Evaluation of Telemedicine Consultations Using Health Outcomes and User Attitudes and Experiences: Scoping Review

BACKGROUND

Despite a recent rise in adoption, telemedicine consultations retention remains challenging, and aspects around the associated experiences and outcomes remain unclear. The need to further investigate these aspects was a motivating factor for conducting this scoping review.

OBJECTIVE

With a focus on synchronous telemedicine consultations between patients with nonmalignant chronic illnesses and health care professionals (HCPs), this scoping review aimed to gain insights into (1) the available evidence on telemedicine consultations to improve health outcomes for patients, (2) the associated behaviors and attitudes of patients and HCPs, and (3) how supplemental technology can assist in remote consultations.

METHODS

PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guided the scoping review process. Inclusion criteria were (1) involving adults with nonmalignant, noncommunicable chronic conditions as the study population; (2) focusing on health outcomes and experiences of and attitudes toward synchronous telemedicine consultations between patients and HCPs; and (3) conducting empirical research. A search strategy was applied to PubMed (including MEDLINE), CINAHL Complete, APA PsycNet, Web of Science, IEEE, and ACM Digital. Screening of articles and data extraction from included articles were performed in parallel and independently by 2 researchers, who corroborated their findings and resolved any conflicts.

RESULTS

Overall, 4167 unique articles were identified from the databases searched. Following multilayer filtration, 19 (0.46%) studies fulfilled the inclusion criteria for data extraction. They investigated 6 nonmalignant chronic conditions, namely chronic obstructive pulmonary disease, diabetes, chronic kidney disease, ulcerative colitis, hypertension, and congestive heart failure, and the telemedicine consultation modality varied in each case. Most observed positive health outcomes for patients with chronic conditions using telemedicine consultations. Patients generally favored the modality's convenience, but concerns were highlighted around cost, practical logistics, and thoroughness of clinical examinations. The majority of HCPs were also in favor of the technology, but a minority experienced reduced job satisfaction. Supplemental technological assistance was identified in relation to technical considerations, improved remote workflow, and training in remote care use.

CONCLUSIONS

For patients with noncommunicable chronic conditions, telemedicine consultations are generally associated with positive health outcomes that are either directly or indirectly related to their ailment, but sustained improvements remain unclear. These modalities also indicate the potential to empower such patients to better manage their condition. HCPs and patients tend to be satisfied with remote care experience, and most are receptive to the modality as an option. Assistance from supplemental technologies mostly resides in addressing technical issues, and additional modules could be integrated to address challenges relevant to patients and HCPs. However, positive outcomes and attitudes toward the modality might not apply to all cases, indicating that telemedicine consultations are more appropriate as options rather than replacements of in-person visits.

Bridging technology and care: integrating web-based PROMs in mental health services for refugees: a study on clinician training and technology adoption

This study explores the integration of a web-based electronic database technology containing patient-reported outcome measures (PROMs) with electronic health records for refugees with PTSD, emphasizing the systematic inclusion of patient perspectives in clinical decision-making. Our research addresses the notable gap in literature regarding training clinicians for the competent integration of health information technology in healthcare. The training program developed aimed at equipping clinicians, particularly inexperienced with technology, to effectively utilize an electronic PROM system for collecting systematic patient information. Our study is set in the context of the Mental Health Services (MHS) in Denmark, focusing on a specialized clinic for treating trauma-affected refugees. The multidisciplinary team involved in this project reflects a wide range of healthcare professionals. The training program employed a variety of activities over nearly 2 years, adapting to feedback and aiming to engage clinicians in continuous improvement processes. Analyzing qualitative data with thematic analysis we interpreted that the training's extended focus on discussion of the implementation process, with limited hands-on experience, potentially reinforced clinicians' hesitations toward new technology, rather than reducing them. Clinicians prioritized immediate concerns over potential long-term benefits. Despite this, their approach reflects a strong commitment to patient welfare and careful evaluation of new practices. Notably, there were also positive engagements with the technology, highlighting its potential in patient care. This study concludes that the successful integration of technology in clinical settings hinges on its alignment with clinicians' workflows, respect for their professional judgment, and clear benefits to patient care.

Impact of telehealth on patient-provider communication in prenatal care for pregnant women from underserved settings

INTRODUCTION

Telehealth has emerged as a promising supplementary modality in prenatal care. However, its impact on patient-provider communication (PPC), especially among pregnant women from underserved settings, requires comprehensive evaluation. This study examined the factors associated with the quality of patient-provider communication during the COVID-19 pandemic among pregnant telehealth users and non-users.

METHODS

Using a cross-sectional study design, 242 women were surveyed (response rate = 23%) regarding their experience with telehealth, quality of PPC, and experiences of discrimination during prenatal care. Multiple regression models were used to identify the factors associated with the quality of PPC during the COVID-19 pandemic. A sub-group analysis explored the factors associated with the quality of PPC separately among telehealth users and non-users.

RESULTS

The majority of the participants were on Medicaid (95%) and self-identified as Black/African American (57.3%). Regression analyses revealed a negative relationship between telehealth use during pregnancy and the quality of PPC (β = -1.13, P = 0.002). Irrespective of the telehealth use, the experience of discrimination was associated with poor quality of PPC among users (β = -3.47, P = .02) and non-users (β = -.78, P = .03), while adjusting for sociodemographic factors and social support during pregnancy.

DISCUSSION

While telehealth offers advantages like convenience, increased accessibility, and continuity of care, challenges in establishing effective PPC in virtual settings have emerged that emphasize the necessity for comprehensive provider training extending beyond technical competencies. The persistent issue of perceived discrimination, impacting PPC across both groups, underscores the necessity to rethink existing strategies of mandatory training to increase providers' knowledge.

Development and Validation of Telehealth Competency Questionnaire-Provider

Background: Given the rapid increase in telehealth utilization, health care providers are being increasingly trained to deliver services virtually. However, there are limited measures available to assess the extent to which structured trainings influence competency domains associated with telehealth delivery. Methods: The authors developed the Telehealth Competency Questionnaire-Provider (TCQ-P) using a multistep process, including a literature review and expert reviewers. Using two datasets, we used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to validate and refine the tool, respectively. The final version contained 17 items. Model fit was evaluated using the comparative fit index (CFI) (>0.90), Tucker-Lewis index (TLI) (>0.80), standardized root mean square residual (SRMR) (<0.08) and root mean square of error of approximation (RMSEA) (<0.08). Results: Participants included n = 701 in the exploratory study and n = 721 in the confirmatory study. Two items were revised, and one item was deleted as a result of the EFA, and the CFA of 17 number of items supported a 3-factor model (i.e., Evaluation, Rapport, Troubleshooting). Model fit was good, with CFI = 0.984, TLI = 0.978, RMSEA = 0.051, and SRMR = 0.035. Discussion: The TCQ-P measures three essential domains of telehealth competency, which is essential for future health care providers. The measure may be used to assess telehealth training outcomes.

Breaking barriers: exploring physiotherapists' willingness and challenges in embracing telerehabilitation in a developing country

INTRODUCTION

Telerehabilitation (TR) is an innovative approach that can address the limited availability and restricted access to rehabilitation services, particularly during challenging times such as pandemics and natural disasters. This study focuses on understanding the desires, perceptions, and barriers that physiotherapists face when implementing TR in a developing country.

METHOD

The study was conducted with 219 physiotherapists residing in a developing country using a web-based survey on Google Docs.

RESULT

The findings revealed that a significant majority of physiotherapists (88.1%) recognized TR as a potential solution for individuals with physical problems during the pandemic. Additionally, 89.5% expressed satisfaction with the opportunity to receive consultations from different hospitals, indicating a positive perception of TR. However, the study also highlighted certain barriers that hindered the implementation of TR. Around 40.2% of physiotherapists reported having training deficiencies, suggesting a need for educational support in utilizing TR effectively. Furthermore, the analysis of demographic factors revealed interesting insights. It was noteworthy that the age and years of experience of physiotherapists had an impact on their willingness and adoption of TR.

CONCLUSION

The study reveals that physiotherapists in the developing country exhibit a positive attitude towards TR and recognize its potential benefits. However, various barriers, such as training deficiencies, need to be addressed to facilitate a broader adoption of TR in their practices. Overcoming these barriers is anticipated to heighten physiotherapists' readiness to embrace TR, ultimately enhancing the accessibility and delivery of rehabilitation services.

Telemedicine entrustable professional activities for nurses in long-term care: A modified Delphi study

BACKGROUND

As the use of telemedicine proliferates in community care, it is essential to ensure practice recommendations and guidelines are available to assist healthcare providers in providing telemedicine-based care. This study aimed to develop entrustable professional activities (EPAs) for nursing home nurses involved in telemedicine consultations.

AIM

To develop entrustable professional activities (EPAs) for nursing home nurses involved in telemedicine consultations.

DESIGN

Modified Delphi study.

METHODS

The study was conducted in two stages. First, content analysis of 28 healthcare provider interviews and literature review on telemedicine competencies was conducted to develop an initial list of EPAs. An expert workgroup comprising of an international panel of academics and clinicians reviewed the activities. In the second stage, a three-round e-Delphi technique was used to develop telemedicine EPAs for nurses in long-term care. Descriptive statistics and qualitative feedback were distributed to participants after each round. Agreement within survey rounds was computed.

