bring medical specialists closer to some of the intricacies of patients' lives. This proximity offers new insights and renders visible the roles of caregivers and relatives in the patient's care. The metaphor of 'the video window' encapsulates this tension between distance and closeness in video consultations, portraying the patient as both fragmented and socially situated. Our study extends beyond traditional patient and provider satisfaction evaluations, providing nuanced insights into how video consultations reconfigure the art of medicine.
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Affiliation(s)
- Anne Sofie Borsch
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark.
| | - Anja M B Jensen
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark
| | - Sif Sofie Vange
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark
| | - Signe Smith Jervelund
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark
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Said CM, Ramage E, McDonald CE, Bicknell E, Hitch D, Fini NA, Bower KJ, Lynch E, Vogel AP, English K, McKay G, English C. Co-designing resources for rehabilitation via telehealth for people with moderate to severe disability post stroke. Physiotherapy 2024; 123:109-117. [PMID: 38458033 DOI: 10.1016/j.physio.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/15/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES The COVID-19 pandemic necessitated rapid transition to telehealth. Telehealth presents challenges for rehabilitation of stroke survivors with moderate-to-severe physical disability, which traditionally relies on physical interactions. The objective was to co-design resources to support delivery of rehabilitation via telehealth for this cohort. DESIGN Four-stage integrated knowledge translation co-design approach. Stage 1: Research team comprising researchers, clinicians and stroke survivors defined the research question and approach. Stage 2: Workshops and interviews were conducted with knowledge users (participants) to identify essential elements of the program. Stage 3: Resources developed by the research team. Stage 4: Resources reviewed by knowledge users and adapted. PARTICIPANTS Twenty-one knowledge users (clinicians n = 11, stroke survivors n = 7, caregivers n = 3) RESULTS: All stakeholders emphasised the complexities of telehealth rehabilitation for stroke and the need for individualised programs. Shared decision-making was identified as critical. Potential risks and benefits of telehealth were acknowledged and strategies to ameliorate risks and deliver effective rehabilitation were identified. Four freely available online resources were co-designed; three resources to support clinicians with shared decision-making and risk management and a decision-aid to support stroke survivors and caregivers throughout the process. Over six months, 1129 users have viewed the webpage; clinician resources were downloaded 374 times and the decision-aid was downloaded 570 times. CONCLUSIONS The co-design process identified key elements for delivery of telehealth rehabilitation to stroke survivors with moderate-to-severe physical disability and led to development of resources to support development of an individualised telehealth rehabilitation plan. Future research should evaluate the effectiveness of these resources. CONTRIBUTION OF PAPER.
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Affiliation(s)
- Catherine M Said
- Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia; Physiotherapy, Western Health, St Albans, Australia; Australian Institute of Musculoskeletal Sciences, St Albans, Australia.
| | - Emily Ramage
- Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia; Physiotherapy, Western Health, St Albans, Australia; School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Australia; Allied Health Strategy, Planning, Innovation, Research and Education Unit, Western Health, St Albans, Australia.
| | - Cassie E McDonald
- Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia; Physiotherapy, The Royal Melbourne Hospital, Parkville, Australia; Allied Health, Alfred Health, Melbourne, Australia.
| | - Erin Bicknell
- Physiotherapy, Western Health, St Albans, Australia; Physiotherapy, The Royal Melbourne Hospital, Parkville, Australia.
| | - Danielle Hitch
- Allied Health Strategy, Planning, Innovation, Research and Education Unit, Western Health, St Albans, Australia; School of Health and Social Development, Deakin University, Geelong, Australia.
| | - Natalie A Fini
- Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia.
| | - Kelly J Bower
- Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia.
| | - Elizabeth Lynch
- College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia.
| | - Adam P Vogel
- Audiology and Speech Pathology, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia; Redenlab Inc, Melbourne, Australia.
| | | | - Gary McKay
- Consumer Representative, Melbourne, Australia.
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Australia.
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Bishay AE, Hughes NC, Zargari M, Paulo DL, Bishay S, Lyons AT, Morkos MN, Ball TJ, Englot DJ, Bick SK. Disparities in Access to Deep Brain Stimulation for Parkinson's Disease and Proposed Interventions: A Literature Review. Stereotact Funct Neurosurg 2024; 102:179-194. [PMID: 38697047 DOI: 10.1159/000538748] [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: 12/21/2023] [Accepted: 03/28/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Deep brain stimulation (DBS) is an effective therapy for Parkinson's disease (PD), but disparities exist in access to DBS along gender, racial, and socioeconomic lines. SUMMARY Women are underrepresented in clinical trials and less likely to undergo DBS compared to their male counterparts. Racial and ethnic minorities are also less likely to undergo DBS procedures, even when controlling for disease severity and other demographic factors. These disparities can have significant impacts on patients' access to care, quality of life, and ability to manage their debilitating movement disorders. KEY MESSAGES Addressing these disparities requires increasing patient awareness and education, minimizing barriers to equitable access, and implementing diversity and inclusion initiatives within the healthcare system. In this systematic review, we first review literature discussing gender, racial, and socioeconomic disparities in DBS access and then propose several patient, provider, community, and national-level interventions to improve DBS access for all populations.
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Affiliation(s)
- Anthony E Bishay
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA,
| | - Natasha C Hughes
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Michael Zargari
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Danika L Paulo
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven Bishay
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Mariam N Morkos
- Arizona College of Osteopathic Medicine, Glendale, Arizona, USA
| | - Tyler J Ball
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Sarah K Bick
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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10
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Cheng TC, Sylvia S, Yip W. Innovative approaches of measuring care quality in China's market for telemedicine. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 46:101070. [PMID: 38645740 PMCID: PMC11033135 DOI: 10.1016/j.lanwpc.2024.101070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Terence C. Cheng
- Department of Global Health and Population, Harvard TH Chan School of Public Health, USA
| | - Sean Sylvia
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, USA
| | - Winnie Yip
- Department of Global Health and Population, Harvard TH Chan School of Public Health, USA
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Pamplin JC, Veazey SR, Barczak S, Fonda SJ, Serio-Melvin ML, Ross KS, Colombo CJ. Randomized Controlled Trial of Telementoring During Resource-Limited Patient Care Simulation Improves Caregiver Performance and Patient Survival. Crit Care Explor 2024; 6:e1090. [PMID: 38736901 PMCID: PMC11086961 DOI: 10.1097/cce.0000000000001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
OBJECTIVES To determine the impact of telementoring on caregiver performance during a high-fidelity medical simulation model (HFMSM) of a critically ill patient in a resource-limited setting. DESIGN A two-center, randomized, controlled study using a HFMSM of a patient with community-acquired pneumonia complicated by acute respiratory distress syndrome. SETTING A notional clinic in a remote location staffed by a single clinician and nonmedical assistant. PARTICIPANTS Clinicians with limited experience managing critically ill patients. INTERVENTIONS Telemedicine (TM) support. MEASUREMENTS The primary outcome was clinical performance as measured by accuracy, reliability, and efficiency of care. Secondary outcomes were patient survival, procedural quality, subjective assessment of the HFMSM, and perceived workload. MAIN RESULTS TM participants (N = 11) performed better than non-TM (NTM, N = 12) in providing expected care (accuracy), delivering care more consistently (reliability), and without consistent differences in efficiency (timeliness of care). Accuracy: TM completed 91% and NTM 42% of expected tasks and procedures. Efficiency: groups did not differ in the mean (± sd) minutes it took to obtain an advanced airway successfully (TM 15.2 ± 10.5 vs. NTM 22.8 ± 8.4, p = 0.10) or decompress a tension pneumothorax with a needle (TM 0.7 ± 0.5 vs. NTM 0.6 ± 0.9, p = 0.65). TM was slower than NTM in completing thoracostomy (22.3 ± 10.2 vs. 12.3 ± 4.8, p = 0.03). Reliability: TM performed 13 of 17 (76%) tasks with more consistent timing than NTM. TM completed 68% and NTM 29% of procedural quality metrics. Eighty-two percent of the TM participants versus 17% of the NTM participants simulated patients survived (p = 0.003). The groups similarly perceived the HFMSM as realistic, managed their patients with personal ownership, and experienced comparable workload and stress. CONCLUSIONS Remote expertise provided with TM to caregivers in resource-limited settings improves caregiver performance, quality of care, and potentially real patient survival. HFMSM can be used to study interventions in ways not possible with real patients.
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Affiliation(s)
- Jeremy C Pamplin
- The U.S. Army Telemedicine and Advanced Technology Research Center, Frederick, MD
- Department of Medicine, Department of Emergency and Operational Medicine, The Uniformed Services University, Bethesda, MD
- Department of Emergency and Operational Medicine, The Uniformed Services University, Bethesda, MD
- The U.S. Army Institute of Surgical Research, San Antonio, TX
- The Geneva Foundation, Tacoma, WA
| | - Sena R Veazey
- The U.S. Army Institute of Surgical Research, San Antonio, TX
| | | | | | | | | | - Christopher J Colombo
- Department of Medicine, Department of Emergency and Operational Medicine, The Uniformed Services University, Bethesda, MD
- The U.S. Army Institute of Surgical Research, San Antonio, TX
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12
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Prayoga W. Concurrent emergencies: overlapping Salmonella and COVID-19 concerns in public health strategies and preparedness. Front Public Health 2024; 12:1331052. [PMID: 38741915 PMCID: PMC11089248 DOI: 10.3389/fpubh.2024.1331052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/08/2024] [Indexed: 05/16/2024] Open
Affiliation(s)
- Windra Prayoga
- Department of Biology, Faculty of Biotechnology, University of Surabaya, Surabaya, Indonesia
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13
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Schwartz JB. Current status of inclusion of older groups in evaluations of new medications: Gaps and implementation needs to fill them. J Am Geriatr Soc 2024. [PMID: 38600697 DOI: 10.1111/jgs.18912] [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: 03/05/2024] [Accepted: 03/16/2024] [Indexed: 04/12/2024]
Abstract
Under-representation of subgroups of the population in clinical trials has been and continues to be a problem despite goals of academia, industry, and government. Older adults are among the groups that are under-represented in trials of medications that they are likely to receive once marketing approval has been received. Recent legislation that mandates that clinical trial participants be representative of patient population has been passed and creates hope that greater numbers of older adults will be enrolled in clinical trials and that they will be representative of "typical" geriatric patients. However, there is the need for collection of current data on disease prevalences with granularity as to age, gender, and race as well as geriatric co-morbidities to assess the representativeness of clinical trial participants relative to patient populations. Consensus on definitions and collection of data relevant to geriatric patient populations are needed to evaluate effects of comorbidities, frailty, cognitive and physical function. There will also be a need for expansion of the geriatric research workforce, facilities for research both in academic centers but also in the community and long-term care facilities, and for engagement with and involvement of communities that have been traditionally under-represented to conduct clinical trials that enroll truly representative patient populations.
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Affiliation(s)
- Janice B Schwartz
- Department of Medicine, Divisions of Geriatrics and Clinical Pharmacology, University of California, San Francisco, San Francisco, California, USA
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14
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Cummins MR, Ivanova J, Ong T, Soni H, Barrera JF, Wilczewski H, Welch BM, Bunnell BE. Will the United States pass on telemedicine progress? JAMIA Open 2024; 7:ooae016. [PMID: 38410742 PMCID: PMC10896640 DOI: 10.1093/jamiaopen/ooae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 10/04/2023] [Accepted: 02/21/2024] [Indexed: 02/28/2024] Open
Abstract
Background During the COVID-19 pandemic, federal and state health policies allowed temporary flexibilities for Medicare and Medicaid beneficiaries, leading to a sharp increase in telemedicine use. However, many of the flexibilities that enabled innovation and growth in telemedicine continue temporarily since the federal emergency declaration ended in May 2023, and the United States has not made permanent decisions about telemedicine policy. Analysts have raised concerns about increased spending, program integrity, safety, and equity, and recommend strengthening oversight. Methods Here, we argue that we must continue the flexibilities to better understand telemedicine's quality, safety, and outcomes, and until the United States can develop an evidence-based digital health strategy. A premature regression to pre-pandemic telemedicine policies risks unintended consequences. Conclusion We must continue the current policy flexibilities, safeguard against fraud and abuse, and immediately prioritize research and evaluation of telemedicine's quality, safety, and outcomes, to avoid unintended consequences and support more permanent policy decision-making.
