Savings Through Telemedicine: Initial Data From a Hospital-at-Home Program

OBJECTIVE

We aimed to estimate travel-related time and cost savings from the use of telemedicine for an inpatient hospital-at-home program.

METHODS

This was a retrospective study on the initial data obtained from a newly implemented hospital-at-home program from June 26, 2023, to March 31, 2024. Time cost savings were calculated based on difference between time spent on teleconsultation versus time needed to travel a round trip to patients' homes to conduct physical consultation via home visit. Travel distances were calculated based on the distance of patient's homes from the hospital.

RESULTS

There were 505 teleconsultations (497 scheduled, 8 unscheduled) delivered throughout 132 enrollments. Total travel distance saved was 4022 km. Total time savings was 18 707 minutes or 13.0 days. Total trip cost savings were Singapore dollars 4618.70.

CONCLUSIONS

Despite being a newly introduced program, utilization of telemedicine in delivery of hospital-at-home showed time savings for the clinicians, cost savings from the distance needed to travel otherwise. Incorporation of telemedicine in hospital-at-home delivery demonstrated time and distance savings even at the pilot phase of program.

The use of a multi-disciplinary geriatric telemedicine service (TELEG) and its acceptance at a tertiary care centre in Malaysia

BACKGROUND

The COVID-19 pandemic has fueled the widespread adoption of telemedicine in healthcare, particularly in Sarawak, Malaysia. This study investigates the use and acceptance of Sarawak's inaugural multidisciplinary geriatric telemedicine service, TELEG.

METHODS

This cross-sectional study took place at the Sarawak Heart Centre's geriatric department from July 1, 2021, to April 30, 2022. Convenient sampling included all TELEG-enrolled patients during this period, to achieve minimum sample size of 148. TELEG's utilization was assessed in terms of medication therapy and treatment plan optimization, as well as enhanced healthcare accessibility. Participants' acceptance of TELEG was measured using the Service User Technology Acceptability Questionnaire (SUTAQ) administered through Google Forms. Descriptive statistics percentages illustrated the proportion of participants who found TELEG moderately to highly acceptable. Associations between baseline characteristics and overall acceptance were explored through bivariate analyses, including Pearson's correlation test, independent t-test, and ANOVA. The influence of six SUTAQ dimensions on overall acceptance, multivariable linear regression using enter method was employed. Statistical significance was determined by p-values less than 0.5.

RESULTS

Among 180 geriatric patients enrolled in TELEG during the study period, 149 agreed to participate. TELEG led to medication therapy optimization for 88.6% of participants, primarily involving dose adjustment (44.7%), de-prescribing (31.8%), and prescribing (15.9%). Additionally, 53.8% received treatment plan optimization, predominantly in the form of self-care education (56.3%), referrals for further treatment (33.8%), additional laboratory investigations (29.6%), and increased monitoring (26.8%). Among those educated in self-care (n = 40), dietary intake (27.5%), lower limb exercise (25.0%), and COVID-19 vaccination (12.5%) were the most common topics. All participants expressed moderate to high acceptance of TELEG (mean = 4.9, SD = 0.65, on a scale of 1 to 6). Notably, care personnel concern (B = 0.256; p < 0.001) had the most significant impact on overall acceptance.

CONCLUSION

This pioneering study evaluates the utilization and user acceptance of a geriatric telemedicine service in the region, providing valuable insights to support its expansion. Follow-up surveys or interviews to gain insights into users' experiences are crucial to further enhance acceptance.

Cost analysis of telemedicine use in paediatric nephrology-the LMIC perspective

BACKGROUND

The overall cost of managing chronic diseases is a significant barrier to accessing complete and timely healthcare, especially in rural and geographically isolated areas. This cost disparity becomes more pronounced in the case of children and more so in under-resourced regions of the world. In the era of COVID-19, as the need for physical distancing increased, there was a transition in approach to healthcare provision to telemedicine consultations. This study evaluates the cost saving using teleconsultations in a paediatric nephrology clinic.

METHODS

This prospective cohort study was conducted at AIIMS Jodhpur, a tertiary care centre in western Rajasthan from March 2021 to October 2022. All consecutive paediatric (29 days-18 years) patients attending telemedicine services for kidney-related illness were enrolled. Basic demographic details were collected. Cost analysis was done after 6 months, regarding perceived cost savings for the patient and family by using telehealth for follow-up during 6 months starting from enrolment.

RESULTS

A total of 112 patients were enrolled; 266 teleconsultations attended; 109 patients who could be followed up saved INR 457,900 during 6 months of follow-up. The average cost saving was INR - 1577/patient/visit. Patients saved 4.99% of the family income (median 2.16% (IQR 0.66-5.5)). The highest expenditure per visit was incurred for food and transport. The median distance from the residence to the clinic was 122.5 km (IQR 30-250). Over the 6-month study period, patients saved a travel distance of 83,274 km (743 km/patient).