RESULTS

Six core telemedicine EPAs with 28 descriptors were developed, from preparing the resident for the teleconsultation encounter to follow-up care post-teleconsultation. Agreement coefficients were high across all Delphi rounds.

CONCLUSION

This study identifies the core functions that long-term care nurses' are expected to perform in telemedicine consultations. The internationally relevant EPAs are sufficiently broad to be adapted to design telemedicine training and workplace-based assessment for nurses. Organisations may utilise the EPAs as a resource during the implementation process of telemedicine services in long-term care in designing nursing workflow and complement the learning and development of nurses for telemedicine services. Equipping long-term care nurses with this resource can ensure consistency, patient safety and quality of teleconsultations delivered to nursing home residents. However, further work is required to expand the EPAs for application to practice.

Telemedicine in Service of Family Doctors in North Macedonia: Search for the New Frontier for Medical Professionals

Introduction: Innovative medical technologies such as telemedicine, telehealth, and artificial intelligence have great potential in North Macedonia. Our nation was a leader in the region in advancing internet connections. A key barrier to wider adoption has been human resources. Material and Methods: Family doctors are skilled and trained enough to accept and use these technologies in everyday work. In our School of Family Medicine, we thought that additional training was necessary. This was the key objective of our task-if telemedicine and telehealth are presented to a critical mass of doctors as yet another tool that will make their day-to-day work easier, the "chain reaction" of adopting and applying telemedicine and telehealth would not be stopped. Discussion: To further study this objective, we started with a pilot project with a course in telemedicine and telehealth for future family medicine specialists. Telepsychiatry and teledermatology were the first modules to be taught. In addition, telehealth care equipment was also presented to participants. Conclusion: Participants' reactions were very positive.

Teledentistry within oral health care providers' training: A scoping review

INTRODUCTION

Despite teledentistry (TD) ubiquitous utilization, it has yet to be fully adopted by oral health care providers' educational training. This study aimed to explore TD incorporation in the training of oral health care providers.

METHODS

This review included studies on the TD content offered to oral health care providers. The JBI (Joanna Briggs Institute) methodology was used, and two reviewers screened the literature. Studies published between 1989 and 4 June 2022 were searched using "Teledentistry" and "Education" as initial keywords. The searched databases included MEDLINE, Cochrane Library, CINAHL, EPPI, Scopus, Epistemonikos, ERIC, MedEdPORTAL, ProQuest Dissertations and Theses Global, and Google Scholar. All of the relevant literature, regardless of their language, were added. The data were extracted using an extraction table and are presented in tabular and narrative summary formats.

RESULTS

A total of 2180 documents were found, and 1804 documents were screened by the title and abstract after deduplication; 59 were selected for full-text review; and 19 were eligible for data extraction. Of all studies, 63.15% were published after the COVID-19 pandemic. Practicing TD and TD reimbursement were some of the addressed topics. Didactic education and hands-on practice were the most employed training methods. Self/peer evaluations and surveys were among the employed assessment techniques.

CONCLUSION

TD education has been emphasized during the COVID-19 pandemic. There is a variation in the existing TD educational programmes, from addressing topics to assessment techniques. However, the number of educational programmes on this topic is sparse.

The design and evaluation of gamified online role-play as a telehealth training strategy in dental education: an explanatory sequential mixed-methods study

To evaluate user perceptions and educational impact of gamified online role-play in teledentistry as well as to construct a conceptual framework highlighting how to design this interactive learning strategy, this research employed an explanatory sequential mixed-methods design. Participants were requested to complete self-perceived assessments toward confidence and awareness in teledentistry before and after participating in a gamified online role-play. They were also asked to complete a satisfaction questionnaire and participate in an in-depth interview to investigate their learning experience. The data were analyzed using descriptive statistics, paired sample t-test, one-way analysis of variance, and framework analysis. There were 18 participants who completed self-perceived assessments and satisfaction questionnaire, in which 12 of them participated in a semi-structured interview. There were statistically significant increases in self-perceived confidence and awareness after participating in the gamified online role-play (P < 0.001). In addition, the participants were likely to be satisfied with this learning strategy, where usefulness was perceived as the most positive aspect with a score of 4.44 out of 5, followed by ease of use (4.40) and enjoyment (4.03). The conceptual framework constructed from the qualitative findings has revealed five key elements in designing a gamified online role-play, including learner profile, learning settings, pedagogical components, interactive functions, and educational impact. The gamified online role-play has demonstrated its potential in improving self-perceived confidence and awareness in teledentistry. The conceptual framework developed in this research could be considered to design and implement a gamified online role-play in dental education. This research provides valuable evidence on the educational impact of gamified online role-play in teledentistry and how it could be designed and implemented in dental education. This information would be supportive for dental instructors or educators who are considering to implement teledentistry training in their practice.

Review article: Telehealth in Emergency Medicine in Australasia: Advantages and barriers

The COVID-19 pandemic catapulted Telehealth to the forefront of Emergency Medicine (EM) as an alternative way of assessing and managing patients. This challenged the traditional idea that EM can only be practised within brick-and-mortar EDs. Many Emergency Physicians may find the idea of practising Telehealth in Emergency Medicine (TEM) confronting, particularly in the absence of training and clear practice guidelines. The purpose of the present paper is to describe the current use of TEM in Australasia, and outline the advantages and barriers in adopting this practice domain.

Telehealth Education in Allied Health Care and Nursing: Web-Based Cross-Sectional Survey of Students' Perceived Knowledge, Skills, Attitudes, and Experience

BACKGROUND

The COVID-19 pandemic has highlighted the growing relevance of telehealth in health care. Assessing health care and nursing students' telehealth competencies is crucial for its successful integration into education and practice.

OBJECTIVE

We aimed to assess students' perceived telehealth knowledge, skills, attitudes, and experiences. In addition, we aimed to examine students' preferences for telehealth content and teaching methods within their curricula.

METHODS

We conducted a cross-sectional web-based study in May 2022. A project-specific questionnaire, developed and refined through iterative feedback and face-validity testing, addressed topics such as demographics, personal perceptions, and professional experience with telehealth and solicited input on potential telehealth course content. Statistical analyses were conducted on surveys with at least a 50% completion rate, including descriptive statistics of categorical variables, graphical representation of results, and Kruskal Wallis tests for central tendencies in subgroup analyses.

RESULTS

A total of 261 students from 7 bachelor's and 4 master's health care and nursing programs participated in the study. Most students expressed interest in telehealth (180/261, 69% very or rather interested) and recognized its importance in their education (215/261, 82.4% very or rather important). However, most participants reported limited knowledge of telehealth applications concerning their profession (only 7/261, 2.7% stated profound knowledge) and limited active telehealth experience with various telehealth applications (between 18/261, 6.9% and 63/261, 24.1%). Statistically significant differences were found between study programs regarding telehealth interest (P=.005), knowledge (P<.001), perceived importance in education (P<.001), and perceived relevance after the pandemic (P=.004). Practical training with devices, software, and apps and telehealth case examples with various patient groups were perceived as most important for integration in future curricula. Most students preferred both interdisciplinary and program-specific courses.

CONCLUSIONS

This study emphasizes the need to integrate telehealth into health care education curricula, as students state positive telehealth attitudes but seem to be not adequately prepared for its implementation. To optimally prepare future health professionals for the increasing role of telehealth in practice, the results of this study can be considered when designing telehealth curricula.

Factors influencing the willingness to adopt telerehabilitation among rehabilitation professionals in Austria and Germany: a survey comparing data before and during COVID-19

PURPOSE

To investigate determinants of willingness to adopt telerehabilitation, willingness of technology use, core affect regarding using telerehabilitation, and digital competencies in rehabilitation professionals in Austria and Germany before and during the COVID-19 pandemic.

MATERIALS AND METHODS

A cross-sectional paper-based and online survey was conducted before and during COVID-19, respectively, with three cohorts of rehabilitation professionals. Outcomes were the willingness to adopt telerehabilitation evaluated using the extended Unified Theory of Acceptance and Use of Technology; willingness of technology use using the short scale for assessing the willingness of technology use; digital competencies and core affect using the Digital Competence Framework and semantic differential, respectively. Multivariate ordinal regression analysis was performed to determine predictors.

RESULTS

Included were 603 rehabilitation professionals. Analysis revealed differences between Austria and Germany and before and during the pandemic for most outcomes. German residency, the pandemic, and a higher educational level were most important predictors of higher willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect.

The pandemic increased most aspects of willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. Results confirm that rehabilitation professionals with higher degrees are more prone to adopt innovations in healthcare.Registration: German Clinical Trials Register (DRKS00021464)IMPLICATIONS FOR REHABILITATIONThe willingness to adopt telerehabilitation is associated with external factors increasing the need for alternative rehabilitation delivery, such as COVID-19, and with financial facilitators, such as reimbursement.As the willingness to adopt telerehabilitation is higher among speech and language therapists and dietitians, efforts are necessary to enhance its use in physiotherapists and occupational therapists.As a higher willingness to adopt telerehabilitation was observed in younger rehabilitation professionals and those with higher education, increasing the importance of telerehabilitation in education curricula and further knowledge transfer into practice for those already working in the field seems necessary.