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Affiliation(s)
- Mollie R Cummins
- College of Nursing, University of Utah, Salt Lake City, UT 84112-5880, United States
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84112-5880, United States
- Doxy.me Research, Doxy.me Inc, Rochester, NY 14623, United States
| | - Julia Ivanova
- Doxy.me Research, Doxy.me Inc, Rochester, NY 14623, United States
| | - Triton Ong
- Doxy.me Research, Doxy.me Inc, Rochester, NY 14623, United States
| | - Hiral Soni
- Doxy.me Research, Doxy.me Inc, Rochester, NY 14623, United States
| | - Janelle F Barrera
- Doxy.me Research, Doxy.me Inc, Rochester, NY 14623, United States
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33613, United States
| | | | - Brandon M Welch
- Doxy.me Research, Doxy.me Inc, Rochester, NY 14623, United States
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Brian E Bunnell
- Doxy.me Research, Doxy.me Inc, Rochester, NY 14623, United States
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33613, United States
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15
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Zhong Y, Hahne J, Wang X, Wang X, Wu Y, Zhang X, Liu X. Telehealth Care Through Internet Hospitals in China: Qualitative Interview Study of Physicians' Views on Access, Expectations, and Communication. J Med Internet Res 2024; 26:e47523. [PMID: 38551618 PMCID: PMC11015369 DOI: 10.2196/47523] [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: 03/22/2023] [Revised: 09/27/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Internet hospitals in China are an emerging medical service model similar to other telehealth models used worldwide. Internet hospitals are currently in a stage of rapid development, giving rise to a series of new opportunities and challenges for patient care. Little research has examined the views of chronic disease physicians regarding internet hospitals in China. OBJECTIVE We aimed to explore the experience and views of chronic disease physicians at 3 tertiary hospitals in Changsha, China, regarding opportunities and challenges in internet hospital care. METHODS We conducted semistructured qualitative interviews with physicians (n=26) who had experience working in internet hospitals affiliated with chronic disease departments in 3 tertiary hospitals in Changsha, Hunan province, south central China. Interviews were transcribed verbatim and analyzed by content analysis using NVivo software (version 11; Lumivero). RESULTS Physicians emphasized that internet hospitals expand opportunities to conduct follow-up care and health education for patients with chronic illnesses. However, physicians described disparities in access for particular groups of patients, such as patients who are older, patients with lower education levels, patients with limited internet or technology access, and rural patients. Physicians also perceived a gap between patients' expectations and the reality of limitations regarding both physicians' availability and the scope of services offered by internet hospitals, which raised challenges for doctor-patient boundaries and trust. Physicians noted challenges in doctor-patient communication related to comprehension and informed consent in internet hospital care. CONCLUSIONS This study explored the experience and views of physicians in 3 tertiary hospitals in Changsha, China, regarding access to care, patients' expectations versus the reality of services, and doctor-patient communication in internet hospital care. Findings from this study highlight the need for physician training in telehealth communication skills, legislation regulating informed consent in telehealth care, public education clarifying the scope of internet hospital services, and design of internet hospitals that is informed by the needs of patient groups with barriers to access, such as older adults.
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Affiliation(s)
- Yuqiong Zhong
- School of Humanities, Central South University, Changsha, China
- Xiangya Hospital, Central South University, Changsha, China
| | - Jessica Hahne
- Department of Psychological & Brain Sciences, Washington University in St Louis, St Louis, MO, United States
| | - Xiaomin Wang
- Center for Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, China
- Center for Medical Ethics, Central South University, Changsha, China
| | - Xuxi Wang
- School of Humanities, Central South University, Changsha, China
| | - Ying Wu
- School of Humanities, Central South University, Changsha, China
| | - Xin Zhang
- Xiangya Hospital, Central South University, Changsha, China
- Medical Humanities Research Center, Central South University, Changsha, China
| | - Xing Liu
- Medical Humanities Research Center, Central South University, Changsha, China
- Office of International Cooperation and Exchanges, Xiangya Hospital, Central South University, Changsha, China
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16
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Aljerian NA, Alharbi AA, Alghamdi HA, Binhotan MS, AlOmar RS, Alsultan AK, Arafat MS, Aldhabib A, Alabdulaali MK. External Vs Internal e-Referrals: Results from a Nationwide Epidemiological Study Utilizing Secondary Collected Data. Risk Manag Healthc Policy 2024; 17:739-751. [PMID: 38562249 PMCID: PMC10984205 DOI: 10.2147/rmhp.s453042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/23/2024] [Indexed: 04/04/2024] Open
Abstract
Background E-referral systems, streamlining patient access to specialists, have gained global recognition yet lacked a comparative study between internal and external referrals in Saudi Arabia (KSA). Methods This retrospective study utilized secondary data from the Saudi Medical Appointments and Referrals Centre system. The data covers 2020 and 2021, including socio-demographic data, referral characteristics, and specialties. Logistic regression analysis was used to assess factors associated with external referrals. Results Out of 645,425 e-referrals from more than 300 hospitals, 19.87% were external. The northern region led with 48.65%. Males were 55%, and those aged 25-64 were 56.68% of referrals. Outpatient clinic referrals comprised 47%, while 61% of referrals were due to a lack of specialty services. Several significant determinants are associated with higher rates of external referral with (p-value <0.001) and a 95% Confidence interval. Younger individuals under 25 exhibit higher referral rates than those aged 25-64. Geographically, compared to the central region, in descending order, there were increasing trends of external referral in the northern, western, and southern regions, respectively (OR = 19.26, OR = 4.48, OR 3.63). External referrals for outpatient departments (OPD) and dialysis services were higher than for routine admissions (OR = 1.38, OR = 1.26). The rate of external referrals due to the lack of available equipment was more predominant than other causes. Furthermore, in descending order, external referrals for organ transplantation and oncology are more frequent than for medical specialties, respectively (OR = 9.39, OR = 4.50). Conclusion The study reveals trends in e-referrals within the KSA, noting regional differences, demographic factors, and types of specialties regarding external referrals, benefiting the New Model of Care for the 2030 Vision. Findings suggest expanding virtual consultations to reduce external referrals. Strengthening primary care and preventive medicine could also decrease future referrals. Future studies should assess resource distribution, including infrastructure and workforce, to further inform healthcare strategy.
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Affiliation(s)
- Nawfal A Aljerian
- Medical Referrals Centre, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
- Emergency Medicine Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah A Alharbi
- Family and Community Medicine Department, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Hani A Alghamdi
- Department of Family and Community Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Meshary S Binhotan
- Emergency Medical Services Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Reem S AlOmar
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Ali K Alsultan
- Medical Referrals Centre, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed S Arafat
- Medical Referrals Centre, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
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D'Souza K, Singh S, Westgard CM, Barnhardt S. A qualitative assessment of barriers and facilitators of telemedicine volunteerism during the COVID-19 pandemic in India. HUMAN RESOURCES FOR HEALTH 2024; 22:21. [PMID: 38520012 PMCID: PMC10958920 DOI: 10.1186/s12960-024-00897-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/30/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The COVID-19 pandemic further propelled the recent growth of telemedicine in low-resource countries, with new models of telemedicine emerging, including volunteer-based telemedicine networks. By leveraging existing infrastructure and resources to allocate health personnel more efficiently, these volunteer networks eased some of the pandemic burden placed on health systems. However, there is insufficient understanding of volunteer-based telemedicine models, especially on the human resources engagement on such networks. This study aims to understand the motivations and barriers to health practitioner engagement on a volunteer telemedicine network during COVID-19, and the mechanisms that can potentially sustain volunteer engagement to address healthcare demands beyond the pandemic. METHODS In-depth qualitative interviews were conducted with health practitioners volunteering on an Indian, multi-state telemedicine network during the COVID-19 pandemic. Data were analyzed using thematic content analysis methods. RESULTS Most practitioners reported being motivated to volunteer by a sense of duty to serve during the pandemic. Practitioners suggested organizational-level measures to make the process more efficient and facilitate a more rewarding provider-patient interaction. These included screening calls, gathering patient information prior to consultations, and allowing for follow-up calls with patients to close the loop on consultations. Many practitioners stated that non-financial incentives are enough to maintain volunteer engagement. However, practitioners expressed mixed feelings about financial incentives. Some stated that financial incentives are needed to maintain long-term provider engagement, while others stated that financial incentives would devalue the volunteer experience. Most practitioners highlighted that telemedicine could increase access to healthcare, especially to the rural and underserved, even after the pandemic. Practitioners also expressed an interest in continuing to volunteer with the network if the need arose again. CONCLUSION Our study findings suggest that practitioners are highly intrinsically motivated to volunteer during large healthcare emergencies and beyond to address the healthcare needs of the underserved. Following the recommendations presented in the study, telemedicine networks can more successfully engage and maintain volunteer practitioners. Volunteer-based telemedicine networks have the potential to bridge shortages of health personnel in resource-constrained settings both in times of crises and beyond.
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Affiliation(s)
- Karishma D'Souza
- Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1101B McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC, 27599, USA.
| | - Saksham Singh
- School of Human Ecology, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Christopher M Westgard
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Sharon Barnhardt
- Centre for Social and Behaviour Change, Ashoka University, Rajiv Gandhi Education City, Sonipat, Haryana, 131029, India
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18
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Barnawi NA, Al-Otaibi H, Alkhudairy AI, Alajlan MA, Alajlan RA, Alay SM, Alqahtani SM, Bushnak IA, Abolfotouh MA. Awareness, Knowledge, Attitude, and Skills (AKAS) of Telemedicine and Its Use by Primary Healthcare Providers. Int J Gen Med 2024; 17:1047-1058. [PMID: 38532847 PMCID: PMC10964027 DOI: 10.2147/ijgm.s452641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
Background This study aimed to determine the rate of telemedicine (TM) use and the levels of awareness, knowledge, attitude, and skills of TM among primary healthcare (PHC) providers. Methods In a cross-sectional study, 104 PHC providers were subjected to a validated AKAS scale via Survey Monkey. The tool consists of 4 parameters that users can respond to using a 4-point Likert scale to assess their awareness (12 statements), knowledge (11 statements), attitude (11 statements), and skills (13 statements) on TM. Total and percentage mean scores (PMS) were calculated for each parameter. Participants were categorized in each parameter into three categories: low (≤ 49% score), average (50-70% score), and high (≥ 71% score) levels. The association of AKAS levels with personal characteristics and TM use was investigated. The significance was set at p<0.05. Results One-half of participants (51%) reported current use of TM, and two-thirds (63.5%) reported a high level of AKAS, with a PMS of 72.9±14.7, 95% CI: 70.1-75.7. There were significant associations between the following: years of experience and levels of knowledge (Χ2LT = 6.77, p= 0.009) and skills (Χ2LT = 4.85, p = 0.028), respectively; and total household income and levels of skills (Χ2LT = 6.91, p= 0.009). The rate of TM use was significantly associated with awareness levels (Χ2LT = 6.14, p = 0.013). Lack of training ranked as the first barrier (45.5%), followed by connection problems and tools' unavailability (35.1% each). The participants recommended providing TM training (41.1%) and stabilization of connection and networking signals (30.1%). Conclusion Despite their high level of TM awareness, the rate of TM use by PHC providers is less than satisfactory. Establishing standardized TM training and supporting the network signals are recommended. A large-scale study on the impact of TM integration with PHC services is necessary.