CONCLUSIONS

The use of telemedicine as a follow-up method helps save significant costs and distances travelled by patients. A higher-resolution version of the Graphical abstract is available as Supplementary information.

Digital Health Interventions among People Living with Frailty: A Scoping Review

OBJECTIVES

Digital health interventions (DHIs) are interesting resources to improve various health conditions. However, their use in the older and frail population is still sparse. We aimed to give an overview of DHI used in the frail older population.

DESIGN

Scoping review with PRISMA guidelines based on Population, Concept, and Context.

SETTING AND PARTICIPANTS

We included original studies in English with DHI (concept) on people described as frail (population) in the clinical or community setting (context) and no limitation on date of publication. We searched 3 online databases (PubMed, Scopus, and Web of Science).

MEASURES

We described DHI in terms of purpose, delivering, content and assessment. We also described frailty assessment and study design.

RESULTS

We included 105 studies that fulfilled our eligibility criteria. The most frequently reported DHIs were with the purpose of monitoring (45; 43%), with a delivery method of sensor-based technologies (59; 56%), with a content of feedback to users (34; 32%), and for assessment of feasibility (57; 54%). Efficacy was reported in 31 (30%) studies and usability/feasibility in 57 (55%) studies. The most common study design was descriptive exploratory for new methodology or technology (24; 23%). There were 14 (13%) randomized controlled trials, with only 4 of 14 studies (29%) showing a low or moderate risk of bias. Frailty assessment using validated scales was reported in only 47 (45%) studies.

CONCLUSIONS AND IMPLICATIONS

There was much heterogeneity among frailty assessments, study designs, and evaluations of DHIs. There is now a strong need for more standardized approaches to assess frailty, well-structured randomized controlled trials, and proper evaluation and report. This work will contribute to the development of better DHIs in this vulnerable population.

Health-tech startups in healthcare service delivery: A scoping review

BACKGROUND

An efficient and affordable healthcare service delivery to everyone is a prerogative of the national governments. Such delivery is quite exacting, and gaps remain. In this regard, startups are trying to disrupt the market with innovative solutions and reach the underserved market. Though anecdotal evidence remains, a rigorous literature review is missing. This paper attempts to understand the status of health-tech startups in healthcare service delivery.

METHODS

We scanned a total of 110 journals - Financial Times top 50, top ten information systems journals listed by the Australian Business Dean Council, and the top 50 Scopus indexed journals in health informatics and health information management. We followed a systematic process for this scoping review - reading of titles, abstracts, and then full papers for final analysis based on inclusion and exclusion criteria.

RESULTS

A total of 76 articles met the inclusion criteria. Only five studies portrayed the status of health-tech startups in healthcare service delivery. To capture the overall startup ecosystem, we continued with a scoping review of all the 76 articles.

DISCUSSIONS

The identified five themes are Technology adoption, Electronic health services, Business planning and framework, Psychographics, and Regulations. There is evidence of technology adoption in service delivery and its nature in the businesses undertaken by startups. Very few studies represented the patterns of the existing business model. The acceptance of the services is dependent on service effectiveness and affordability. The challenges are licensing, policies, data privacy and security, and inadequate technology access among healthcare seekers.

CONCLUSIONS

Albeit the feasibility potential, research concerning the impact of health tech startups in healthcare service delivery is emerging but incipient. The review indicates that research on startups is inadequate, especially related to entrepreneurship, business frameworks, and regulations. Future research should explore the same.

Comparison of in-person and telegeriatric follow-up consultations

INTRODUCTION

Telehealth has the potential to support the care of older adults and their desire to age at home by providing a videoconferencing connection to specialist geriatric care. However, more information is needed to determine how telehealth services affect the care of older adults, and how telehealth services for older adults compare to traditional in-person methods of care provision. The aim of this study was to compare telegeriatric and in-person geriatric consultation methods with respect to outcomes and costs.

METHODS

This was a retrospective chart analysis of consultation letters from patients' first follow-up appointment with a geriatric specialist during the 2017/2018 fiscal year (N = 95) in a health jurisdiction of a Western Canadian province.

RESULTS

Patients seen through telehealth and in person were similar in mean age (M = 79.1 and 78.1 years, respectively) and were predominately female. Telegeriatric consultations resulted in more requests for further testing and screening (p = 0.003), new diagnoses (p = 0.002), medication changes (p = 0.009) and requests for follow-up (p = 0.03) compared to in-person consultations. An average one-day clinic with one geriatric specialist providing consultations through telehealth cost Can$1684-$1859 less than an equivalent in-person clinic.

DISCUSSION

Although additional research is needed to explain the differences in outcomes further between telehealth and in-person consultations found in this work, telehealth consultations cost substantially less than in-person consultations and are a promising way to improve access to geriatric care for older adults in underserved areas.