Service User Experience of Receiving Remote Inpatient Mental Health Treatment via the Homecare Service

The Homecare Service was developed as a response to the COVID-19 pandemic, providing all the elements of a mental health inpatient programme remotely, in the comfort and safety of the service user's home thus reducing the need for a physical admission. The aim of this study was to explore service user experiences of a remote virtual inpatient care at an Irish independent mental health service. All participants who had a virtual admission in a 3-month period were invited to complete a series of questions via an online survey. Three open-ended questions generated qualitative data from this mixed methods study, which were thematically analysed. Three themes reflected service user experience: 'The Homecare Service: a viable alternative to inpatient care'; 'Importance of relationships' and 'Technology and Homecare.' Overall, there was general satisfaction with the service. This study provided a good opportunity to identify issues that have emerged considering the prompt implementation of the initiative. Feedback relating to improvements can be implemented in future service delivery.

How clinicians make decisions for patient management plans in telehealth

AIM

This systematic integrative literature review explores how clinicians make decisions for patient management plans in telehealth.

BACKGROUND

Telehealth is a modality of care that has gained popularity due to the development of digital technology and the COVID-19 pandemic. It is recognized that telehealth, compared to traditional clinical settings, carries a higher risk to patients due to its virtual characteristics. Even though the landscape of healthcare service is increasingly moving towards virtual systems, the decision-making process in telehealth remains not fully understood.

DESIGN

A systematic integrative review.

DATA SOURCES

Databases include CINAHL, APA PsycInfo, Academic Search Complete, PubMed, Web of Science and Google Scholar.

REVIEW METHODS

This systematic integrative review method was informed by Whittemore and Knafl (2005). The databases were initially searched with keywords in November 2022 and then repeated in October 2023. Thematic synthesis was conducted to analyse and synthesize the data.

RESULTS

The search identified 382 articles. After screening, only 10 articles met the eligibility criteria and were included. Five studies were qualitative, one quantitative and four were mixed methods. Five main themes relevant to decision-making processes in telehealth were identified: characteristics of decision-making in telehealth, patient factor, clinician factor, CDSS factor and external influencing factor.

CONCLUSIONS

The decision-making process in telehealth is a complicated cognitive process influenced by multi-faceted components, including patient factors, clinician factors, external influencing factors and technological factors.

IMPACT

Telehealth carries higher risk and uncertainty than face-to-face encounters. CDSS, rather than bringing unification and clarity, seems to bring more divergence and ambiguity. Some of the clinical reasoning processes in telehealth remain unknown and need to be verbalized and made transparent, to prepare junior clinicians with skills to minimize risks associated with telehealth.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable.

Changes in mental health services in response to the COVID-19 pandemic in high-income countries: a rapid review

BACKGROUND

Severe deterioration in mental health and disrupted care provision during the COVID-19 increased unmet needs for mental health. This review aimed to identify changes in mental health services for patients in response to the pandemic and understand the impact of the changes on patients and providers.

METHODS

Following the Cochrane guidance for rapid reviews, Cochrane CENTRAL, MEDLINE, Embase and PsycInfo were searched for empirical studies that investigated models of care, services, initiatives or programmes developed/evolved for patients receiving mental health care during COVID-19, published in English and undertaken in high-income countries. Thematic analysis was conducted to describe the changes and an effect direction plot was used to show impact on outcomes.

RESULTS

33 of 6969 records identified were included reporting on patients' experiences (n = 24), care providers' experiences (n = 7) and mixed of both (n = 2). Changes reported included technology-based care delivery, accessibility, flexibility, remote diagnostics and evaluation, privacy, safety and operating hours of service provision. These changes had impacts on: (1) care access; (2) satisfaction with telehealth; (3) comparability of telehealth with face-to-face care; (4) treatment effectiveness; (5) continuity of care; (6) relationships between patients and care providers; (7) remote detection and diagnostics in patients; (8) privacy; (9) treatment length and (10) work-life balance.

CONCLUSIONS

A shift to telecommunication technologies had a significant impact on patients and care providers' experiences of mental health care. Improvements to care access, flexibility, remote forms of care delivery and lengths of operating service hours emerged as crucial changes, which supported accessibility to mental health services, increased attendance and reduced dropouts from care. The relationships between patients and care providers were influenced by service changes and were vastly depending on technological literacy and context of patients and availability and care access ranging from regular contact to a loss of in-person contact. The review also identified an increase in care inequality and a feeling of being disconnected among marginalised groups including homeless people, veterans and ethic minority groups. Telehealth in mental care could be a viable alternative to face-to-face service delivery with effective treatment outcomes. Further research is needed to better understand the impact of the changes identified particularly on underserved populations.

Narrative review of telemedicine applications in decentralized research

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.

Incorporating telehealth education into the genetic counseling curriculum

As the provision of telehealth genetic counseling (THGC) services continues to expand, it is imperative that genetic counseling students gain proficiency in telehealth service delivery. To prepare students to provide THGC services, the MSGC program at the University of Pennsylvania has included didactic sessions on THGC, THGC role plays, THGC standardized patient sessions, and THGC fieldwork experiences and clinical rotations. This article highlights best practices in THGC and guidance for Master of Science in Genetic Counseling (MSGC) programs training the next generation of genetic counselors providing THGC services.

Telehealth follow-up consultations for melanoma patients during the COVID-19 pandemic: Patient and clinician satisfaction

INTRODUCTION

The COVID-19 pandemic caused rapid implementation of telehealth for melanoma follow-up care in Australia. This study explores Australian melanoma patients and clinicians' level of satisfaction with telehealth.

METHODS

A cross-sectional study was conducted across three specialist melanoma centres in Sydney, Australia. Melanoma patients (all stages) and clinicians completed mixed methods surveys seeking socio-demographic and clinical information and questionnaires to assess satisfaction with telehealth. Additionally, patients completed measures of quality of life, fear of cancer recurrence and trust in their oncologist. Patients and clinicians provided open-ended responses to qualitative questions about their perceptions of telehealth.

RESULTS

One hundred and fifteen patients and 13 clinicians responded to surveys. Telephone was used by 109 (95%) patients and 11 (85%) clinicians. Fifty-seven (50%) patients and nine (69%) clinicians preferred face-to-face consultations, 38 (33%) patients and 3 (23%) clinicians preferred a combination of face-to-face and telehealth consultations. Five (4%) patients and nil clinicians preferred telehealth consultations. Patients diagnosed with early-stage melanoma, using telehealth for the first time, who have lower trust in their oncologist, and having higher care delivery, communication and supportive care concerns were likely to report lower satisfaction with telehealth. Open-ended responses were consistent between patients and clinicians, who reported safety, convenience and improved access to care as major benefits, while identifying personal, interpersonal, clinical and system-related disadvantages.

DISCUSSION

While telehealth has been widely implemented during COVID-19, the benefits identified by patients and clinicians may extend past the pandemic. Telehealth may be considered for use in conjunction with face-to-face consultations to provide melanoma follow-up care.

Mental health service users' experiences of telehealth interventions facilitated during the COVID-19 pandemic and their relevance to nursing: An integrative review

WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Service users report telehealth interventions to be useful in terms of access and convenience however, a preference for face-to-face interventions remains. Nurses are using telehealth interventions in clinical practice however, further research is necessary in this area as the evidence of their involvement is limited. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This paper highlights the use of telehealth interventions should augment rather than replace face-to-face care provision.

ABSTRACT

INTRODUCTION: The Covid-19 pandemic saw the swift implementation of physical and social distancing that impacted the way in which mental health services were facilitated. Consequently, telehealth/e-health interventions are increasing in use.

AIM

This integrative review aims to explore existing literature regarding mental health service users' experiences of telehealth interventions facilitated through the COVID-19 pandemic, to determine the visibility of nursing involvement in the facilitation of telehealth interventions and to use these experiences to inform nursing practice.

METHOD

A methodical search of eight (n = 8) academic databases was undertaken using CINAHL, SCOPUS, EMBASE, PsycINFO, Web of Science, Cochrane, MEDLINE and Academic Search Complete between January 2020 and January 2022.

RESULTS

A total of 5133 papers were screened by title and abstract of which (n = 77) progressed for full-text screening. Five (n = 5) papers met the inclusion criteria for this review and results were mapped onto the four meta-paradigms of nursing: person; where the findings discuss the acceptability of telehealth interventions; environment; where the findings highlight barriers and facilitators to the use of telehealth interventions; health; where the findings discuss staff time and logistical issues relating to telehealth interventions and nursing; where the findings centre around the therapeutic relationship.

DISCUSSION

This review highlights there is a paucity of direct evidence relating to nursing involvement in the facilitation of telehealth interventions. However, there are benefits to the use of telehealth interventions that include increased access to services, less perceived stigma and increased engagement which are relevant to nursing practice. A lack of individual contact and concerns relating to infrastructure indicates a fondness for face-to-face interventions remains high.

IMPLICATIONS FOR PRACTICE

There is a need for further research on the role of the nurse in the facilitation of telehealth interventions, specific interventions used and outcomes of such interventions.