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Affiliation(s)
- Najla A Barnawi
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Nursing, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | - Hazza Al-Otaibi
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abdulaziz I Alkhudairy
- College of Medicine, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | - Mohammed A Alajlan
- College of Medicine, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | - Renad A Alajlan
- College of Medicine, Imam Muhammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Saeed M Alay
- College of Pharmacy, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | | | - Ibraheem A Bushnak
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mostafa A Abolfotouh
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Anawade PA, Sharma D, Gahane S. A Comprehensive Review on Exploring the Impact of Telemedicine on Healthcare Accessibility. Cureus 2024; 16:e55996. [PMID: 38618307 PMCID: PMC11009553 DOI: 10.7759/cureus.55996] [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: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 04/16/2024] Open
Abstract
Telemedicine has emerged as a transformative force in healthcare delivery, particularly in improving healthcare accessibility. This comprehensive review examines the impact of telemedicine on healthcare accessibility, exploring its ability to overcome geographical, financial, sociocultural, and infrastructural barriers to healthcare access. Through remote consultations, monitoring, and diagnosis facilitated by technology, telemedicine extends healthcare reach to remote and underserved areas while enhancing temporal accessibility with round-the-clock availability. By streamlining healthcare delivery systems, telemedicine reduces costs and promotes efficiency, ultimately fostering health equity and improving health outcomes. However, technological barriers, regulatory hurdles, and patient acceptance remain. To realize telemedicine's full potential, collaboration among stakeholders in the healthcare and technology sectors is imperative. Policymakers must enact supportive regulations, healthcare providers must integrate telemedicine into their practices, and technology companies must innovate to develop user-friendly platforms. Through concerted efforts, telemedicine can catalyze advancing healthcare accessibility and enhance the health and well-being of individuals worldwide.
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Affiliation(s)
- Pankajkumar A Anawade
- Management, School of Allied Sciences, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Deepak Sharma
- Management, School of Allied Sciences, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shailesh Gahane
- Science and Technology, School of Allied Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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DeDent AM, Collard HR, Thakur N. Neighborhood Health and Outcomes in Idiopathic Pulmonary Fibrosis. Ann Am Thorac Soc 2024; 21:402-410. [PMID: 37962494 PMCID: PMC10913773 DOI: 10.1513/annalsats.202304-323oc] [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: 04/09/2023] [Accepted: 11/10/2023] [Indexed: 11/15/2023] Open
Abstract
Rationale: Living in a disadvantaged neighborhood has been associated with worse survival in people with idiopathic pulmonary fibrosis (IPF), however, prior studies have only examined the impact of neighborhood health on outcomes in IPF as a composite measure. Objectives: To investigate the association between neighborhood health and disease severity, measured by pulmonary function at presentation, and death in follow-up, with an additional focus on the contributions of the neighborhood's underlying physical and social factors to these outcomes. Methods: In a retrospective study of participants from the University of California, San Francisco, IPF Cohort (2001-2020), geocoded home addresses were matched to the California Healthy Places Index (HPI), a census-tract measure of neighborhood health. The HPI comprises 25 indicators of neighborhood health that are organized into eight physical and social domains, each of which is weighted and summed to provide a composite HPI score. Regression models were used to examine associations between the HPI as a continuous variable, in quartiles, and across each physical and social domain of the HPI (higher values indicate greater advantage) and forced vital capacity (FVC) percent predicted (% predicted), diffusing capacity of the lung for carbon monoxide (DlCO) % predicted, and death, adjusting for demographic and clinical covariates. We also studied the interaction between disease severity at presentation and neighborhood health in our time-to-event models. Results: In 783 participants with IPF, each 10% increase in HPI was associated with a 1% increase in FVC % predicted and DlCO % predicted (95% confidence intervals [CIs] = 0.55, 1.72; and 0.49, 1.49, respectively). This association appeared primarily driven by the economic, education, access, and social HPI domains. We also observed differences in the associations of HPI with mortality depending on disease severity at presentation. In participants with normal to mildly impaired FVC % predicted (⩾70%) and DlCO % predicted (⩾60%), decreased HPI was associated with higher mortality (hazard ratio = 2.91 Quartile 1 vs. Quartile 4; 95% CI = 1.20, 7.05). No association was observed between the HPI and death for participants with moderate to severely impaired FVC % predicted and DlCO % predicted. Conclusions: Living in disadvantaged neighborhoods was associated with worse pulmonary function in participants with IPF and was independently associated with increased mortality in participants with normal to mild physiological impairment at presentation.
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Affiliation(s)
- Alison M DeDent
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Harold R Collard
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Neeta Thakur
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
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Patel R, Huang J, Hsueh L, Gopalan A, Millman A, Franklin I, Reed M. Telemedicine's Impact on Diabetes Care during the COVID-19 Pandemic: A Cohort Study in a Large Integrated Healthcare System. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.25.24303335. [PMID: 38464156 PMCID: PMC10925369 DOI: 10.1101/2024.02.25.24303335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Introduction To examine if patients exposed to primary care telemedicine (telephone or video) early in the COVID-19 pandemic had higher rates of downstream HbA1c measurement and improved HbA1c levels in the second year of the pandemic. Research Design and Methods In a cohort of 242, 848 Kaiser Permanente Northern California patients with diabetes, we examined associations between early-pandemic patient-initiated telemedicine visit and downstream HbA1c monitoring and results during the second year of the pandemic. Results Adjusted HbA1c measurement rates were significantly higher among patients with telemedicine exposure in the early-pandemic prior year than those with no visits in the prior year (91.0% testing for patients with video visits, 90.5% for telephone visits, visits, 86.7% for no visits, p < 0.05). Among those with HbA1c measured, the rates of having an HbA1c < 8% in the second year of the COVID-19 pandemic were also statistically significantly higher among patients with telemedicine exposure in the early-pandemic prior year than those with no visits in the prior year (68.5% with HbA1c< 8% for video visits, 67.3% for telephone visits, 66.6% for no visits, p < 0.05). Conclusions Access to telephone and video telemedicine throughout the early COVID-19 pandemic was associated with patients' continued engagement in recommended diabetes care. Although our study analyzed telemedicine use during a pandemic, telemedicine visits may continue to support ongoing health care access and positive clinical outcomes.
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Affiliation(s)
- Reysha Patel
- University of California Riverside, School of Medicine, Riverside, CA
| | - Jie Huang
- Kaiser Permanente Division of Research, Oakland, CA
| | | | | | | | | | - Mary Reed
- Kaiser Permanente Division of Research, Oakland, CA
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Wang QP, Chang WY, Han MM, Hu YX, Lin SS, Gu YC. Application of telemedicine system for older adults postoperative patients in community: a feasibility study. Front Public Health 2024; 12:1291916. [PMID: 38435285 PMCID: PMC10904463 DOI: 10.3389/fpubh.2024.1291916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose In response to the growing challenges posed by an aging society, a telemedicine system was developed specifically for older adults postoperative patients, and its effectiveness was thoroughly investigated. Methods Between May 2020 and May 2022, a total of 88 older adults postoperative patients were enrolled and randomly allocated into an experimental group and a control group. The experimental group received telemedicine services after discharge, while the control group received conventional medical services following the traditional protocol. One month after discharge, various indicators were evaluated for both groups, including number of visits, medical expenditures, postoperative recovery, anxiety, depression and satisfaction. Results The number of visits and medical expenditures of the experimental group were less than those of the control group [1 (0, 1) vs. 1 (1, 2), Z = -3.977, p < 0.001; 25.25 (0.00, 277.40) yuan vs. 174.65 (49.63, 446.10) yuan, Z = -2.150, p = 0.032]. In both groups, there were 2 cases of incision infection, respectively. No significant difference was observed between the two groups (Fisher χ2, p = 0.259). In both groups, there was no instance of incision bleeding, incision dehiscence, readmission, or reoperation. Additionally, there was no significant difference in physical status between the two groups at discharge and after discharge (66.06 ± 8.92 vs. 65.45 ± 7.39 t = 0.287, p = 0.775; 73.33 ± 9.97 vs. 70.91 ± 7.50, t = 1.202, p = 0.235). And there was no significant difference in the change of physical status between the two groups after discharge [10.00 (0.00, 10.00) vs. 5.00 (0.00, 10.00), Z = -1.077, p = 0.281]. There was no significant difference in body weight change between the two groups after discharge [1.05 (0.38, 1.60) Kg vs. 0.80 (0.50, 1.43) Kg, Z = -0.265, p = 0.791]. There was no significant difference in the levels of anxiety and depression between the two groups at discharge (45.64 ± 8.10 vs. 44.60 ± 8.24, t = 0.520, p = 0.604, 48.33 ± 8.46 vs. 47.50 ± 6.85, t = 0.418, p = 0.677). But the levels of anxiety and depression in the experimental group were lower than those in the control group after discharge (34.92 ± 7.38 vs. 39.03 ± 8.42, t = -2.183, p = 0.032, 37.86 ± 7.29 vs. 41.93 ± 7.13, t = -2.281, p = 0.025); The change of anxiety level and depression level of the experimental group were more than those of the control group [-10.00 (-11.25, -8.75) vs. -5.00 (-7.81, -3.75), Z = -5.277, p < 0.001; -10.00 (-12.50, -7.50) vs. -5.00 (-7.75, -3.44), Z = -4.596, p < 0.001]. The level of satisfaction regarding medical services, daily care, and psychological comfort was higher in the experimental group compared to the control group [3 (3, 3.25) vs. 2 (1, 2), Z = -5.931, p < 0.001; 3 (3, 4) vs. 3 (2, 3), Z = -2.286, p = 0.022; 2 (1, 3) vs. 1 (0.75, 2), Z = -2.081, p = 0.037]. Conclusion In the context of an aging society, telemedicine system can offer improved healthcare to older adults postoperative patients. This includes benefits such as reducing number of visits, saving medical expenditures, enhancing psychological comfort and daily care.
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Affiliation(s)
- Quan-Peng Wang
- General Surgery Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Wan-Ying Chang
- Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Man-Man Han
- General Surgery Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Ye-Xiao Hu
- General Surgery Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Sai-Sai Lin
- General Surgery Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Ye-Chun Gu
- General Surgery Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
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23
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Ishikawa T, Sato J, Hattori J, Goda K, Kitsuregawa M, Mitsutake N. Changes in Demand Volume and Patient/Health Care Provider Characteristics of First-Time Telehealth Users: A Comparative Analysis Before and After the COVID-19 Policy Response Using the Administrative Claims Database. Telemed J E Health 2024; 30:509-517. [PMID: 37590549 DOI: 10.1089/tmj.2023.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Introduction: The COVID-19 pandemic has led to a decrease in demand for medical services in Japan, but the utilization of telehealth, which the Japanese government has recently promoted, has seen a temporary increase. This study aims to analyze the trend of telehealth utilization and changes in patient characteristics following the policy response to COVID-19. Methods: This retrospective study analyzed data from 26,152 adult patients who used telehealth for the first time between April 2019 and April 2021 in Mie Prefecture, Japan. An interrupted time series analysis was conducted to evaluate changes in the number of first-time patients before and after April 2020. Results: The number of telehealth users increased by 111.87% after April 2020, but the trend showed a declining slope thereafter. Patient characteristics and disease types showed different trends. The percentage of patients choosing a hospital over a clinic increased for the first time. Conclusions: After the policy response to COVID-19, the number of first-time telehealth users overall increased immediately, but gradually showed a declining trend. However, some diseases have shown both an immediate increase and a continued upward trend in telehealth utilization. Patients with these diseases may be candidates for adopting telehealth services in clinical settings.