Improving geriatric care and reducing hospitalisations in regional and remote areas: The benefits of telehealth

INTRODUCTION

The aim of this study was to compare the effectiveness of two geriatrician models of care, the telegeriatric service (TGS) and visiting geriatrician (VG), in regional and remote settings in terms of potential cost-savings to the health system and impact on health service use (HSU). Furthermore, to establish whether longer wait-times for clinic appointments led to increased HSU by study participants.

METHODS

Trends in patient emergency department presentations, hospitalisations and bed-days (HSU) were compared from 18 months before to 12 months after geriatrician appointment for the two services in the Western Australian Midwest region. The relationships between wait times, patient triage level and HSU were modelled. The costs of providing the services were offset against reductions in HSU after appointments.

RESULTS

The sample comprised consecutive patients using the TGS (n = 84) and VG service (n = 124). Patient characteristics were similar, although patients using the VG service had longer wait-times, were triaged as more urgent and demonstrated the highest levels of HSU. Both models were effective with similar rates of reduced HSU following appointments. Increased wait-times and higher patient triage urgency were associated with increased HSU.

DISCUSSION

Although TGS and VG showed similar reduced rates of HSU, TGS had the capacity to see a higher volume of patients, a broader geographical reach and improved waitlist management. Consequently, TGS was more effective at reducing avoidable hospitalisations and subsequent health deterioration due to shorter wait-times. Whilst face-to-face consultations are recognised as 'gold standard' a combination of the two models is most efficient.

Telemedicine for Specialist Geriatric Care in Small Rural Hospitals: Preliminary Data

Small rural hospitals admit and manage older adults who, in city hospitals, would usually be offered geriatrician-supported comprehensive geriatric assessment and coordinated subacute care if required. Distance and diseconomies of scale prohibit access to the conventional in-person approach. A telegeriatric service model involving a geriatrician consulting remotely using wireless, mobile, high-definition videoconferencing; a trained host nurse at the rural site; structured geriatric assessment configured on a web-based clinical decision support system; routine weekly virtual rounds; and support from a local multidisciplinary team was established to overcome these barriers. This was a prospective observational study to examine the feasibility and sustainability of the model. Patient characteristics were recorded using the interRAI Acute Care assessment system. Usage patterns were derived from health service data sets and a service statistics database. Patients had characteristics that are consistent with characteristics of individuals typically referred for geriatric assessment. Overall, 53% of patients had cognitive impairment, 75% had limitations with activities of daily living, and the average Frailty Index was 0.44 ± 0.12. Stable patterns of consultation occurred within 6 months of start-up and continued uninterrupted for the remainder of the 24-month observation period. The estimated overall rate of initial consultation was 1.83 cases per occupied bed per year and 2.66 review cases per occupied bed per year. The findings indicate that the model was feasible and was sustained throughout and beyond the study period. This telegeriatric service model appears suitable for use in small rural hospitals.

Web-based (online) comprehensive geriatric assessment is more time efficient, and as reliable, as reading patient medical records and conducting traditional in person consultations

The aim of this study was to report the time taken by geriatricians to reach triage decisions using an online assessment format compared with face-to-face (FTF) assessment. Patients ( N = 166) were randomly allocated to two groups: online and FTF assessments (OF group); and dual FTF assessments (FF group). Case preparation was conducted by trained nurse assessors using a web-enabled clinical decision support system. Geriatricians allocated to perform an ‘online’ assessment had access to this information only. Geriatricians allocated FTF assessments reviewed this data, as well as the paper-based medical file and then consulted directly with the patient and attending staff. Data were collected in relation to time taken to complete OL assessments, compared with FTF assessments. A complete OL consultation averages 10 minutes, and a FTF consultation almost 26 minutes. In FTF consultations, less time is spent using the OL material when the geriatrician is aware that they will have access to the patient chart and need time to speak with the patient. The less time taken using the OL approach did not significantly alter the triage decisions made by the geriatricians.

Improving Access to Specialist Care for an Aging Population

Objective: The objective of the study is to examine the Champlain. BASETM (Building Access to Specialists through eConsultation) eConsult service's impact on access to care for older persons. Methods: We conducted a cross-sectional analysis of all eConsult cases submitted between April 15, 2011, and July 31, 2015, in which the patient was above the age of 65 years. Study data consisted of utilization data collected automatically by the service and responses to surveys completed by primary care providers at the conclusion of all eConsult cases. Results: A total of 1,796 cases were submitted for older persons between April 15, 2011, and July 31, 2015, accounting for 21.3% of all cases submitted during the study period. Specialists responded to cases in a median of 0.8 days. In 94% of cases, providers rated eConsult as having great or excellent value for themselves and their patients. Sixty-eight percent of eConsults did not require a face-to-face visit; only 28% of all cases resulted in a referral. Discussion: As they suffer from higher than average rates of comorbid disease and mobility issues, older persons stand to benefit from shorter wait times and better access to care, which the eConsult service can provide.