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Cecchi R, Haja TM, Calabrò F, Fasterholdt I, Rasmussen BSB. Artificial intelligence in healthcare: why not apply the medico-legal method starting with the Collingridge dilemma? Int J Legal Med 2024; 138:1173-1178. [PMID: 38172326 DOI: 10.1007/s00414-023-03152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
Technology has greatly influenced and radically changed human life, from communication to creativity and from productivity to entertainment. The authors, starting from considerations concerning the implementation of new technologies with a strong impact on people's everyday lives, take up Collingridge's dilemma and relate it to the application of AI in healthcare. Collingridge's dilemma is an ethical and epistemological problem concerning the relationship between technology and society which involves two approaches. The proactive approach and socio-technological experimentation taken into account in the dilemma are discussed, the former taking health technology assessment (HTA) processes as a reference and the latter the AI studies conducted so far. As a possible prevention of the critical issues raised, the use of the medico-legal method is proposed, which classically lies between the prevention of possible adverse events and the reconstruction of how these occurred.The authors believe that this methodology, adopted as a European guideline in the medico-legal field for the assessment of medical liability, can be adapted to AI applied to the healthcare scenario and used for the assessment of liability issues. The topic deserves further investigation and will certainly be taken into consideration as a possible key to future scenarios.
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Affiliation(s)
- Rossana Cecchi
- Laboratory of Forensic Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Tudor Mihai Haja
- Laboratory of Forensic Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Calabrò
- Laboratory of Forensic Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Iben Fasterholdt
- CIMT - Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Benjamin S B Rasmussen
- Department of Radiology & CAI-X - Centre for Clinical Artificial Intelligence, Odense University Hospital, Odense, Denmark
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Catapan SDC, Bruckmann G, Nilson LG, Caffery LJ, Kelly JT, Calvo MCM, Boing AF. Increasing primary care capacity and referral efficiency: A case study of a telehealth centre eConsult service in Brazil. J Telemed Telecare 2024:1357633X241235426. [PMID: 38446874 DOI: 10.1177/1357633x241235426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
INTRODUCTION eConsults are asynchronous digital communications for primary care professionals to seek timely specialist advice. Potential benefits include increased primary healthcare capacity and referral efficiency. Santa Catarina Telehealth Centre in Brazil has offered eConsults for an increasing number of specialties since 2008. This study described the characteristics of this service, including referral efficiency, sustainability, and satisfaction. METHODS Retrospective longitudinal analysis of eConsults activity data from 2015 to 2022 with three domains of the Model for Assessment of Telemedicine Applications used to structure the analysis. RESULTS Characteristics of the application: The total number of eConsults performed in 2015 was 4764, reaching 41,178 in 2022. While 30.3% of eConsults were synchronous in 2015, only asynchronous communication remained from 2021. Clinical effectiveness: eConsults requested to refer patients to specialist care resulting in primary care management remaining above 30% of the total for all specialties from 2019 to 2022, with hematology having the highest percentage (>52%). Organizational aspects: Established workflows with local specialists responding to eConsults (cardiology, endocrinology, hematology and orthopaedics) kept a constant or increasing number of eConsults and maintained the proportion of primary care management from 2019 to 2022, once recovered from COVID-19 and funding restrictions-related reductions. Over 90% of primary care professionals are either satisfied or very satisfied with the eConsult service. CONCLUSION Over 8 years, 223,734 consultations were conducted, with high satisfaction, demonstrating the substantial potential for increased primary care-sensitive conditions management. Hiring local specialists, fostering integrated care, and enabling sustainable workflows are key to eConsults' success.
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Affiliation(s)
- Soraia de Camargo Catapan
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Guilherme Bruckmann
- Public Health Department, Federal University of Santa Catarina, Florianopolis, Brazil
- Telehealth Centre of the Federal University of Santa Catarina, Florianopolis, Brazil
| | - Luana Gabrielle Nilson
- Telehealth Centre of the Federal University of Santa Catarina, Florianopolis, Brazil
- Medicine and Public Health Department, Regional University of Blumenau, Blumenau, Brazil
| | - Liam J Caffery
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jaimon T Kelly
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Maria Cristina Marino Calvo
- Public Health Department, Federal University of Santa Catarina, Florianopolis, Brazil
- Telehealth Centre of the Federal University of Santa Catarina, Florianopolis, Brazil
| | - Antonio Fernando Boing
- Public Health Department, Federal University of Santa Catarina, Florianopolis, Brazil
- Telehealth Centre of the Federal University of Santa Catarina, Florianopolis, Brazil
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Torbjørnsen A, Spildo I, Mollestad MA, Jensen AL, Singstad T, Weldingh NM, Joranger P, Ribu L, Holmen H. Investigating Digital Patient-Reported Outcome Measures in Patient-Centered Diabetes Specialist Outpatient Care (DigiDiaS): Protocol for a Multimethod Prospective Observational Study. JMIR Res Protoc 2024; 13:e52766. [PMID: 38441955 PMCID: PMC10951827 DOI: 10.2196/52766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/22/2023] [Accepted: 01/11/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Living with type 1 diabetes is challenging, and to support self-management, repeated consultations in specialist outpatient care are often required. The emergence of new digital solutions has revolutionized how health care services can be patient centered, providing unprecedented opportunities for flexible, high-quality care. However, there is a lack of studies exploring how the use of digital patient-reported outcome measures (PROMs) for flexible specialist care affects diabetes self-management. To provide new knowledge on the relevance