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Affiliation(s)
- Tomoki Ishikawa
- Institute for Health Economics and Policy, Minato-ku, Tokyo, Japan
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Jumpei Sato
- Institute of Industrial Science, the University of Tokyo, Meguro-ku, Tokyo, Japan
| | - Junko Hattori
- Institute of Industrial Science, the University of Tokyo, Meguro-ku, Tokyo, Japan
| | - Kazuo Goda
- Institute of Industrial Science, the University of Tokyo, Meguro-ku, Tokyo, Japan
| | - Masaru Kitsuregawa
- Institute of Industrial Science, the University of Tokyo, Meguro-ku, Tokyo, Japan
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24
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Krukowski RA, Ross KM, Western MJ, Cooper R, Busse H, Forbes C, Kuntsche E, Allmeta A, Silva AM, John-Akinola YO, König LM. Digital health interventions for all? Examining inclusivity across all stages of the digital health intervention research process. Trials 2024; 25:98. [PMID: 38291539 PMCID: PMC10826214 DOI: 10.1186/s13063-024-07937-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/15/2024] [Indexed: 02/01/2024] Open
Abstract
Digital interventions offer many possibilities for improving health, as remote interventions can enhance reach and access to underserved groups of society. However, research evaluating digital health interventions demonstrates that such technologies do not equally benefit all and that some in fact seem to reinforce a "digital health divide." By better understanding these potential pitfalls, we may contribute to narrowing the digital divide in health promotion. The aim of this article is to highlight and reflect upon study design decisions that might unintentionally enhance inequities across key research stages-recruitment, enrollment, engagement, efficacy/effectiveness, and retention. To address the concerns highlighted, we propose strategies including (1) the standard definition of "effectiveness" should be revised to include a measure of inclusivity; (2) studies should report a broad range of potential inequity indicators of participants recruited, randomized, and retained and should conduct sensitivity analyses examining potential sociodemographic differences for both the effect and engagement of the digital interventions; (3) participants from historically marginalized groups should be involved in the design of study procedures, including those related to recruitment, consent, intervention implementation and engagement, assessment, and retention; (4) eligibility criteria should be minimized and carefully selected and the screening process should be streamlined; (5) preregistration of trials should include recruitment benchmarks for sample diversity and comprehensive lists of sociodemographic characteristics assessed; and (6) studies within trials should be embedded to systematically test recruitment and retention strategies to improve inclusivity. The implementation of these strategies would enhance the ability of digital health trials to recruit, randomize, engage, and retain a broader and more representative population in trials, ultimately minimizing the digital divide and broadly improving population health.
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Affiliation(s)
- Rebecca A Krukowski
- Department of Public Health Sciences, School of Medicine, University of Virginia, PO Box 800765, Charlottesville, VA, 22908-0765, USA.
| | - Kathryn M Ross
- Department of Clinical & Health Psychology, College of Public Health & Health Professions, University of Florida, PO Box 100165, Gainesville, FL, 32610-0165, USA
| | - Max J Western
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Rosie Cooper
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, UK
| | - Heide Busse
- Leibniz Institute for Prevention Research and Epidemiology- BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Cynthia Forbes
- Hull York Medical School, University of Hull, Allam Medical Building, Cottingham Road, Hull, UK
| | - Emmanuel Kuntsche
- Centre for Alcohol Policy Research, La Trobe University, Plenty Road and Kingsbury Drive, Melbourne, 3086 VIC, Australia
| | - Anila Allmeta
- University of Bayreuth, Fritz-Hornschuch-Straße 13, 95326, Kulmbach, Germany
| | - Anabelle Macedo Silva
- Instituto de Estudos Em Saúde Coletiva IESC/ Universidade Federal Do Rio de Janeiro /Leibiniz Science Campus Digital Public Health/Ministério Público Do Estado Do Rio de Janeiro, Rua das Bauhineas 200, Bl B 1602, Península, Barra da Tijuca, Rio de Janeiro, 22776-090, Brazil
| | - Yetunde O John-Akinola
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, College of Medicine, Queen Elizabeth Road, UCH Campus, Ibadan, Nigeria
| | - Laura M König
- University of Bayreuth, Faculty of Life Sciences: Food, Nutrition and Health University of Vienna, Faculty of Psychology, Wächtergasse 1, 1010, Vienna, Austria
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25
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Cummins MR, Soni H, Ivanova J, Ong T, Barrera J, Wilczewski H, Welch B, Bunnell BE. Narrative review of telemedicine applications in decentralized research. J Clin Transl Sci 2024; 8:e30. [PMID: 38384915 PMCID: PMC10880018 DOI: 10.1017/cts.2024.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 12/04/2023] [Accepted: 01/05/2024] [Indexed: 02/23/2024] Open
Abstract
Telemedicine enables critical human communication and interaction between researchers and participants in decentralized research studies. There is a need to better understand the overall scope of telemedicine applications in clinical research as the basis for further research. This narrative, nonsystematic review of the literature sought to review and discuss applications of telemedicine, in the form of synchronous videoconferencing, in clinical research. We searched PubMed to identify relevant literature published between January 1, 2013, and June 30, 2023. Two independent screeners assessed titles and abstracts for inclusion, followed by single-reviewer full-text screening, and we organized the literature into core themes through consensus discussion. We screened 1044 publications for inclusion. Forty-eight publications met our inclusion and exclusion criteria. We identified six core themes to serve as the structure for the narrative review: infrastructure and training, recruitment, informed consent, assessment, monitoring, and engagement. Telemedicine applications span all stages of clinical research from initial planning and recruitment to informed consent and data collection. While the evidence base for using telemedicine in clinical research is not well-developed, existing evidence suggests that telemedicine is a potentially powerful tool in clinical research.
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Affiliation(s)
- Mollie R. Cummins
- University of Utah, College of Nursing, Salt Lake City, UT, USA
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
| | - Hiral Soni
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
| | | | - Triton Ong
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
| | - Janelle Barrera
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | | | - Brandon Welch
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Brian E. Bunnell
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
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26
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Rabat Restrepo JM, Rebollo Pérez IM, García Luna PP, Pereira Cunill JL, Vílchez López FJ, Gonzalo Marín M, Yestes Doblas C, Martínez Ortega AJ, Martínez-Ramírez MJ, Losada Morell C, Rojas García J, Ortiz Sánchez M, Obando de la Corte J, Macías Colorado Campiña ME. [Consensus on criteria and minimum data set for the referral of candidate patients for home enteral nutrition teleconsultation: TELENUT project]. NUTR HOSP 2024. [PMID: 38258660 DOI: 10.20960/nh.04702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION teleconsultation is a useful healthcare tool in the multidisciplinary management of patients with indications of home enteral nutrition (HEN). The use of different teleconsultation platforms, as it happens in the Andalusian Health System (SAS), results in heterogeneous referral processes between Primary Care and hospital services in the same region. OBJECTIVES to establish a consensus on patient profiles and the minimum data set necessary to guarantee an adequate referral to NED teleconsultation regardless of the existing platform. These agreed aspects in Andalusia can serve as a reference in other regions. METHODS three consecutive steps were followed: a) non-systematic review of the indexed literature on teleconsultation in clinical nutrition in Spain; b) survey to know the implementation and unmet needs of teleconsultation platforms in Andalusian public hospitals; and c) working meetings and consensus of 14 health professionals of Primary Care (n = 4) and endocrinology and hospital clinical nutrition (n = 10). RESULTS three referral forms were agreed in which three patient profiles were defined, with the corresponding minimum set of data necessary to request NED teleconsultation. The Primary Care team should provide this set of data to the clinical nutrition specialist via a teleconsultation platform, implemented in the SAS. CONCLUSIONS three agreed forms between healthcare professionals involved in the referral process serve to standardize the request for teleconsultation of NED between healthcare teams based on patient profiles.
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Affiliation(s)
| | | | - Pedro P García Luna
- Servicio de Endocrinología y Nutrición. Hospital Universitario Virgen del Rocío
| | | | | | | | - Carmen Yestes Doblas
- Servicio de Endocrinología y Nutrición. Hospital Universitario Clínico San Cecilio
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27
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Binoy S, Montaser-Kouhsari L, Ponger P, Saban W. Remote assessment of cognition in Parkinson's disease and Cerebellar Ataxia: the MoCA test in English and Hebrew. Front Hum Neurosci 2024; 17:1325215. [PMID: 38259338 PMCID: PMC10800372 DOI: 10.3389/fnhum.2023.1325215] [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: 10/20/2023] [Accepted: 12/06/2023] [Indexed: 01/24/2024] Open
Abstract
There is a critical need for accessible neuropsychological testing for basic research and translational studies worldwide. Traditional in-person neuropsychological studies are inherently difficult to conduct because testing requires the recruitment and participation of individuals with neurological conditions. Consequently, studies are often based on small sample sizes, are highly time-consuming, and lack diversity. To address these challenges, in the last decade, the utilization of remote testing platforms has demonstrated promising results regarding the feasibility and efficiency of collecting patient data online. Herein, we tested the validity and generalizability of remote administration of the Montreal Cognitive Assessment (MoCA) test. We administered the MoCA to English and Hebrew speakers from three different populations: Parkinson's disease, Cerebellar Ataxia, and healthy controls via video conferencing. First, we found that the online MoCA scores do not differ from traditional in-person studies, demonstrating convergent validity. Second, the MoCA scores of both our online patient groups were lower than controls, demonstrating construct validity. Third, we did not find differences between the two language versions of the remote MoCA, supporting its generalizability to different languages and the efficiency of collecting binational data (USA and Israel). Given these results, future studies can utilize the remote MoCA, and potentially other remote neuropsychological tests to collect data more efficiently across multiple different patient populations, language versions, and nations.
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Affiliation(s)
- Sharon Binoy
- Center for Accessible Neuropsychology and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
- Department of Occupational Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Loyola Stritch School of Medicine, Chicago, IL, United States
| | - Leila Montaser-Kouhsari
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Penina Ponger
- Movement Disorders Division, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - William Saban
- Center for Accessible Neuropsychology and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
- Department of Occupational Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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28
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Bjoraker KJ, Eggerding C, Ellenberg E, Hollander S, Holmes BM, Lindstrom K, McNutt M, Miller S, Northrup H, Rogers M, Rose S, Scott M, Shim S, Wardley B, Wessenberg L, Bilder DA. Best practice recommendations for the management of anxiety during the pegvaliase journey. Mol Genet Metab 2024; 141:107737. [PMID: 38043481 DOI: 10.1016/j.ymgme.2023.107737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Pegvaliase, an enzyme substitution therapy, is a treatment option for phenylketonuria (PKU). Due to the neuropathophysiology and disease burden of PKU, individuals can experience baseline anxiety unrelated to pegvaliase therapy. In addition, there are aspects of pegvaliase therapy that may be anxiety-inducing for those considering or receiving treatment. The aim of this manuscript is to present best practice recommendations for the identification and management of anxiety symptoms that can occur along the pegvaliase journey. METHODS A modified Delphi approach was used to seek consensus among a multidisciplinary panel of experts. To this end, an in-person meeting was held that was preceded by a medical specialist- and patient-specific survey to develop preliminary recommendations on ways to address anxiety along the pegvaliase journey. After the meeting, an additional survey was conducted to rank the proposed solutions and mitigation strategies from which a set of recommendations was developed. All recommendations were voted on with the aim of consensus generation, defined as achieving ≥75% agreement among experts. RESULTS The panel reached consensus on a total of 28 best practice recommendations for the management of anxiety during the pre-treatment, induction and titration, early maintenance (pre-efficacy), and late maintenance (post-efficacy) stages. The recommendations offer strategies to identify and address the most common causes of pegvaliase-related anxiety, including self-injection, side effects, the titration schedule, prescribed dietary changes, and variable time to efficacy. Overall, managing anxiety in those considering or receiving pegvaliase involves patient-centered communication, shared decision-making, and personalized treatment plans. CONCLUSIONS The best practice recommendations described herein can guide healthcare providers in proactively addressing anxiety during the different stages of pegvaliase treatment, and support providers with initiating and managing pegvaliase in individuals who may experience baseline and treatment-related anxiety.
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Affiliation(s)
| | | | | | - Suzanne Hollander
- Department of Clinical Nutrition, Boston Children's Hospital, Boston, MA, USA; Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA
| | - Brittany M Holmes
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA
| | | | - Markey McNutt
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Suzanne Miller
- Program for Inherited Metabolic Diseases, Mount Sinai Health System, New York, NY, USA
| | - Hope Northrup
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth) and Children's Memorial Hermann Hospital, Houston, TX, USA
| | | | - Sarah Rose
- BioMarin Pharmaceutical Inc., Novato, CA, USA.
| | - Mia Scott
- Individual with PKU, Tucson, AZ, USA
| | - Soo Shim
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | | | | | - Deborah A Bilder
- Department of Psychiatry, University of Utah Huntsman Mental Health Institute, Salt Lake City, UT, USA
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29
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Grant MJ, Chiang AC. Telehealth and Outcomes in Patients With Cancer: Data and Innovation. Cancer J 2024; 30:16-21. [PMID: 38265921 DOI: 10.1097/ppo.0000000000000697] [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: 01/26/2024]
Abstract
ABSTRACT Despite that telehealth has been crucial to the delivery of oncology care during the COVID-19 pandemic, the impact of this care delivery mechanism on outcomes in cancer care has not been rigorously studied relative standard in-person care for patients with cancer. Patient-centered outcomes such as quality of life, patient satisfaction, and symptoms are important outcomes that have been the primary focus of many of the existing studies in this space, yet only a select few have evaluated overall survival and other objective efficacy endpoints. Studies have alluded to positive effects of telehealth on mitigating financial toxicity and enhancing cost-effective care delivery in oncology. Telehealth carries much potential for advancing care for patients with cancer, but future study should focus on additional efficacy endpoints, implementation, and ways to reduce disparities.