Knowledge, perception, and willingness to provide telepharmacy services among pharmacy students: a multicenter cross-sectional study in Indonesia

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic accelerated the provision of telepharmacy services. However, little is known about the knowledge, perception, and willingness of pharmacy students as future key players in telepharmacy adoption to provide such a service, particularly in a setting without well-established telepharmacy services before the COVID-19 pandemic.

OBJECTIVE

With this survey we aimed to assess the level of knowledge, perception, and willingness to provide telepharmacy services and to identify associated factors among pharmacy students in Indonesia.

METHODS

We applied a multicenter cross-sectional study design with convenience sampling technique among pharmacy students in three public universities in Bandung City, Surabaya City, and Special Region of Yogyakarta, Indonesia. The knowledge, perception, and willingness to provide telepharmacy services were assessed using an online questionnaire. Ordinal regression analysis was performed to determine factors associated with a high knowledge level, whereas binary logistic regression analyses were performed to determine factors associated with a positive perception of telepharmacy services. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported.

RESULTS

Among 313 respondents, 83.4% were female, and the mean age was 20 years. Although only 13.2% showed a high knowledge level, 66.5% showed a positive perception of telepharmacy services and 97.4% were willing to provide telepharmacy services in the future. An increase in age (OR 1.33; 95% CI 1.14-1.54) and being advance in smartphone usage (OR 5.21; 95% CI 2.03-13.42) are associated with an increased likelihood of having a high knowledge level about telepharmacy services. Male students had a lower likelihood of having a positive perception of telepharmacy services than females (OR 0.46; 95% CI 0.24-0.85).

CONCLUSION

Despite limited knowledge of telepharmacy, the majority of pharmacy students reported a positive perception and willingness to provide telepharmacy services in their future careers. Therefore, telepharmacy practice models must be included as a subject course in the curriculum, better preparing future pharmacists to perform their roles effectively. Furthermore, student-specific factors such as age and expertise in smartphone usage that associated with knowledge and gender that associated with perception should be considered to facilitate telepharmacy adoption in Indonesia.

Videoconferencing Applications for Training Professionals on Nonverbal Communication in Online Clinical Consultations

OBJECTIVES

The use of videoconferencing technologies for clinician-patient online consultations has become increasingly popular. Training on online communication competence through a videoconferencing application that integrates nonverbal communication detection with feedback is one way to prepare future clinicians to conduct effective online consultations. This case report describes and evaluates two such applications designed for healthcare professionals and students in healthcare-related fields.

METHODS

We conducted a literature review using five databases, including the Web of Science, Scopus, PubMed, ACM, IEEE, and CINAHL in the spring of 2022.

RESULTS

We identified seven studies on two applications, ReflectLive and EQClinic. These studies were conducted by two research groups from the USA and Australia and were published between 2016 and 2020. Both detected nonverbal communication from video and audio and provided computer-generated feedback on users' nonverbal communication. The studies evaluated usability, effectiveness in learning communication skills, and changes in the users' awareness of their nonverbal communication. The developed applications were deemed feasible. However, the feedback given by the applications needs improvement to be more beneficial to the user. The applications were primarily evaluated with medical students, with limited or no attention given to questions regarding ethics, information security, privacy, sustainability, and costs.

CONCLUSIONS

Current research on videoconferencing systems for training online consultation skills is very limited. Future research is needed to develop more user-centered solutions, focusing on a multidisciplinary group of students and professionals, and to explore the implications of these technologies from a broader perspective, including ethics, information security, privacy, sustainability, and costs.

Delivery of telehealth nutrition and physical activity interventions to adults living in rural areas: a scoping review

BACKGROUND

Lifestyle behaviours related to smoking, alcohol, nutrition, and physical activity are leading risk factors for the development of chronic disease. For people in rural areas, access to individualised lifestyle services targeting behaviour change may be improved by using telehealth. However, the scope of literature investigating telehealth lifestyle behaviour change interventions for rural populations is unknown, making it difficult to ascertain whether telehealth interventions require adaptation for rural context via a systematic review. This scoping review aimed to address this gap, by mapping existing literature describing telehealth lifestyle interventions delivered to rural populations to determine if there is scope for systematic review of intervention effectiveness in this research topic.

METHODS

The PRISMA extension for scoping review checklist guided the processes of this scoping review. A search of eight electronic databases reported in English language until June 2023 was conducted. Eligible studies included adults (18 years and over), who lived in rural areas of high-income countries and undertook at least one synchronous (video or phone consultation) telehealth intervention that addressed either addictive (smoking or alcohol), or non-addictive lifestyle behaviours (nutrition or physical activity). Studies targeting addictive and non-addictive behaviours were separated after full text screening to account for the involvement of addictive substances in smoking and alcohol studies that may impact behaviour change interventions described. Studies targeting nutrition and/or physical activity interventions are presented here.

RESULTS

The search strategy identified 17179 citations across eight databases, with 7440 unique citations once duplicates were removed. Full texts for 492 citations were retrieved and screened for inclusion with 85 publications reporting on 73 studies eligible for data extraction and analysis. Of this, addictive behaviours were comprised of 15 publications from 13 studies. Non-addictive behaviours included 70 publications from 58 studies and are reported here. Most interventions were delivered within the United States of America (n = 43, 74.1%). The most common study design reported was Randomised Control Trial (n = 27, 46.6%). Included studies involved synchronous telehealth interventions targeting nutrition (11, 18.9%), physical activity (5, 8.6%) or nutrition and physical activity (41, 70.7%) and were delivered predominately via videoconference (n = 17, 29.3%).

CONCLUSIONS

Despite differences in intervention characteristics, the number of randomised control trials published suggests sufficient scope for future systematic reviews to determine intervention effectiveness related to nutrition and physical activity telehealth interventions for rural populations.

TRIAL REGISTRATION

The scoping review protocol was not pre-registered.

Digital divide or digital exclusion? Do allied health professionals' assumptions drive use of telehealth?

INTRODUCTION

Telehealth use within allied health services currently lacks structure and consistency, ultimately affecting who can, and cannot, access services. This study aimed to investigate the factors influencing allied health professionals' (AHP) selection of consumers and appointments for telehealth.

METHODS

This study was conducted across 16 allied health departments from four Australian hospitals. Semi-structured focus groups were conducted with 58 AHPs. Analysis was underpinned by Qualitative Description methodology with inductive coding guided by Braun and Clarke's thematic analysis approach.

RESULTS

Six themes were identified that influenced AHPs' evaluation of telehealth suitability and selection of consumers. These included the following: (1) ease, efficiency and comfort of telehealth for clinicians; (2) clear benefits of telehealth for the consumer, yet the consumers were not always given the choice; (3) consumers' technology access and ability; (4) establishing and maintaining effective therapeutic relationships via telehealth; (5) delivering clinically appropriate and effective care via telehealth; and (6) external influences on telehealth service provision. A further theme of 'assumption versus reality' was noted to pervade all six themes.

DISCUSSION

Clinicians remain the key decision makers for whether telehealth is offered within allied health services. Ease and efficiency of use is a major driver in AHP's willingness to use telehealth. Assumptions and pre-conceived frames-of-reference often underpin decisions to not offer telehealth and present major barriers to telehealth adoption. The development of evidence-based, decision-support frameworks that engage the consumer and clinician in determining when telehealth is used is required. Services need to actively pursue joint decision-making between the clinician and consumer about service delivery preferences.

Tele-orthodontics education model for orthodontic residents: A preliminary study

OBJECTIVES

Tele-orthodontics is an important medium to use for diagnosis and treatment planning and to refer patients for specific treatment when deemed necessary. The effectiveness of the Tele-orthodontics Education Model serves to improve resident's knowledge, confidence, and skills in delivering tele-orthodontic patient care. The purpose of this educational single-arm pre-test-post-test interventional study was to assess and educate orthodontic residents (6 year-one, and 6 year-two) to appropriately use tele-orthodontics.

METHODS

The Tele-orthodontics Education Model utilizes three learning modules, a questionnaire before and after the training to assess participant knowledge, confidence and skills levels, three online multiple-choice questionnaires, three explanatory videos and an in-person simulation session. The Blackboard Learning Management System (virtual learning platform) facilitates access to the various modules of the program. Within each learning module, a participant's knowledge level was determined by utilizing five multiple-choice questions before and after each module. The various modules were introduced to the participants and then evaluated by reviewing the participant's responses to the multiple-choice questions.

RESULTS

Twelve orthodontic residents completed the model in one session. Everyone fully completed the questionnaire. Post-test results showed higher mean scores for all questions addresses knowledge, the mean confidence, and skills score for post-test showed no change when compared to pre-test.

CONCLUSIONS

This education model was effective in improving basic knowledge in tele-orthodontics among first, and second-year orthodontic residents. We hypothesize that the residents are more informed and prepared for future tele-orthodontic practices.

Digital Health Training, Attitudes and Intentions to Use It among Romanian Medical Students: A Study Performed during COVID-19 Pandemic

INTRODUCTION

This study focuses on medical students from the University of Medicine and Pharmacy in Cluj-Napoca, Romania, and has three objectives. First, it evaluates the opinions of medical students regarding their previous training as well as their needs for future training in the field of digital health. Second, it assesses their attitudes regarding digital health and their intention to use digital tools as physicians. Lastly, the interrelationship between these issues as well as the socio-demographic factors which influence them are investigated.