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30
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Sadauskas L, Commodore-Mensah Y, Wu C, Taylor CO, Epstein JA, Stackhouse BK, Hasselfeld BW, Hughes HK. Individual- and Neighborhood-Level Disparities in Audio-Only Telemedicine Utilization Across a Large Academic Health System. Telemed J E Health 2024; 30:47-56. [PMID: 37389845 DOI: 10.1089/tmj.2023.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Introduction: The objective of this study was to understand whether use of audio-only telemedicine visits differed by individual- and neighborhood-level patient characteristics during the COVID-19 pandemic. Methods: We conducted a retrospective cross-sectional study of telemedicine encounter data from a large academic health system. The primary outcome was rate of audio-only versus video visits. The exposures of interest were individual- (age, race, insurance, preferred language) and neighborhood-level (Social Deprivation Index [SDI]) patient characteristics. Results: Our study included 1,054,465 patient encounters from January 1, 2020 to December 31, 2021, of which 18.33% were completed via audio-only. Encounters among adults 75 years or older, Black patients, Spanish-speakers, and those with public insurance were more frequently conducted by audio-only (p < 0.001). Overall, populations showed decreasing rates of audio-only visits over time. We also observed an increase in the rate of audio-only encounters as SDI scores increased. Discussion: We found that audio-only disparities exist in telemedicine utilization by individual and zip code level characteristics. Though these disparities have improved over time as seen by our temporal analysis, marginalized and minority groups still showed the lowest rates of video utilization. In conclusion, access to audio-only care is a critical component to ensure that telemedicine is accessible to all populations. State and federal policy should support continued reimbursement of audio-only care to ensure equitable access to care while the implications of different care modalities are further studied.
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Affiliation(s)
- Lilija Sadauskas
- Office of Telemedicine, Johns Hopkins Health System, Baltimore, Maryland, USA
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Colin Wu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Casey Overby Taylor
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeremy A Epstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian K Stackhouse
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian W Hasselfeld
- Office of Telemedicine, Johns Hopkins Health System, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Helen K Hughes
- Office of Telemedicine, Johns Hopkins Health System, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kaihlanen AM, Virtanen L, Kainiemi E, Heponiemi T. Professionals Evaluating Clients' Suitability for Digital Health and Social Care: Scoping Review of Assessment Instruments. J Med Internet Res 2023; 25:e51450. [PMID: 38032707 PMCID: PMC10722370 DOI: 10.2196/51450] [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: 08/01/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Increased digital health and social care services are generally considered to improve people's access to services. However, not everyone can equally access and use these resources. Health and social care professionals should assess clients' suitability for digital solutions, but to succeed, they need information about what to evaluate and how. OBJECTIVE This scoping review aimed to identify evaluation tools that professionals can use when assessing clients' suitability for digital health and social care. We summarized the dimensions and the practical usefulness of the instruments. METHODS The MEDLINE (Ovid), CINAHL, Web of Science, and ASSIA databases were searched in February 2023 following the Joanna Briggs Institute's Manual for Evidence Synthesis. Studies were included if they focused on health and social care clients and professionals, examined clients' suitability for using digital health or social care, and applied related assessment methods in the direct client work of professionals. Studies focusing primarily on instruments intended for research use without clear applicability to professionals' practical contexts were excluded. Details of the eligible studies were extracted, and qualitative content analysis according to the research objectives was performed. RESULTS A total of 19 articles introducing 12 different assessment instruments intended for the health care context were included in the review. No instruments were found for evaluating the suitability for digital social care. The instruments contained 60 dimensions of the client's suitability for digital health, which reflected four perspectives: (1) skill-based suitability, (2) suitability based on general ability to maintain health, (3) suitability based on attitude and experience, and (4) suitability based on practical matters. The described practical usefulness of the instruments included professionals' possibility to (1) identify clients most in need of education and support, (2) direct and recommend the right clients for the right digital services, (3) ensure that clients can use digital health, (4) improve effectiveness and maximize the provision of digital health, (5) develop and redesign services, and (6) empower clients. CONCLUSIONS Based on the diverse assessment instruments available and the dimensions they measure, there seems to be no comprehensive evaluation tool for assessing clients' prerequisites to use digital solutions. It is important to further develop comprehensive screening tools applicable to professionals' busy work (both in health and social care) with defined threshold values for suitability.
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Affiliation(s)
| | - Lotta Virtanen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Emma Kainiemi
- Finnish Institute for Health and Welfare, Helsinki, Finland
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32
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Talmesany TA, Alzahrani MA, Alzahrani OM, Alzahrani SA, Al-Omari TK, Alghamdi SM, Alzahrani MA. Assessing the Awareness and Perception of Telemedicine Among the General Population in the Al-Baha Region, Saudi Arabia. Cureus 2023; 15:e49732. [PMID: 38046730 PMCID: PMC10690062 DOI: 10.7759/cureus.49732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 12/05/2023] Open
Abstract
Telemedicine plays an important role in healthcare by improving the quality of the healthcare system. However, various challenges associated with the effective implementation of telemedicine have been reported. This study aimed to explore the awareness and utilization of telemedicine services among the general population in the Al-Baha region of Saudi Arabia and the factors affecting it. Using a cross-sectional design for the study, the quantitative approach was employed through a questionnaire-based survey. Data from 359 participants from the Al-Baha general population were collected, including both males and females over the age of 18. The analysis of the collected data shows a low level of familiarity within the general population; indeed, 54.9% (197) of participants have experienced using telemedicine services. Moreover, the study reveals that the major concerns influencing the use of telemedicine services are limited availability, privacy and security, and quality of care. Almost half of the participants have used telemedicine, and they expressed concerns related to quality of care, privacy and security, limited availability, and technical difficulties. However, telemedicine was positively perceived among the participants. There is a need to raise public awareness about the importance and effectiveness of telemedicine.
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Affiliation(s)
- Terad A Talmesany
- Community and Family Medicine, Faculty of Medicine, Al-Baha University, Al-Baha, SAU
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Calton BA, Nouri S, Davila C, Kotwal A, Zapata C, Bischoff KE. Strategies to Make Telemedicine a Friend, Not a Foe, in the Provision of Accessible and Equitable Cancer Care. Cancers (Basel) 2023; 15:5121. [PMID: 37958296 PMCID: PMC10647602 DOI: 10.3390/cancers15215121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
Telemedicine has the potential to improve access to cancer care, particularly for patients with functional limitations, high symptom burdens, or financial or geographic constraints. However, there is also a risk that telemedicine can widen healthcare disparities among patients facing systemic disadvantages like those with technological barriers, poor digital literacy, older age, or non-English language preferences. To optimize telemedicine usage, we must implement practical strategies like video onboarding programs, user-friendly technology platforms, optimizing the clinician's environment, and best practices for using interpreters. Policy changes such as state licensing requirements, controlled substance prescribing requirements, and payment parity are also crucial. This Perspective highlights these practical strategies and policy recommendations to ensure accessible and equitable cancer care augmented by telemedicine.
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Affiliation(s)
- Brook A. Calton
- Department of Medicine, Division of Palliative Medicine and Geriatrics, The Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Sarah Nouri
- Department of Medicine, Division of Palliative Medicine, University of California, San Francisco, CA 94720, USA; (S.N.); (C.Z.); (K.E.B.)
| | - Carine Davila
- Department of Medicine, Division of Palliative Medicine and Geriatrics, The Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Ashwin Kotwal
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA 94720, USA;
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
| | - Carly Zapata
- Department of Medicine, Division of Palliative Medicine, University of California, San Francisco, CA 94720, USA; (S.N.); (C.Z.); (K.E.B.)
| | - Kara E. Bischoff
- Department of Medicine, Division of Palliative Medicine, University of California, San Francisco, CA 94720, USA; (S.N.); (C.Z.); (K.E.B.)
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Armaignac DL, Ramamoorthy V, DuBouchet EM, Williams LM, Kushch NA, Gidel L, Badawi O. Descriptive Comparison of Two Models of Tele-Critical Care Delivery in a Large Multi-Hospital Health Care System. Telemed J E Health 2023; 29:1465-1475. [PMID: 36827094 DOI: 10.1089/tmj.2022.0415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Introduction: The Society of Critical Care Medicine Tele-Critical Care (TCC) Committee has identified the need for rigorous comparative research of different TCC delivery models to support the development of best practices for staffing, application, and approaches to workflow. Our objective was to describe and compare outcomes between two TCC delivery models, TCC with 24/7 Bedside Intensivist (BI) compared with TCC with Private Daytime Attending Intensivist (PI) in relation to intensive care unit (ICU) and hospital mortality, ICU and hospital length of stay (LOS), cost, and complications across the spectrum of routine ICU standards of care. Methods: Observational cohort study at large health care system in 12 ICUs and included patients, ≥18, with Acute Physiology and Chronic Health Evaluation (APACHE) IVa scores and predictions (October 2016-June 2019). Results: Of the 19,519 ICU patients, 71.7% (n = 13,993) received TCC with 24/7 BI while 28.3% (n = 5,526) received TCC with PI. ICU and Hospital mortality (4.8% vs. 3.1%, p < 0.0001; 12.6% vs. 8.1%, p < 0.001); and ICU and Hospital LOS (3.2 vs. 2.4 days, p < 0.001; 9.8 vs. 7.2 days, p < 0.001) were significantly higher among 24/7 BI compared with PI. The APACHE observed/expected ratios (odds ratio [OR]; 95% confidence interval [CI]) for ICU mortality (0.62; 0.58-0.67) vs. (0.53; 0.46-0.61) and Hospital mortality (0.95; 0.57-1.48) vs. (0.77; 0.70-0.84) were significantly different for 24/7 BI compared with PI. Multivariate mixed models that adjusted for confounders demonstrated significantly greater odds of (OR; 95% CI) ICU mortality (1.58; 1.28-1.93), Hospital mortality (1.52; 1.33-1.73), complications (1.55; 1.18-2.04), ICU LOS [3.14 vs. 2.59 (1.25; 1.19-1.51)], and Hospital LOS [9.05 vs. 7.31 (1.23; 1.21-1.25)] among 24/7 BI when compared with PI. Sensitivity analyses adjusting for ICU admission within 24 h of hospital admission, receiving active ICU treatments, nighttime admission, sepsis, and highest third acute physiology score indicated significantly higher odds for 24/7 BI compared with PI. Conclusion: Our comparison demonstrated that TCC delivery model with PI provided high-quality care with significant positive effects on outcomes. This suggests that TCC delivery models have broad-ranging applicability and benefits in routine critical care, thus necessitating progressive research in this direction.
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Affiliation(s)
- Donna Lee Armaignac
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida, USA
- Tele-Critical Care, Telehealth Center, Baptist Health South Florida, Miami, Florida, USA
| | | | - Eduardo Martinez DuBouchet
- Tele-Critical Care, Telehealth Center, Baptist Health South Florida, Miami, Florida, USA
- Wertheim School of Medicine, Florida International University, Miami, Florida, USA
| | - Lisa-Mae Williams
- Tele-Critical Care, Telehealth Center, Baptist Health South Florida, Miami, Florida, USA
- Wertheim School of Medicine, Florida International University, Miami, Florida, USA
| | | | - Louis Gidel
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida, USA
- Tele-Critical Care, Telehealth Center, Baptist Health South Florida, Miami, Florida, USA
| | - Omar Badawi
- School of Pharmacy, University of Maryland, Baltimore, Maryland, USA
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van der Ven J, van den Bemt BJF, van Dijk L, Opdam M, Haegens LL, Vriezekolk JE, Verhoef LM. Preferences of Patients With Musculoskeletal Disorders Regarding the Timing and Channel of eHealth and Factors Influencing Its Use: Mixed Methods Study. JMIR Hum Factors 2023; 10:e44885. [PMID: 37756049 PMCID: PMC10568401 DOI: 10.2196/44885] [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: 12/07/2022] [Revised: 06/22/2023] [Accepted: 07/22/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Implementation of eHealth is progressing slowly. In-depth insight into patients' preferences and needs regarding eHealth might improve its use. OBJECTIVE This study aimed to describe when patients want to use eHealth, how patients want to communicate and receive information digitally, and what factors influence the use of eHealth in clinical practice. METHODS A multimethod study was conducted. Two meetings of ~5.5 hours with plenary information sessions and focus groups were held with 22 patients from the rheumatology, orthopedics, and rehabilitation departments of a Dutch hospital specialized in musculoskeletal disorders. Assignments were performed during the focus groups in which qualitative (eg, semistructured interview questions) and quantitative (ie, voting and ranking factors) data were collected. RESULTS The way patients want to use eHealth varies between patients and moments of a patient's care pathway. Patients' digital channel preferences depended on the need for interaction with a health care provider (HCP). The interaction need is in turn influenced by the degree to which information or communication is specific to an individual patient and leads to consequences for the patient. The 5 most important factors influencing the use of eHealth were access to medical information (eg, electronic health records), perceived control over disease management, correctness and completeness of information, data security, and access to information or an HCP at any time. The 5 least important factors influencing eHealth use were help with using digital devices, having internet or equipment, digital skills, attitude or emotions toward eHealth, and societal benefits. CONCLUSIONS Patients identified opportunities for using eHealth during all moments of their care pathway. However, preferences for eHealth varied between patients and phases in the care pathway. As a consequence, eHealth should be tailored to fit individual patients' preferences but also the need for interaction regarding different topics by offering a variety of digital channels with a gradient of interaction possibilities. Furthermore, digital skills and access to the internet might become less important to focus on in the future. Improving eHealth use by patients may be achieved by providing patients access to correct and safe (medical) information and more control over their care.
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Affiliation(s)
- Jeffrey van der Ven
- Department of Research, Sint Maartenskliniek, Ubbergen, Netherlands
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - Bart J F van den Bemt
- Department of Research, Sint Maartenskliniek, Ubbergen, Netherlands
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Merel Opdam
- Department of Research, Sint Maartenskliniek, Ubbergen, Netherlands
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - Lex L Haegens
- Department of Research, Sint Maartenskliniek, Ubbergen, Netherlands
- Radboud University Medical Centre, Nijmegen, Netherlands
| | | | - Lise M Verhoef
- Department of Research, Sint Maartenskliniek, Ubbergen, Netherlands
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Wei Q, Yuan B, Xu J, He P, Xu H, Meng Q. Continuity of health care: measurement and application in two rural counties of Guangxi Province, China. BMC Health Serv Res 2023; 23:917. [PMID: 37644426 PMCID: PMC10464216 DOI: 10.1186/s12913-023-09916-4] [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: 05/16/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Continuity of care (COC) is highly regarded in health promotion and health system strengthening. However, there is a lack of multidimensional quantitative assessment of continuity, making it challenging to evaluate and compare. Our objective was to create a novel measurement for COC and apply it in two rural counties in China to assess its validity and feasibility in evaluating health system reform. METHOD This study conducted a scoping literature review on COC, examining existing frameworks and indicators. Following an online expert poll, a composite indicator was developed using the analytical hierarchy process (AHP). The measurement tool was then applied to assess the current state of COC in two rural counties in China. In addition to descriptive analysis, demographic and economic characteristics were analyzed for their association with COC scores using t-tests and multiple linear regression models. RESULTS The final COC measurement encompasses three dimensions, six sub-dimensions, and ten individual indicators, which integrated and improved the current frameworks and indicators. Relational continuity, informational continuity, and management continuity were identified as the primary dimensions of COC measurement. The COC score is 0.49 in County A and 0.41 in County B, with information continuity being the highest-scoring dimension. Notably, the disparity in continuity scores is most pronounced among individuals with varying attitudes towards health, demonstrating a positive correlation. CONCLUSION The construction of the composite indicator in this study offers a scientific and effective metric for comprehensively measuring continuity of care. The empirical data analysis conducted in Western China serves as an illustrative application of the indicator, demonstrating its efficiency. The results obtained from this analysis provide a solid foundation and valuable reference for strengthening the health system.
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Affiliation(s)
- Qianchen Wei
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University Health Science Center, Beijing, China
| | - Beibei Yuan
- China Center for Health Development Studies, Peking University Health Science Center, Beijing, China
| | - Jin Xu
- China Center for Health Development Studies, Peking University Health Science Center, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University Health Science Center, Beijing, China
| | - Hanyi Xu
- China Center for Health Development Studies, Peking University Health Science Center, Beijing, China
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University Health Science Center, Beijing, China.
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Di Tosto G, Hefner JL, Walker DM, Gregory ME, McAlearney AS, Sieck CJ. Development of a conceptual model of the capacity for patients to engage in their health care: a group concept mapping study. BMC Health Serv Res 2023; 23:846. [PMID: 37563581 PMCID: PMC10413602 DOI: 10.1186/s12913-023-09785-x] [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: 10/06/2022] [Accepted: 07/05/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Patient engagement is seen as a necessary component in achieving the triple aim of improved population health, improved experience of care, and lower per capita health care costs. While there has been a substantial increase in the number of tools and patient-centered initiatives designed to help patients participate in health decisions, there remains a limited understanding of engagement from the perspective of patients and a lack of measures designed to capture the multi-faceted nature of the concept. METHODS Development of a concept map of patient engagement followed a five-step modified Group Concept Mapping (GCM) methodology of preparation, generation, structuring, analysis and interpretation. We engaged a Project Advisory Committee at each step, along with three rounds of survey collection from clinicians and patients for element generation (272 clinicians, 61 patients), statement sorting (30 clinicians, 15 patients), and ranking and rating of statements (159 clinicians, 67 patients). The survey of three separate samples, as opposed to focus groups of 'experts,' was an intentional decision to gain a broad perspective about the concept of patient engagement. We conducted the structure and analysis steps within the groupwisdom concept mapping software. RESULTS The final concept map comprised 47 elements organized into 5 clusters: Relationship with Provider, Patient Attitudes and Behaviors, Access, Internal Resources and External Resources. There was considerable agreement in the way elements in each cluster were rated by patients and clinicians. An analysis of the importance of the constitutive elements of patient engagement relative to their addressability highlighted actionable items in the domain of Relationship with Provider, aimed at building trust and enabling patients to ask questions. At the same time, the analysis also identified elements traditionally considered barriers to engagement, like personal access to the internet and the patient's level of digital literacy, as difficult to address by the healthcare system, but also relatively less important for patients. CONCLUSIONS Through our GCM approach, incorporating perspectives of both patients and clinicians, we identified items that can be used to assess patient engagement efforts by healthcare systems. As a result, our study offers specific insight into areas that can be targeted for intervention by healthcare systems to improve patient engagement.
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Affiliation(s)
- Gennaro Di Tosto
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4100, Columbus, OH, USA.
| | - Jennifer L Hefner
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Daniel M Walker
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4100, Columbus, OH, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Megan E Gregory
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ann Scheck McAlearney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4100, Columbus, OH, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Cynthia J Sieck
- Center for Health Equity, Dayton Children's Hospital, Dayton, OH, USA
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Shah AQ, Noronha N, Chin-See R, Hanna C, Kadri Z, Marwaha A, Rambharack N, Ng JY. The use and effects of telemedicine on complementary, alternative, and integrative medicine practices: a scoping review. BMC Complement Med Ther 2023; 23:275. [PMID: 37533042 PMCID: PMC10394941 DOI: 10.1186/s12906-023-04100-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/21/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Telemedicine includes the delivery of health-care services and sharing of health information across distances. Past research has found that telemedicine can play a role in enhancing complementary, alternative, and integrative medicine (CAIM) while allowing the maintenance of cultural values and ancestral knowledge. This scoping review synthesized evidence regarding the use of telemedicine in the context of CAIM. METHODS Following Arksey and O'Malley's scoping review framework, CINAHL, PsycINFO, MEDLINE, EMBASE and AMED databases were searched systematically. The CADTH website was also searched for grey literature. Eligible articles included a CAIM practice or therapy offered through telemedicine, with no restrictions placed on the type of telemedicine technology used. Inductive thematic analysis was conducted to synthesise common themes among the included studies. RESULTS Sixty-two articles were included in this synthesis. The following themes emerged: 1) the practitioner view of CAIM delivered through telemedicine, 2) the patient view of CAIM delivered through telemedicine, and 3) the technological impacts of telemedicine delivery of CAIM. CONCLUSIONS Studies have shown that telemedicine delivery of CAIM is feasible, acceptable, and results in positive health outcomes. Some barriers remain such as the presence of chronic illness and morbidity, inability to form strong patient-provider relationships relative to face-to-face approaches, and technological difficulties. Future intervention research should focus on reducing such barriers, as well as explore which patient population would realize the greatest benefit from CAIM delivered via telemedicine, and the impact of interventions on providers and caregivers.
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Affiliation(s)
- Aimun Qadeer Shah
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Noella Noronha
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Robert Chin-See
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Christina Hanna
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Zeest Kadri
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Amn Marwaha
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Neetu Rambharack
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jeremy Y Ng
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
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Haegens LL, Huiskes VJB, van der Ven J, van den Bemt BJF, Bekker CL. Factors Influencing Preferences of Patients With Rheumatic Diseases Regarding Telehealth Channels for Support With Medication Use: Qualitative Study. JMIR Form Res 2023; 7:e45086. [PMID: 37471137 PMCID: PMC10401190 DOI: 10.2196/45086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/04/2023] [Accepted: 05/04/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Patients with rheumatic diseases are known to experience drug-related problems at various times during their treatment. As these problems can negatively influence patients' health, they should be prevented or resolved as soon as possible, for which patients might benefit from additional support. Telehealth has the potential to continuously provide information and offers the possibility to easily contact a health care provider in order to support patients with medication use. Knowledge of factors influencing the patient's preference for telehealth channels can improve the actual use of telehealth channels. OBJECTIVE This study aims to identify factors that influence the preferences of patients with rheumatic diseases regarding telehealth channels for support with medication use. METHODS A qualitative study with face-to-face interviews was performed among patients with an inflammatory rheumatic disease in the Netherlands. A total of 4 telehealth channels were used: a frequently asked questions page, a digital human, an app for SMS text messaging with health care providers, and an app for video-calling with health care providers. Using a semistructured interview guide based on domains of the Capability, Opportunity, Motivation, and Behavior (COM-B) model, participants were questioned about (1) their general opinion on the 4 telehealth channels, (2) factors influencing preference for individual telehealth channels, and (3) factors influencing preference for individual telehealth channels in relation to the other available channels. Interviews were recorded, transcribed, and categorically analyzed. RESULTS A total of 15 patients were interviewed (female: n=8, 53%; male: n=7, 47%; mean age 55, SD 16.8 years; median treatment duration of 41, IQR 12-106 months). The following 3 categories of factors influencing patient preference regarding telehealth channels were identified: (1) problem-related factors included problems needing a visual check, problems specifically related to the patient, and urgency of the problem; (2) patient-related factors included personal communication preference and patient characteristics; and (3) channel-related factors included familiarity with the telehealth channel, direct communication with a health care provider, methods of searching, and conversation history. CONCLUSIONS Preference for telehealth channels is influenced by factors related to the problem experienced, the patient experiencing the problem, and telehealth channel characteristics. As the preference for telehealth channels varies between these categories, multiple telehealth channels should be offered to enable patients to tailor the support with their medication use to their needs.