MATERIALS AND METHODS

A cross-sectional survey was performed during June-August 2021 among fifth and sixth year students of the Faculty of Medicine from the Iuliu Hațieganu University of Medicine and Pharmacy in Cluj-Napoca, Romania. Anonymous online questionnaires were used which were filled in by 306 students.

RESULTS

Less than half of the participating students declared that they benefited from training or different practical examples during medical education regarding the use of digital tools in different medical areas, while the majority said that they would like to receive more training in the field of digital health. A total of 58.2% said that they totally agree with the introduction of a formal training in the medical curricula regarding digital health. Many students declared positive attitudes toward the use of digital tools in different domains within the medical field and intention to use digital tools as physicians; several differences were noted, including gender, year of study, type of domain, and previous training with regard to the use of digital tools in those domains. Moreover, the need for future training and the desire for the introduction of a formal training program into the medical curricula with regard to this field were stronger among those with more positive attitudes and higher intentions to use digital tools in their medical activity.

CONCLUSIONS

To the best of our knowledge, this is the first study from Romania which investigated the training, attitudes, and intentions regarding the use of digital health among Romanian medical students, and offers valuable information to guide the education of medical students.

Self-reported perceptions and knowledge of telemedicine in medical students and professionals who enrolled in an online course in Peru

BACKGROUND

Telemedicine has become more relevant during the COVID-19 pandemic. However, medical students and professionals do not acquire competences in telemedicine during their training. Our objective was to describe the self-reported perception and baseline knowledge of telemedicine among medical students and professionals enrolled in a virtual course.

METHODS

Cross-sectional study that included physicians or medical students aged 18 years or older who were interested in a free virtual telemedicine course and who completed the data collection questionnaire. We used a Likert scale to assess the self-reported perceptions of four domains related to telemedicine. The participants were grouped into three levels for each domain: low, medium and high. We also objectively assessed telemedicine knowledge by means of 10 questions, with a cut-off point of 50% of correct answers. The Fisher's exact test, the Chi-square test, and the Mann-Whitney U test were used for the comparison of categorical data. A p-value < 0.05 was considered statistically significant.

RESULTS

We included 161 participants: 118 medical students and 43 physicians. We observed no significant differences between medical students and physicians in self-reported perceptions of knowledge, security, or utility of telemedicine. However, students had a high self-reported perception of the disadvantages of telemedicine especially related to patient security (p = 0.018), efficiency of care (p = 0.040), and the possibility of medical malpractice (p = 0.010) compared to physicians. Nearly half of the students (n = 53,44.9%) and physicians (n = 22,51.7%) answered 50% or more of the questions related to telemedicine knowledge correctly.

CONCLUSION

Among the physicians and medical students enrolled in the course, the students perceived the disadvantages of telemedicine more frequently. Although physicians and students have limited knowledge of telemedicine, there appears to be no influence of experience and prior training in telemedicine.

Artificial intelligence education for radiographers, an evaluation of a UK postgraduate educational intervention using participatory action research: a pilot study

BACKGROUND

Artificial intelligence (AI)-enabled applications are increasingly being used in providing healthcare services, such as medical imaging support. Sufficient and appropriate education for medical imaging professionals is required for successful AI adoption. Although, currently, there are AI training programmes for radiologists, formal AI education for radiographers is lacking. Therefore, this study aimed to evaluate and discuss a postgraduate-level module on AI developed in the UK for radiographers.

METHODOLOGY

A participatory action research methodology was applied, with participants recruited from the first cohort of students enrolled in this module and faculty members. Data were collected using online, semi-structured, individual interviews and focus group discussions. Textual data were processed using data-driven thematic analysis.

RESULTS

Seven students and six faculty members participated in this evaluation. Results can be summarised in the following four themes: a. participants' professional and educational backgrounds influenced their experiences, b. participants found the learning experience meaningful concerning module design, organisation, and pedagogical approaches, c. some module design and delivery aspects were identified as barriers to learning, and d. participants suggested how the ideal AI course could look like based on their experiences.

CONCLUSIONS

The findings of our work show that an AI module can assist educators/academics in developing similar AI education provisions for radiographers and other medical imaging and radiation sciences professionals. A blended learning delivery format, combined with customisable and contextualised content, using an interprofessional faculty approach is recommended for future similar courses.

Impact of the Fourth Industrial Revolution on clinical pharmaceutical services: A scoping review

BACKGROUND

Digital technologies are becoming increasingly sophisticated and integrated, but the scope of the Fourth Industrial Revolution (4IR) is wider: technologies and innovations are diffusing faster and more widely. Despite the extensive use of telepharmacy technology by patients and pharmacists, there is an absence of research that examines the use of telepharmacy.

OBJECTIVE

To investigate the current evidence concerning the impact of the 4IR on the provision of pharmaceutical services.

METHODS

A scoping review based on the PCC (Population, Concept, and Context) mnemonic was conducted in Pubmed, Scopus and Web of Science. Population included pharmacist/clinical pharmaceutical services, the concept referred to the 4IR and the context was open. Electronic searches retrieved 8,694 articles that were screened by titles and abstracts. The search yielded 59 studies that were analyzed in terms of country of focus, publication year, type of publication, main technologies, types of pharmacy services, and the role of the Fourth Industrial Revolution.

RESULTS

Most of the included studies were conducted in the United States and were published between 2005 and 2021, with the highest number of publications in the year of 2021. The majority of included articles were observational studies. Technologies addressed in the studies were those within the scope of telepharmacy, and most of the articles discussed more than one pharmaceutical service, with medication therapy management as the most frequent.

CONCLUSIONS

The Covid-19 pandemic accelerated the use of technologies, identifying promising niches for pharmacists in the field of Pharmaceutical Care. This should encourage pharmacists to fortify their capacity to adopt new technologies in the provision of pharmaceutical services. The frequent use of various technologies has been demonstrated, which indicates the exigency for further health education actions by the pharmacist.

The state of the art in telerehabilitation for musculoskeletal conditions

BACKGROUND

Given the rapid advances in communication technology and the need that emerged from the COVID-19 pandemic, telehealth initiatives have been widely used worldwide. This masterclass aims to provide an overview of telerehabilitation for musculoskeletal conditions, synthesizing the different terminologies used to describe telehealth and telerehabilitation, its effectiveness and how to use it in clinical practice, barriers and facilitators for the implementation in health services, and discuss the need of a curriculum education for the near future.

MAIN BODY

Telerehabilitation refers to the use of information and communication technologies provided by any healthcare professionals for rehabilitation services. Telerehabilitation is a safe and effective option in the management of musculoskeletal conditions in different models of delivery. There are many technologies, with different costs and benefits, synchronous and asynchronous, that can be used for telerehabilitation: telephone, email, mobile health, messaging, web-based systems and videoconferences applications. To ensure a better practice of telerehabilitation, the clinician should certify safety and access, and appropriateness of environment, communication, technology, assessment, and therapeutic prescription. Despite the positive effect of telerehabilitation in musculoskeletal disorders, a suboptimal telerehabilitation implementation may have happened due to the COVID-19 pandemic, especially in countries where telehealth was not a reality, and clinicians lacked training and guidance. This emphasizes the need to identify the necessary curriculum content to guide future clinicians in their skills and knowledge for telerehabilitation. There are some challenges and barriers that must be carefully accounted for to contribute to a health service that is inclusive and relevant to health professionals and end users.

CONCLUSIONS

Telerehabilitation can promote patient engagement in health care and plays an important role in improving health outcomes in patients with musculoskeletal conditions. Digital health technologies can also offer new opportunities to educate patients and facilitate the process of behavior change to a healthy lifestyle. Currently, the main needs in telerehabilitation are the inclusion of it in health curriculums in higher education and the development of cost-effectiveness and implementation trials, especially in low- and middle-income countries where access, investments and digital health literacy are limited.

How to incorporate telemedicine in medical residency: A Brazilian experience in pediatric emergency

INTRODUCTION

The exponential growth of telehealth services during the COVID-19 pandemic led to the implementation of a telemedicine care service in a tertiary university pediatric hospital. It brought the need to develop a training aimed at remote care within the pediatric emergency rotation program.

OBJECTIVE

To describe the implementation of a telemedicine training for pediatric residents and present the preliminary results.

METHODS

Descriptive prospective study (pre and post), with 40 resident physicians of the first year of pediatrics. Reaction Assessments were applied before and after training, in addition to a resident physician perception questionnaire at the end of the training.

RESULTS

There was a significant difference in the resident's perception of experience and safety after initial training. Most rated the proposal as good or excellent, considered teaching telemedicine relevant and that this experience contributed to their learning on the subject.

CONCLUSION

This study describes an innovative proposal for training in telemedicine. The preliminary results were encouraging, demonstrating the program's potential in training future pediatricians.

Training for virtual care: What do the experts think?

Introduction

Virtual care has expanded during COVID-19 and enabled continued access to healthcare services. As with the introduction of any new technology in healthcare delivery, the preparation of healthcare providers for adopting and using such systems is imperative. The purpose of this qualitative study was to explore experts' ascribed opinions on healthcare providers' continuing professional development (CPD) needs in virtual care.