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Affiliation(s)
- Lex L Haegens
- Department of Research and Innovation, Sint Maartenskliniek, Ubbergen, Netherlands
| | | | - Jeffrey van der Ven
- Department of Research and Innovation, Sint Maartenskliniek, Ubbergen, Netherlands
| | - Bart J F van den Bemt
- Department of Research and Innovation, Sint Maartenskliniek, Ubbergen, Netherlands
- Department of Pharmacy, Sint Maartenskliniek, Ubbergen, Netherlands
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
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Izadi R, Bahrami MA, Khosravi M, Delavari S. Factors affecting the acceptance of tele-psychiatry: a scoping study. Arch Public Health 2023; 81:131. [PMID: 37443137 DOI: 10.1186/s13690-023-01146-8] [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: 04/17/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND In today's digital world, providing services through telemedicine has become an essential issue in health systems, and the Covid-19 pandemic has made this necessity even more apparent. On the other hand, mental health services are needed more than ever, and their nature makes their delivery via telemedicine more feasible than other specialized services. This study aimed to determine the factors affecting the acceptance of telemedicine among users of this technology in the field of mental health. METHODS This article is a scoping review based on the PRISMA guidelines and without any time limit until June 20, 2022. The search was performed in PubMed, Scopus, Web of Science, and PsycINFO databases using keywords related to the three fields of telemedicine, acceptance, and mental disorders. Two authors independently selected the studies based on inclusion and exclusion criteria. Then the data were collected using a data extraction form, and finally, the results were determined using the content analysis method. RESULTS Five main factors affect the acceptance of telemedicine among users of this technology in the field of mental health: perceived effectiveness, users' understanding of the effects of telemedicine on the quality and outcomes of care delivery, technological aspects, organizational change capacity, the nature of the disease and psychological and psychosocial factors. These main factors are associated with 21 related sub-factors. CONCLUSIONS Revealing the factors affecting the acceptance of telemedicine among recipients and providers of services, as key actors in health systems, can help managers and policymakers to successfully implement telemedicine in the less-regarded field of mental health, especially in the early stages.
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Affiliation(s)
- Reyhane Izadi
- Department of Health Care Management, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Amin Bahrami
- Health Human Resources Research Center, School of health management and information sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Khosravi
- Department of Health Care Management, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajad Delavari
- Health Human Resources Research Center, School of health management and information sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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Ren JY, Lei YM, Lei BS, Peng YX, Pan XF, Ye HR, Cui XW. The feasibility and satisfaction study of 5G-based robotic teleultrasound diagnostic system in health check-ups. Front Public Health 2023; 11:1149964. [PMID: 37497023 PMCID: PMC10366591 DOI: 10.3389/fpubh.2023.1149964] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/10/2023] [Indexed: 07/28/2023] Open
Abstract
Objective Regular check-up with ultrasound in underserved rural and/or remote areas is hampered due to the limited availability of sonologists and ultrasound devices. This study aimed to assess the feasibility and satisfaction of health check-ups with a 5G-based robotic teleultrasound diagnostic system. Methods In this prospective study, sonologists from two hospitals manipulated the telerobotic ultrasound system to perform teleultrasound check-ups of the liver, gallbladder, pancreas, spleen, kidneys, bladder, prostate (male), uterus and ovaries (female) for the subjects. The feasibility and satisfaction of health check-ups with a 5G-based robotic teleultrasound diagnostic system were evaluated in terms of examination results, examination duration, and satisfaction questionnaire survey. Results A total of 546 subjects were included with the most frequently diagnosed being abdominal disorders (n = 343) and male reproductive illnesses (n = 97), of which fatty liver (n = 204) and prostatic calcification (n = 54) were the most. The median teleultrasound examination duration (interquartile range) for men and women was 9 (9-11) min and 9 (7-11) min (p = 0.236), respectively. All the subjects were satisfied with this new type of telerobotic ultrasound check-ups and 96% reported no fear of the robotic arm during the examination. Conclusion The 5G-based teleultrasound robotic diagnostic system in health check-ups is feasible and satisfactory, indicating that this teleultrasound robot system may have significant application value in underserved rural and/or remote areas to mitigate disparity in achieving health equity.
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Affiliation(s)
- Jia-Yu Ren
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu-Meng Lei
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Bing-Song Lei
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Yue-Xiang Peng
- Department of Ultrasound, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, China
| | - Xiao-Fang Pan
- Health Medical Department, Dalian Municipal Central Hospital, Dalian, China
| | - Hua-Rong Ye
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Kaboli PJ, Shimada SL. A Decade of Focus on and Improvement in Access to Care in the Veterans Health Administration. J Gen Intern Med 2023:10.1007/s11606-023-08208-1. [PMID: 37340265 DOI: 10.1007/s11606-023-08208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Affiliation(s)
- Peter J Kaboli
- Veterans Rural Health Resource Center-Iowa City, VA Office of Rural Health, and Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, IA, USA.
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Raynor HA, Robson SM, Griffiths LA. Translating the Recommended Multicomponent Intervention for Childhood Overweight and Obesity into Practice: Implementation Challenges. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2023; 53:149-156. [PMID: 37840819 PMCID: PMC10575469 DOI: 10.1007/s10879-022-09554-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/29/2022]
Abstract
A multicomponent, family-based intervention with ≥ 26 contact hours is recommended for the treatment of childhood overweight and obesity. This intervention utilizes behavioral strategies to improve diet, physical activity, and sedentary behaviors. The evidence-based recommendations for this treatment have predominantly come from randomized trials in which the intervention is implemented by research-trained staff in academic research settings, with the intervention delivered to fairly homogeneous samples that are limited in being inclusive of those experiencing health disparities. Thus, there are challenges in implementing the recommended intervention into practice. In particular, there are implementation challenges related to providers, contact time, and settings that impact all children. Specifically, the structure of the intervention may diminish its ability to be delivered by many types of providers in different settings, limiting overall accessibility. There are implementation challenges affecting children who experience health disparities, as it is not clear how efficacious the recommended intervention is for African American or Latinx children, or children from households with low income. Several strategies to reduce identified implementation challenges, such as reducing contact time and intensity of the dietary intervention, are discussed. However, use of these strategies may reduce the effect size of the weight improvements commonly seen with the recommended intervention. Suggestions for future research regarding implementation, specifically using study designs that enhance the ability to create cost-efficient and adaptive interventions that can generalize to many different children and families, are provided.
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Affiliation(s)
- Hollie A. Raynor
- Department of Nutrition, University of Tennessee Knoxville, 1215 Cumberland Ave, 229 JHB, Knoxville, TN 37996, USA
| | - Shannon M. Robson
- Behavioral Health & Nutrition, University of Delaware, Newark, DE, USA
| | - Lauren A. Griffiths
- Department of Nutrition, University of Tennessee Knoxville, 1215 Cumberland Ave, 229 JHB, Knoxville, TN 37996, USA
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Atuhairwe I, Ngabirano AA, Ahaisibwe B, Nsubuga A, Kanyike AM, Kihumuro RB, Balizzakiwa T, Ewing H, Ellis R, Forbush L, Joseph O, Nakyeyune MJ, Waniaye JB. Leveraging tele-mentoring and remote learning to strengthen the emergency care capacity of health workers in Uganda. Afr J Emerg Med 2023; 13:86-93. [PMID: 37124320 PMCID: PMC10130342 DOI: 10.1016/j.afjem.2023.04.001] [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: 11/30/2022] [Revised: 03/10/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023] Open
Abstract
Background A robust emergency care system is a cost-effective method of reducing preventable death and disability, especially in low-and middle-income countries. To scale emergency care expertise across the country, the Uganda Ministry of Health and Seed Global Health established the Emergency Medical Services (EMS) ECHO program. We describe the process of establishing the program in a resource-limited setting, best practices, and lessons learned in Uganda. Methods Investigators conducted a mixed-methods evaluation to assess the initial 4 months' implementation of the EMS ECHO. We conducted pre/post-program assessments of healthcare worker knowledge, self-efficacy, and professional's satisfaction with the program. The analysis compared the differences between pre/post-test scores descriptively. Results The EMS ECHO was initiated in November 2021. A phased curriculum was developed with the initial phase focusing on the ABCDE (Airway, Breathing, Circulation, Disability, and Exposure) approach to the emergency patient. This phase reached 2,030 health workers cumulatively across 200 health facilities. The majority of the participants were medical doctors (n = 751, 37%), and nurses (n = 568, 28%). Majority of participants (95%) rated the sessions as informative. On whether the ECHO sessions diminished professional isolation, 66% agreed or strongly agreed. Conclusions Similar to other ECHO program evaluation results, Uganda's EMS ECHO program improved knowledge, skills, and the development of a virtual community of practice thereby diminishing professional isolation. It also demonstrates that through a planned stepwise process, virtual learning and telementorship can be used efficiently to improve healthcare worker knowledge,skills and multiply the limited number of emergency care experts available in the country.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Randall Ellis
- Seed Global Health, Kampala, Uganda
- Department of Emergency Medicine, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Foo CD, Yan JY, Chan ASL, Yap JCH. Identifying Key Themes of Care Coordination for Patients with Chronic Conditions in Singapore: A Scoping Review. Healthcare (Basel) 2023; 11:healthcare11111546. [PMID: 37297686 DOI: 10.3390/healthcare11111546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
A projected rise in patients with complex health needs and a rapidly ageing population will place an increased burden on the healthcare system. Care coordination can bridge potential gaps during care transitions and across the care continuum to facilitate care integration and the delivery of personalised care. Despite having a national strategic vision of improving care integration across different levels of care and community partners, there is no consolidation of evidence specifically on the salient dimensions of care coordination in the Singapore healthcare context. Hence, this scoping review aims to uncover the key themes that facilitate care coordination for patients with chronic conditions in Singapore to be managed in the community while illuminating under-researched areas in care coordination requiring further exploration. The databases searched were PubMed, CINAHL, Scopus, Embase, and Cochrane Library. Results from Google Scholar were also included. Two independent reviewers screened articles in a two-stage screening process based on the Cochrane scoping review guidelines. Recommendation for inclusion was indicated on a three-point scale and rating conflicts were resolved through discussion. Of the 5792 articles identified, 28 were included in the final review. Key cross-cutting themes such as having standards and guidelines for care programmes, forging stronger partnerships across providers, an interoperable information system across care interfaces, strong programme leadership, financial and technical resource availabilities and patient and provider-specific factors emerged. This review also recommends leveraging these themes to align with Singapore's national healthcare vision to contain rising healthcare costs.