Methods

Semistructured interviews were conducted with a purposive sample of key informants representing Canadian provincial and national organizations with expertise in virtual care delivery.

Results

Three main areas of knowledge, skills, and abilities that would be most helpful for healthcare providers in preparing to adopt and use virtual care were identified. The use of technology necessitates knowledge of how to integrate technology and virtual care in the practice workflow. This includes knowing how to use the technology and the privacy and security of the technology. Providers need to be able to adapt their clinical skills to virtual care and build rapport through good communication with patients. Virtual care is not appropriate for all visits, therefore providers need to understand when an in-person visit is necessary with respect to the nature of the appointment, as well as contextual factors for individual patients. Finally, providers need to adapt their examination skills to virtual care.

Discussion

Beyond the COVID-19 pandemic, virtual care will have a continuing role in enhancing continuity of care through access that is more convenient. Key informants identified barriers and challenges in adopting and using virtual care effectively, fundamental knowledge, skills and/or abilities required, and important topics and/or educational experiences to guide CPD program development on virtual care for healthcare providers.

Staff perspectives on the key elements to successful rapid uptake of telerehabilitation in medium-sized public hospital physiotherapy departments

BACKGROUND AND PURPOSE

During the COVID-19 pandemic, hospital physiotherapy departments transitioned to telerehabilitation to ensure continuity of care for patients. The purpose of this study is to determine the key elements to successful, rapid uptake of telerehabilitation in medium-sized public hospital physiotherapy departments in response to COVID-19.

METHODS

This study used a qualitative design. Physiotherapists who delivered telerehabilitation consultations during the COVID-19 restriction period in two Brisbane public hospital physiotherapy departments were eligible to participate in semi-structured interviews. Data were analysed thematically.

RESULTS

Twenty-five physiotherapists (22-60 years of age; 68% female) with 1-40 years of clinical experience provided insights into their perceptions of the rapid uptake of telerehabilitation in the provision of clinical care. Physiotherapists worked across musculoskeletal outpatient (72%), inpatient, community, paediatrics and pelvic health departments. Qualitative analyses in relation to the physiotherapist perceptions of the key elements of rapid transition to telerehabilitation, revealed four key themes underpinning success: (1) 'it requires a whole team approach', (2) 'technology issues will be encountered and can be overcome', (3) 'optimise the situation while understanding the differences' and (4) 'modifying your approach doesn't imply inferior quality of care'.

CONCLUSION

Rapid implementation of telerehabilitation in a hospital setting is possible, and is facilitated by organisational, administrative and management support, willingness of physiotherapists to adopt, shared learning experience, quality software and connection, availability of equipment and space and optimised systems and processes. Key factors facilitating successful telerehabilitation consultations include effective communication, demonstration, involving a third party to help, and clients who are well prepared and willing to engage.

Designing and Implementing TeleBehavioral Health Training to Support Rapid and Enduring Transition to Virtual Care in the COVID Era

As telebehavioral health continues to advance and become part of routine care, there is a need to develop effective training methods. While a consensus on how to best train telebehavioral health has not yet been achieved, this commentary will describe how evidence-based implementation strategies were used to develop a framework to create and implement a telebehavioral health training program that is relevant and enduring for a given audience. Evidence-based implementation strategies included the PARiHS criteria which were used to organize the project. Re-AIM criteria was used to organize chosen outcome measures. Important partnerships were formed to help support infrastructure as well as regional and national reach. A series of Plan-Do-Study-Act loops were used to inform progressive training series. Since April 2020, the Behavioral Health Institute has developed and offered 6 unique telebehavioral health training series, employing both webinar and online formats, and addressing core components as well as more advanced concepts. These series have provided over 19,100 accredited continuing education hours of training through June 2022, to almost 3000 unique learners via webinar and nearly 6800 unique online learners, across 45 states. Evaluations rated these trainings as high quality, relevant, and that material would likely be implemented. Feedback from attendees was considered vital in series planning. This commentary discusses how evidence-based implementation strategies can be used to create a framework upon which to base a training program for health care providers. An example is given on how this framework was used to create successful, relevant, and enduring telebehavioral health training.

Telehealth education and training in entry-to-practice physiotherapy programs in Australian universities: A qualitative study with university educators

BACKGROUND

To explore attitudes to telehealth education and experiences incorporating telehealth education into entry-to-practice physiotherapy programs in Australia, from the perspective of university educators.

METHODS

Qualitative design based on a constructivist paradigm and a phenomenological approach. Sixteen university educators (who had a responsibility for telehealth curriculum or oversight of the broader curriculum in an entry-to-practice physiotherapy programme at an Australian university) were recruited. Individual semi-structured interviews were conducted via Zoom. Interviews were recorded, transcribed verbatim, and analysed thematically using an inductive approach.

RESULTS

Three themes (with associated subthemes) were identified: (i) telehealth education has a role in contemporary physiotherapy practice (COVID-19 pandemic was a driver for telehealth education, acknowledgement that telehealth is here to stay and identified areas of focus for telehealth education and training); (ii) telehealth education and training vary substantially (content delivered and assessment of telehealth competency is ad hoc and student exposure to telehealth on clinical placements is inconsistent); (iii) challenges in telehealth education (finding space and time in the curriculum, as well as insufficient knowledge and expertise of staff, are challenges for implementation of telehealth education, however, course and subject development and/or reviews provide opportunities for implementing telehealth education and training).

CONCLUSION

Current content and volume of telehealth education and training in entry-to-practice physiotherapy programs across Australia varies substantially. Although educators believe telehealth is an important component of contemporary physiotherapy practice, many barriers exist for including telehealth training into the curriculum.

Prioritising enhancements across allied health telehealth services in a metropolitan hospital: Using a concept mapping approach

Introduction

A prior study examining perceptions of Allied Health Professions (AHP) telehealth services at a metropolitan hospital highlighted multiple issues impacting service uptake, operationalisation, and delivery. Concept mapping methodology was utilised to address these issues and prioritise actionable telehealth service improvements.

Methods

Representatives ( n = 22) from seven AHP departments and consumers generated statements addressing the question: ‘What do we need to do to enhance and sustain telehealth services?’ Statements were synthesised and then clinicians and managers sorted them into similar groups and assigned each statement a ranking of perceived (a) importance and (b) changeability. Multivariate and multidimensional scaling was undertaken to develop a final prioritised set of goals for change.

Results

Ninety-six unique statements were generated as actionable goals for change. Statements were grouped into 13 clusters relating to improvements in staff support, infrastructure, consumer support and organisational processes. All clusters were rated >50% for importance (range 3.3–2.4 out of 4) and changeability (range 2.6–2.1 out of 4). Twenty-six statements were ranked highest for importance and changeability. Key prioritised areas were staff training, consumer advocacy and engagement, telehealth operations and workflow.

Conclusion

Concept mapping was an effective process for generating a prioritised list of actions to enhance AHP telehealth services.

Assessment of Primary Care Physicians' Perception of Telemedicine Use During the COVID-19 Pandemic in Primary Health Care Corporation, Qatar

While telemedicine has been extensively researched throughout the globe, the Middle East has seen relatively little research on the topic. The purpose of this study was to investigate the primary care physicians' perceptions of the use of telemedicine, as well as its hurdles and benefits, during the COVID-19 pandemic in the state of Qatar. In this multicenter cross-sectional study, an internally validated questionnaire was distributed among primary care physicians utilizing telemedicine during the pandemic at Primary Health Care Corporation (PHCC), the main primary care provider in Qatar. A convenience sample was taken due to the pandemic restrictions. Out of 254 analyzed questionnaires, about half of the physicians (48%) had used telemedicine in the past primarily in the form of telephone consultations. Nearly three-quarters (74%) of physicians agreed that telemedicine is an easy way to communicate during the pandemic, but only half (52%) felt it improved job performance and effectiveness. Most physicians (90%) agreed that telemedicine is safe during the pandemic, but opinion was split on whether an optimum assessment of COVID-19 disease could be conducted. The majority also considered telemedicine an effective tool for chronic disease reviews (63%) and other consultations such as blood test results and medicine prescriptions (71%). The most significant barrier to telemedicine use was a language barrier followed by a lack of proper training. About 79% of responders felt that telemedicine improves access to healthcare and assists in contacting difficult-to-reach individuals, and 74% also thought it minimizes no-shows in the clinics. Our study has shown that most physicians felt comfortable and safer using telemedicine as an alternative means to conduct consultations during the pandemic. Keeping in view its advantages, the majority suggested that it could be incorporated into daily practice even beyond the pandemic. However, concerns were raised about its use to assess COVID-19 disease, lack of training, and potential barriers such as language differences. Further studies are needed to assess the efficiency and cost-effectiveness of telemedicine as well as the evaluation of alternative media such as video consultation, which could increase the utility of telemedicine and potentially mitigate some of its disadvantages.

Adoption of telehealth technologies: an approach to improving healthcare system

BACKGROUND

Globally, the healthcare industry is well known to be one of the strongest drivers of economic growth and development. The sector has gained substantial attention to deal with the fallout of COVID-19, leading to improvement in the quality observed in developed and developing nations. With the advent of the twenty-first century, globalization an ever-growing populace, and environmental changes prompted the more noteworthy spread of irresistible diseases, highlighting the association between wellbeing and future health security. The massive spread of COVID-19 paralyzed the global economy and took a toll on health governance and wellbeing. The present review aims to map the harrowing impacts of COVID-19 on the QoL (quality of life) observed. Particularly the post-pandemic era is likely to boot-strap the healthcare sector. Hence in post COVID era, there is a dire need to strengthen the healthcare system and understand the evolving challenges to answer calls in recovery in the wake of COVID-19.

CONCLUSION

There is a flurry of research highlighting the implications faced due to the rise of the pandemic, resulting in the wrecking growth and development. However, the massive potential of telehealth is still largely underexplored with scarce research on countless evolving technologies. The current crisis highlighted the need to develop emerging frameworks and facilitate multilateral cooperation. The present research can serve as the baseline for better future strategies to improve global health initiatives. Further, this can help to focus on wider health determinants, redesign strategies and policies for the healthcare industry and to mitigate/deal better with future pandemics.

Assessment of communication skills using telehealth: considerations for educators

Objective

The main aim of this study was to explore the views and perceptions of dietetic educators on their ability to assess communication skills of undergraduate student dietitians in a telehealth setting. A secondary aim was to provide recommendations to educators when assessing these skills using telehealth.

Methods

A descriptive qualitative study design was used. Australian and New-Zealand dietetic educators used a validated global communication rating scale to evaluate three pre-recorded telehealth encounters. Educators then answered a series of open-ended questions on their ability to assessed communication skills in the telehealth environment.

Analysis

Inductive analysis allowed the emergence of themes and sub-themes independent of a specific framework or theory. Peer debriefing and triangulation increased research rigor.

Results

Twenty-four educators were included in this study with the majority (87.5%) having > 10 years experience as a dietetic educator, and 41.6% (n = 10) with experience in assessing dietetics student using telehealth. Most (76%) educators reported the assessment of non-verbal communication skills were challenging in the telehealth environment. Five themes and 15 subthemes emerged relating to advice for students and educators when assessing communication skills and a checklist was developed from recommendations that students and educators can use when preparing, planning, implementing, and assessing telehealth consultations.

Conclusion

Assessing student communication skills via telehealth provides a useful opportunity with the growing use of the online environment, however, it also presents challenges that must be taken into consideration. While verbal communication skills are easier to assess than non-verbal, both need to be adapted for the telehealth setting.

Interprofessional Education and Older Adults in the Shared Virtual Classroom: Lessons Learned During the COVID-19 Pandemic

The current article provides an overview of an interprofessional service-learning course that became virtual in the setting of the coronavirus disease 2019 pandemic. Telehealth video technologies were used to build an intergenerational, virtual classroom and increase engagement of older adults with interdisciplinary health professional students. The virtual classroom involved group health education sessions, individualized Medicare wellness visits, and a clinical huddle. The course addressed the public health need for reliable health information during the early days of the pandemic, social connection, and meeting the educational goals for health care students and older adults in a novel virtual setting. Lessons learned for the interdisciplinary team and for engaging older adults included the need for preparation reading, team building exercises, training videos, and telehealth competency checklists. Beyond the pandemic, adoption of virtual methods enables hybrid approaches to interprofessional education and builds competencies for delivery of telehealth and computer-based visits in professional practice settings. [Journal of Gerontological Nursing, 48(8), 52-56.].

The impact of a didactic and experiential learning model on health profession students' knowledge, perceptions, and confidence in the use of telehealth

BACKGROUND

Training of health profession students in telehealth is important to ensure proper implementation for healthcare delivery. This prospective study aimed to analyze the effects of didactic and experiential learning on knowledge, confidence, and attitudes of telehealth among health profession students (Survey 1). The perceptions of a mixed model telehealth platform were also considered among these students and community clients (Survey 2).

MATERIALS AND METHODS

A quasi-experimental repeated-measure study was conducted on 153 university health profession students in physician assistant, physical therapy, occupational therapy, and nursing (NR) across the 2020-2021 academic year. Survey 1 was administered to students pre/postdidactic telehealth training and at two sequential points within two semesters of telehealth experiential learning. Survey 2 was distributed among students and a pool of 19 community clients at 4 time points across the experience. Survey data were analyzed using R software.

RESULTS

There was a significant improvement in telehealth knowledge, confidence, and attitudes among all student disciplines after the didactic module with marginal means ranging 3.313/5-4.318/5 for pretest to posttest 1. Improvement continued through experiential learning with marginal means ranging 4.170/5-4.369/5 in posttest 3. There was also a significant student and client approval of the telehealth platform with a student mean high of 3.962/5 ± 0.527 and client mean high of 4.727/5 ± 0.238.

CONCLUSION

A didactic training module combined with experiential learning is effective for health profession students' improvement in perception, knowledge, and attitudes toward telehealth. Health profession students and community clients approve a mixed model telehealth platform.

Teleconsultation in health and social care professions education: A systematic review

Introduction

Teleconsultation education in health care and social work education is under‐reported. However, literature indicates that educating the workforce in teleconsultation skills is essential to continue with safe, high‐quality delivery of services and increases the likelihood of implementing teleconsultations in health care. Training for students should, therefore, be encouraged. This systematic literature review aims to investigate global experiences of teleconsultation training in undergraduate health care and social work education.

Methods

A systematic review of peer‐reviewed literature was undertaken. The review was guided by the Joanna Briggs Institute guidelines. Electronic databases were searched for eligible evidence. Studies were included only if they described and evaluated teleconsultation education for undergraduate health care and social work students.

Results/Discussion

This review shows that mandatory education in teleconsultation is limited in undergraduate health care and social work education. Narrative synthesis and analysis of 14 studies led to the development of two themes: pedagogical aspects, and perspectives on telecommunication and teleconsultation learning and teaching. Practical experiences with simulated patients or during clinical placements with real patients were the most common mode of delivery. Feedback on teleconsultation education was generally positive; overall, health care students felt more confident using teleconsultation and valued safety of learning through simulation.

Conclusion

Teleconsultation education is a legitimate way to expose students to telehealth. High satisfaction rates, increased knowledge and confidence in use indicate the positive impact this learning has on students. Nevertheless, further high‐quality research and guidance for educators are warranted.

Training Intervention and Program of Support (TIPS) for fostering adoption of family-centred telehealth in pediatric rehabilitation: Protocol for a multi-method, prospective hybrid type 3 implementation-effectiveness study (Preprint)

Background

Children with disability face long wait times for rehabilitation services. Before the COVID-19 pandemic, telehealth adoption was low across pediatric rehabilitation. Owing to the COVID-19 pandemic restrictions, pediatric therapists were asked to rapidly shift to telehealth, often with minimal training. To facilitate the behavior changes necessary for telehealth adoption, provision of appropriate evidence-based training and support is required. However, evidence to support the effective implementation of such training is lacking. The successful real-world implementation of a training intervention and program of support (TIPS) targeting pediatric therapists to enhance the adoption of family-centered telerehabilitation (FCT) requires the evaluation of both implementation and effectiveness.

Objective

This study aimed to evaluate TIPS implementation in different pediatric rehabilitation settings and assess TIPS effectiveness, as it relates to therapists’ adoption, service wait times, families’ perception of service quality, and costs.

Methods

This 4-year, pan-Canadian study involves managers, pediatric occupational therapists, physiotherapists, speech-language pathologists, and families from 20 sites in 8 provincial jurisdictions. It will use a multimethod, prospective, hybrid type 3 implementation-effectiveness design. An interrupted time series will assess TIPS implementation. TIPS will comprise a 1-month training intervention with self-paced learning modules and a webinar, followed by an 11-month support program, including monthly site meetings and access to a virtual community of practice. Longitudinal mixed modeling will be used to analyze indicators of therapists’ adoption of and fidelity to FCT collected at 10 time points. To identify barriers and facilitators to adoption and fidelity, qualitative data will be collected during implementation and analyzed using a deductive-inductive thematic approach. To evaluate effectiveness, a quasi-experimental pretest-posttest design will use questionnaires to evaluate TIPS effectiveness at service, therapist, and family levels. Generalized linear mixed effects models will be used in data analysis. Manager, therapist, and family interviews will be conducted after implementation and analyzed using reflective thematic analysis. Finally, cost data will be gathered to calculate public system and societal costs.

Results

Ethics approval has been obtained from 2 jurisdictions (February 2022 and July 2022); approval is pending in the others. In total, 20 sites have been recruited, and data collection is anticipated to start in September 2022 and is projected to be completed by September 2024. Data analysis will occur concurrently with data collection, with results disseminated throughout the study period.

Conclusions

This study will generate knowledge about the effectiveness of TIPS targeting pediatric therapists to enhance FCT adoption in pediatric rehabilitation settings, identify facilitators for and barriers to adoption, and document the impact of telehealth adoption on therapists, services, and families. The study knowledge gained will refine the training intervention, enhance intervention uptake, and support the integration of telehealth as a consistent pediatric rehabilitation service option for families of children with disabilities.