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Affiliation(s)
- Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Jia Yin Yan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Audrey Swee Ling Chan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Jason C H Yap
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
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Cunha AS, Pedro AR, Cordeiro JV. Facilitators and barriers to access hospital medical specialty telemedicine consultations during the COVID-19 pandemic: Systematic Review. J Med Internet Res 2023. [PMID: 37262124 DOI: 10.2196/44188] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND COVID-19 pandemic accelerated the digital transition in healthcare, which required a rapid adaptation of stakeholders. Telemedicine has emerged as an ideal tool to ensure continuity of care by allowing remote access to specialized medical services. However, its rapid implementation has exacerbated disparities in healthcare access, especially for the most vulnerable populations. OBJECTIVE To characterize the determinants factors (facilitators and barriers) of access to hospital medical specialty telemedicine consultations during the COVID-19 pandemic; to identify the main opportunities and challenges (technological, ethical, legal and/or social) generated by the use of telemedicine in the context of the COVID-19 pandemic. METHODS A systematic review was conducted according to PRISMA guidelines. Four databases (Scopus, Web of Science, PubMed and Cochrane COVID-19 Study Register) were searched for empirical studies published between January 3rd, 2020, and December 31st, 2021, using established criteria. The protocol of this review was registered and published in PROSPERO (CRD42022302825). A methodological quality assessment was performed, and results were integrated into a thematic synthesis. The identification of main opportunities and challenges was done by interpreting and aggregating the thematic synthesis results. RESULTS Of the 106 studies identified, 9 met the inclusion criteria and the intended quality characteristics. All studies were originally from the United States of America (USA). The following facilitating factors of telemedicine use were identified: health insurance coverage; prevention of SARS-CoV-2 infection; access to Internet services; access to technological devices; better management of work-life balance; and savings in travel costs. We identified the following barriers to telemedicine use: lack of access to Internet services; lack of access to technological devices; racial and ethnic disparities; low digital literacy; low income; age; language barriers; health insurance coverage; concerns about data privacy and confidentiality; geographic disparities; and need for complementary diagnostic tests or for the delivery of test results. CONCLUSIONS The facilitating factors and barriers identified in this systematic review present different opportunities and challenges, including those of technological nature (access to technological devices and internet services, level of digital literacy), sociocultural and demographic nature (ethnic and racial disparities, geographical disparities, language barriers, age), socioeconomic nature (income level and health insurance coverage), and ethical and legal nature (data privacy and confidentiality). To expand telemedicine access to hospital-based specialty medical consultations and provide high-quality care to all, including the most vulnerable communities, the challenges identified must be thoroughly researched and addressed with informed and dedicated responses. CLINICALTRIAL
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Affiliation(s)
- Ana Soraia Cunha
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal, Avenida Padre Cruz, Lisbon, PT
| | - Ana Rita Pedro
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal, Lisbon, PT
| | - João Valente Cordeiro
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal, Lisbon, PT
- Interdisciplinary Centre of Social Sciences (CICS.NOVA), Universidade NOVA de Lisboa, Lisbon, Portugal, Lisbon, PT
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Tao TJ, Lim TK, Yeung ETF, Liu H, Shris PB, Ma LKY, Lee TMC, Hou WK. Internet-based and mobile-based cognitive behavioral therapy for chronic diseases: a systematic review and meta-analysis. NPJ Digit Med 2023; 6:80. [PMID: 37117458 PMCID: PMC10141870 DOI: 10.1038/s41746-023-00809-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/30/2023] [Indexed: 04/30/2023] Open
Abstract
Positive adjustment to chronic diseases reduces psychiatric comorbidity and enhances quality of life. Very little is known about the benefit of internet-based and mobile-based Cognitive Behavioral Therapy (IM-CBT) on physical outcomes and its reciprocal interactions with psychiatric outcomes, the active therapeutic elements, and effect moderators among people with major chronic medical conditions. In this systematic review and meta-analysis (PROSPERO: CRD42022265738), CINAHL of Systematic Reviews, MEDLINE, PsycINFO, PubMed, Web of Science are systematically searched up to 1 June 2022, for randomized controlled trials (RCTs) comparing IM-CBT against non-CBT control condition(s) among people with chronic disease(s). Primary outcomes include improvements in psychiatric symptoms (depressive, anxiety, PTSD symptoms, general psychological distress) from baseline to post-intervention and follow-ups. Secondary outcomes include improvements in physical distress (physical symptoms, functional impairment, self-rated ill health, objective physiological dysfunction). Among 44 RCTs (5077 patients with seven different chronic diseases), IM-CBT improves depressive symptoms, anxiety symptoms, and general psychological distress at post-intervention and across follow-ups, and improves physical distress and functional impairment at post-intervention. Preliminary evidence suggests that behavioral modification and problem-solving could be necessary components to reduce psychiatric symptoms in IM-CBT, whereas cognitive restructuring, psychoeducation, and mindfulness elements relate to reduced physical distress. IM-CBT shows stronger benefits in chronic pain, cancer, arthritis, and cardiovascular disease, relative to other conditions. Changes in psychiatric symptoms and physical distress prospectively predict each other over time. IM-CBT is an effective intervention for comprehensive symptom management among people with chronic diseases.
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Affiliation(s)
- Tiffany Junchen Tao
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Teck Kuan Lim
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Ernest Tsun Fung Yeung
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Huinan Liu
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
- Department of Special Education and Counselling, The Education University of Hong Kong, Hong Kong SAR, China
| | - Phoenix Bibha Shris
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
| | - Lawrence Ka Yin Ma
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
| | - Tatia Mei Chun Lee
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Neuropsychology & Human Neuroscience, The University of Hong Kong, Hong Kong SAR, China
| | - Wai Kai Hou
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China.
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China.
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Slightam C, Wray C, Tisdale RL, Zulman DM, Gray C. Opportunities to Enhance the Implementation of Veterans Affairs Video-Based Care: Qualitative Perspectives of Providers from Diverse Specialties. J Med Internet Res 2023; 25:e43314. [PMID: 37093642 PMCID: PMC10167580 DOI: 10.2196/43314] [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: 10/07/2022] [Revised: 02/02/2023] [Accepted: 03/12/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Increasing the adoption of digital care tools, including video visits, is a long-term goal for the US Department of Veterans Affairs (VA). While previous work has highlighted patient-specific barriers to the use of video visits, few have examined how clinicians view such barriers and how they have overcome them during the rapid uptake of web-based care. OBJECTIVE This study sought input from providers, given their role as critical participants in video visit implementation, to qualitatively describe successful strategies providers used to adapt their practices to a web-based care setting. METHODS We conducted interviews with 28 VA providers (physicians and nurse practitioners) from 4 specialties that represent diverse clinical services: primary care (n=11), cardiology (n=7), palliative care (n=5), and spinal cord injury (n=5). All interviews were audio recorded and transcribed, and transcripts were reviewed and coded according to an iteratively created codebook. To identify themes, codes were grouped together into categories, and participant comments were reviewed for repetition and emphasis on specific points. Finally, themes were mapped to Expert Recommendations for Implementing Change (ERIC) strategies to identify evidence-based opportunities to support video visit uptake in the VA. RESULTS Interviewees were mostly female (57%, 16/28), with an average age of 49 years and with 2-20 years of experience working in the VA across 16 unique VA facilities. Most providers (82%, 23/28) worked in urban facilities. Many interviewees (78%, 22/28) had some experience with video visits prior to the COVID-19 pandemic, though a majority (61%, 17/28) had conducted fewer than 50 video visits in the quarter prior to recruitment. We identified four primary themes related to how providers adapt their practices to a web-based care setting: (1) peer-based learning and support improved providers' perceived value of and confidence in video visits, (2) providers developed new and refined existing communication and clinical skills to optimize video visits, (3) providers saw opportunities to revisit and refine team roles to optimize the value of video visits for their care teams, and (4) implementing and sustaining web-based care requires institutional and organizational support. We identified several ERIC implementation strategies to support the use of video visits across the individual-, clinic-, and system-levels that correspond to these themes: (1) individual-level strategies include the development of educational materials and conducting education meetings, (2) clinic-level strategies include identifying champions and revising workflows and professional roles, and (3) system-level strategies include altering incentive structures, preparing implementation blueprints, developing and implementing tools for quality monitoring, and involving executive leadership to encourage adoption. CONCLUSIONS This work highlights strategies to support video visits that align with established ERIC implementation constructs, which can be used by health care systems to improve video visit implementation.
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Affiliation(s)
- Cindie Slightam
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Charlie Wray
- Department of Medicine, University of California, San Francisco, CA, United States
- Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Rebecca L Tisdale
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA, United States
| | - Donna M Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
- Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Caroline Gray
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
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Rammohan R, Joy MV, Saggar T, Magam SG, Sinha A, Natt D, Gomez S, Sheikh S, Anand P, Mustacchia P. Healthcare Disparities and Upper Gastrointestinal Bleeding: Exploring the Linkages. Cureus 2023; 15:e37977. [PMID: 37101799 PMCID: PMC10123219 DOI: 10.7759/cureus.37977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 04/28/2023] Open
Abstract
Introduction Upper gastrointestinal bleeding (UGIB) refers to blood loss from a gastrointestinal (GI) source proximal or above the ligament of Treitz. Health equity means giving everyone an equal chance to achieve optimal health by addressing injustices, overcoming barriers, and eliminating health disparities. Healthcare providers must analyze racial and ethnic disparities in UGIB management to ensure all patients receive equal care. Identifying risk factors in specific populations leads to tailored interventions that improve outcomes. Our study aims to examine trends and identify disparities in upper gastrointestinal bleeding across races and ethnicities to promote health equity. Methods Retrospective data on upper gastrointestinal bleeding from June 2009 to June 2022 were collected and categorized into five groups based on race. The baseline characteristics of each group were matched to ensure equitable comparison. A joinpoint regression model was used to compare incidence trends, identifying potential healthcare disparities for different racial/ethnic groups over time. Patients aged 18-75 who suffered from upper gastrointestinal bleeding at Nassau University Medical Center in New York from 2010 to 2021 were selected, excluding those with incomplete baseline comorbidity information. Results This study examined 5103 cases of upper gastrointestinal bleeding, with 41.9% female. The cohort was diverse, with 29.4% African American, 15.6% Hispanic, 45.3% White, 6.8% Asian, and 2.9% of other races. Data were split into two groups; 49.9% occurred between 2009 and 2015 and 50.1% between 2016 and 2022. Findings showed increased UGIB among Hispanics and decreased bleeding among Asians during 2016-2021 compared to 2009-2015. However, no significant difference was found for African Americans, Whites, and other races. In addition, Hispanics had a rise in the annual percentage change (APC) rate, whereas Asians had a decrease. Conclusion Our study examined trends in upper gastrointestinal bleeding and potential healthcare disparities across races and ethnicities. Our findings highlight an increased incidence of UGIB in Hispanics and a decreased incidence in Asians. Additionally, we identified a significant increase in the annual percentage change rate in Hispanics and a decrease in Asians over time. Our study underscores the importance of identifying and addressing disparities in UGIB management to promote health equity. Future research can build on these findings to develop tailored interventions that improve patient outcomes.
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Affiliation(s)
- Rajmohan Rammohan
- Gastroenterology, Nassau University Medical Center, East Meadow, USA
| | - Melvin V Joy
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Tulika Saggar
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | | | - Atul Sinha
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
| | - Dilman Natt
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Sandra Gomez
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
| | - Saher Sheikh
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
| | - Prachi Anand
- Rheumatology, Nassau University Medical Center, East Meadow, USA
| | - Paul Mustacchia
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
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Implementation of Telemedicine Delivery of Medications for Opioid Use Disorder in Pennsylvania Treatment Programs During COVID-19. J Addict Med 2023; 17:e110-e118. [PMID: 36129690 PMCID: PMC10022523 DOI: 10.1097/adm.0000000000001079] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Temporary policy changes during the coronavirus disease 2019 pandemic facilitated rapid expansion of medication for opioid use disorder via telemedicine (tele-MOUD). Evidence for tele-MOUD best practices and its impact on treatment engagement and retention remains limited. This quality improvement initiative compared tele-MOUD implementation among Pennsylvania medication for opioid use disorder (MOUD) programs, evaluated sociodemographic characteristics of patients using tele-MOUD, and described trends in tele-MOUD use and patient engagement and retention. METHODS Five health systems with MOUD programs completed questionnaires regarding their tele-MOUD models and provided aggregated sociodemographic data for MOUD patients with in-person and telemedicine visits in 2020. Three programs provided aggregated monthly appointment data (scheduled, completed, no-show, tele-MOUD visits) over the period in which tele-MOUD scaled up. RESULTS Differences in tele-MOUD protocols related to provision of tele-MOUD inductions, patient eligibility for tele-MOUD, and operationalization of remote drug testing. Across programs, 88% of prescribers conducted tele-MOUD appointments, and 50% of patients used tele-MOUD in 2020. We observed sociodemographic differences, with a greater proportion of female, White, and non-Hispanic patients using tele-MOUD. Across programs with appointment data, overall patient enrollment increased, and new patient enrollment remained relatively constant. Engagement trends suggested a temporary decline in no-show appointments that aligned with the escalation of tele-MOUD in one program. CONCLUSIONS Tele-MOUD protocol differences indicate a need for research to inform evidence-based guidance. Findings suggest that patients largely remained engaged and retained in MOUD as tele-MOUD was implemented but reveal inequities in tele-MOUD use, highlighting the need for efforts to overcome technology access barriers and avoid exacerbating disparities in MOUD access.
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