Trial Registration

ClinicalTrials.gov NCT05312827; https://clinicaltrials.gov/ct2/show/NCT05312827

International Registered Report Identifier (IRRID)

PRR1-10.2196/40218

Managing innovation: a qualitative study on the implementation of telehealth services in rural emergency departments

BACKGROUND

Telehealth studies have highlighted the positive benefits of having the service in rural areas. However, there is evidence of limited adoption and utilization. Our objective was to evaluate this gap by exploring U.S. healthcare systems' experience in implementing telehealth services in rural hospital emergency departments (TeleED) and by analyzing factors influencing its implementation and sustainability.

METHODS

We conducted semi-structured interviews with 18 key informants from six U.S. healthcare systems (hub sites) that provided TeleED services to 65 rural emergency departments (spoke sites). All used synchronous high-definition video to provide the service. We applied an inductive qualitative analysis approach to identify relevant quotes and themes related to TeleED service uptake facilitators and barriers.

RESULTS

We identified three stages of implementation: 1) the start-up stage; 2) the utilization stage; and 3) the sustainment stage. At each stage, we identified emerging factors that can facilitate or impede the process. We categorized these factors into eight domains: 1) strategies; 2) capability; 3) relationships; 4) financials; 5) protocols; 6) environment; 7) service characteristics; and 8) accountability.

CONCLUSIONS

The implementation of healthcare innovation can be influenced by multiple factors. Our study contributes to the field by highlighting key factors and domains that play roles in specific stages of telehealth operation in rural hospitals. By appreciating and responding to these domains, healthcare systems may achieve more predictable and favorable implementation outcomes. Moreover, we recommend strategies to motivate the diffusion of promising innovations such as telehealth.

Pediatric Assessments for Preschool Children in Digital Physical Therapy Practice: Results From a Scoping Review

PURPOSE

To examine and map the extent and scope of pediatric physical therapy assessments previously used in the digital context.

METHODS

A 6-step evidence-based scoping methodological framework was used. Articles containing assessments conducted by a physical therapist using technology to assess a child aged 0 to 5 years were included and synthesized using descriptive statistics and thematic analysis.

RESULTS

Eighteen studies identifying 25 assessments were eligible. Asynchronous observational developmental instruments administered in the child's natural environment to those at risk or presenting with neurodevelopmental conditions were the most common. There is a need for detailed procedures and training for caregivers and clinicians.

CONCLUSION

Limited research exists on the use of pediatric physical therapy assessments for young children with musculoskeletal and cardiorespiratory conditions in a digital context. The development of new instruments or modifications of existing ones should be considered and be accompanied by detailed administration protocols and user guides.

Curriculum Interventions and Pedagogical Approaches for Virtual Care Delivery: A Scoping Review

The onset of the COVID-19 pandemic has accelerated the adoption of virtual care as a modality for home-based care delivery to individuals and cohorts who might not otherwise have access. While a number of positive outcomes have been reported, rapid growth has occurred without critical consideration of clinician education and training. Little is known about the curricular and pedagogical requirements for educating current and future clinicians in virtual care provision. This review was informed by Arksey and O’Malley’s five-stage methodological framework for scoping reviews, first published in 2005. Using a clearly articulated search strategy and reporting process, over 4000 pieces of literature were analysed to inform this review. A final 17 papers were included. Common themes emerging in relation to curricula content include the basics of virtual care, cultural awareness, interprofessional collaboration/training, telepresence, encompassing non-verbal, verbal and environmental considerations, and virtual care clinical skills. Standalone modules are recommended for delivering ‘the basics’ of virtual care, while the interactive/participative approach is endorsed as an appropriate method of instruction. The reviewed literature reviewed offers a set of core inclusions and pedagogical approaches for a virtual care education program, although these are often mentioned in general terms and are not always well described. Moving beyond the COVID-19 pandemic, virtual care education for current and future clinicians requires a consistent and cohesive approach to curricula and pedagogies. These approaches should be rigorously evaluated as part of a continuous quality improvement process.

Remote Consulting in Primary Health Care in Low- and Middle-Income Countries: Feasibility Study of an Online Training Program to Support Care Delivery During the COVID-19 Pandemic

Background

Despite acceleration of remote consulting throughout the COVID-19 pandemic, many health care professionals are practicing without training to offer teleconsultation to their patients. This is especially challenging in resource-poor countries, where the telephone has not previously been widely used for health care.

Objective

As the COVID-19 pandemic dawned, we designed a modular online training program for REmote Consulting in primary Health care (REaCH). To optimize upscaling of knowledge and skills, we employed a train-the-trainer approach, training health workers (tier 1) to cascade the training to others (tier 2) in their locality. We aimed to determine whether REaCH training was acceptable and feasible to health workers in rural Tanzania to support their health care delivery during the pandemic.

Methods

We developed and pretested the REaCH training program in July 2020 and created 8 key modules. The program was then taught remotely via Moodle and WhatsApp (Meta Platforms) to 12 tier 1 trainees and cascaded to 63 tier 2 trainees working in Tanzania’s rural Ulanga District (August-September 2020). We evaluated the program using a survey (informed by Kirkpatrick's model of evaluation) to capture trainee satisfaction with REaCH, the knowledge gained, and perceived behavior change; qualitative interviews to explore training experiences and views of remote consulting; and documentary analysis of emails, WhatsApp texts, and training reports generated through the program. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed thematically. Findings were triangulated and integrated during interpretation.

Results

Of the 12 tier 1 trainees enrolled in the program, all completed the training; however, 2 (17%) encountered internet difficulties and failed to complete the evaluation. In addition, 1 (8%) opted out of the cascading process. Of the 63 tier 2 trainees, 61 (97%) completed the cascaded training. Of the 10 (83%) tier 1 trainees who completed the survey, 9 (90%) would recommend the program to others, reported receiving relevant skills and applying their learning to their daily work, demonstrating satisfaction, learning, and perceived behavior change. In qualitative interviews, tier 1 and 2 trainees identified several barriers to implementation of remote consulting, including lacking digital infrastructure, few resources, inflexible billing and record-keeping systems, and limited community awareness. The costs of data or airtime emerged as the greatest immediate barrier to supporting both the upscaling of REaCH training and subsequently the delivery of safe and trustworthy remote health care.

Conclusions

The REaCH training program is feasible, acceptable, and effective in changing trainees’ behavior. However, government and organizational support is required to facilitate the expansion of the program and remote consulting in Tanzania and other low-resource settings.

Telerehabilitation Readiness, Knowledge, and Acceptance of Future Physiatrists in the Philippines: An Online Survey During the COVID-19 Pandemic

Background

Clinical, educational, and research interest in telerehabilitation has not been widely explored until the COVID-19 pandemic. Amid the enduring pandemic, telerehabilitation remains part of the daily service, academic, and research responsibilities of residents in various training institutions worldwide.

Objective

To determine the Rehabilitation Medicine residents' current levels of telerehabilitation readiness, knowledge, and acceptance, their pattern of beliefs about telerehabilitation, and the factors affecting their readiness.

Methods

All bona fide residents from all training institutions in the Philippines were invited to participate in an online survey evaluating the following constructs: technological readiness (using the Technological Readiness Index or TRI 2.0); telerehabilitation knowledge (using an original multiple-choice examination); and telerehabilitation acceptance (using the Unified Theory of Acceptance and Use of Technology questionnaire). A pre-test and pilot test were conducted. The TRI responses were classified according to technology adoption segments to determine the respondents' pattern of beliefs about telerehabilitation.

Results

Sixty-two residents participated (86.1% response rate). They had good telerehabilitation readiness (3.3 ± 0.4 out of 5), fair telerehabilitation knowledge (2.1 ± 1.1 out of 5), and excellent telerehabilitation acceptance (4.5 ± 0.6 out of 5). The majority were classified either as telerehabilitation skeptics (38.7%), pioneers (19.4%), or explorers (19.4%). The factors that significantly influenced telerehabilitation readiness were optimism, innovativeness, discomfort, and insecurity (p < 0.05).

Conclusion

Despite having favorable levels of telerehabilitation readiness and acceptance, the Rehabilitation Medicine residents showed fair telerehabilitation knowledge. Our results suggest the need for formal education and training on virtual rehabilitation care during residency.

Implementation of telehealth during COVID-19: Implications for providing behavioral health services to pediatric patients

The coronavirus pandemic and in-person contact restrictions necessitated rapid implementation of telehealth, specifically videoconferencing, to provide essential care to patients. This study surveyed 25 pediatric behavioral health providers at a single center during their first month of utilizing telehealth during coronavirus disease 2019 (COVID-19). Twenty-one participants completed a pre-questionnaire distributed prior to telehealth service delivery, and 23 providers completed a post-questionnaire approximately three weeks later. Results indicate the majority of behavioral health providers had no experience providing telehealth services prior to COVID-19. The majority of participating behavioral health providers utilized telehealth to provide pediatric patient care within the first month of access to telehealth. Participants' confidence in their ability to provide telehealth services significantly increased within the first month of implementation, regardless of previous training in telehealth. This study identified differences between anticipated and actual barriers to treatment, with technological issues identified as the largest actual barrier to service delivery. Participants indicated a preference for in-person service delivery, which they reported allows for better rapport-building, behavioral observations, reduced technological barriers, and fewer distractions. However, most participants reported they intend to continue utilizing telehealth for certain types of behavioral health services (e.g., diagnostic interviews and outpatient therapy) after the pandemic has subsided.