of using PROMs in standard care, we have designed a multimethod prospective study. OBJECTIVE The overall aim of this protocol is to describe our prospective multimethod observational study designed to investigate digital PROMs in a routine specialist outpatient setting for flexible patient-centered diabetes care (DigiDiaS). METHODS This protocol outlines the design of a multimethod prospective observational cohort study that includes data from electronic health records, self-reported questionnaires, clinical consultation field observations, and individual in-depth interviews with patients and diabetes health care personnel. All patients with type 1 diabetes at a designated outpatient clinic were invited to participate and use the digital PROM implemented in clinical care. Both users and nonusers of the digital PROM were eligible for the prospective study, allowing for a comparison of the two groups. Data were collected at baseline and after 12 months, including self-management as the primary outcome assessed using the Patient Activation Measure, along with the secondary outcomes of digital health literacy, quality of life, health economy, and clinical variables such as glycated hemoglobin. RESULTS The digital solution was implemented for routine clinical care in the department in November 2021, and data collection for the prospective study started in October 2022. As of September 6, 2023, 84.6% (186/220) of patients among those in the digital PROM and 15.5% (34/220) of patients among the nonusers have consented to participate. We expect the study to have enough participants by the autumn of 2023. With 1 year of follow-up, the results are expected by spring 2025. CONCLUSIONS In conclusion, a multimethod prospective observational cohort study can offer valuable insights into the relevance, effectiveness, and acceptability of digital tools using PROMs in diabetes specialist care. Such knowledge is crucial for achieving broad and successful implementation and use of these tools in a large diabetes outpatient clinic. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52766.
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Affiliation(s)
- Astrid Torbjørnsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University - OsloMet, Oslo, Norway
| | - Ingeborg Spildo
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University - OsloMet, Oslo, Norway
| | - Maria Aadland Mollestad
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University - OsloMet, Oslo, Norway
| | - Annesofie Lunde Jensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- SDCA-Steno Diabetes Centre, Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Tone Singstad
- Division of Medicine, Akershus University Hospital, Akershus, Norway
| | - Nina Mickelson Weldingh
- Division of Research and Innovation, Department of Research Support Service, Akershus University Hospital, Akershus, Norway
| | - Pål Joranger
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University - OsloMet, Oslo, Norway
| | - Lis Ribu
- The Centre for Senior Citizen Staff, Oslo Metropolitan University - OsloMet, Oslo, Norway
| | - Heidi Holmen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University - OsloMet, Oslo, Norway
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
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Katz C, Robles N, Novillo-Ortiz D, Saigí-Rubió F. Selection of criteria for a telemedicine framework for designing, implementing, monitoring and evaluating telemedicine interventions: Validation using a modified Delphi process. Digit Health 2024; 10:20552076241251951. [PMID: 38726219 PMCID: PMC11080763 DOI: 10.1177/20552076241251951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives The call to scale up telemedicine services globally as part of the digital health transformation lacks an agreed-upon set of constructs to guide the implementation process. A lack of guidance hinders the development, consolidation, sustainability and optimisation of telemedicine services. The study aims to reach consensus among telemedicine experts on a set of implementation constructs to be developed into an evidence-based support tool. Methods A modified Delphi study was conducted to evaluate a set of evidence-informed telemedicine implementation constructs comprising cores, domains and items. The study evaluated the constructs consisting of five cores: Assessment of the Current Situation, Development of a Telemedicine Strategy, Development of Organisational Changes, Development of a Telemedicine Service, and Monitoring, Evaluation and Optimisation of Telemedicine Implementation; seven domains: Individual Readiness, Organisational Readiness, Clinical, Economic, Technological and Infrastructure, Regulation, and Monitoring, Evaluation and Optimisation; divided into 53 items. Global telemedicine specialists (n = 247) were invited to participate and evaluate 58 questions. Consensus was set at ≥70%. Results Forty-five experts completed the survey. Consensus was reached on 78% of the constructs evaluated. Regarding the core constructs, Monitoring, Evaluation and Optimisation of Telemedicine Implementation was determined to be the most important one, and Development of a Telemedicine Strategy the least. As for the domains, the Clinical one had the highest level of consensus, and the Economic one had the lowest. Conclusions This research advances the field of telemedicine, providing expert consensus on a set of implementation constructs. The findings also highlight considerable divergence in expert opinion on the constructs of reimbursement and incentive mechanisms, resistance to change, and telemedicine champions. The lack of agreement on these constructs warrants attention and may partly explain the barriers that telemedicine services continue to face in the implementation process.
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Affiliation(s)
- Che Katz
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Noemí Robles
- eHealth Centre, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems, World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Francesc Saigí-Rubió
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
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Kidholm K, Jensen LK, Johansson M, Montori VM. Telemedicine and the assessment of clinician time: a scoping review. Int J Technol Assess Health Care 2023; 40:e3. [PMID: 38099431 PMCID: PMC10859839 DOI: 10.1017/s0266462323002830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Telemedicine may improve healthcare access and efficiency if it demands less clinician time than usual care. We sought to describe the degree to which telemedicine trials assess the effect of telemedicine on clinicians' time and to discuss how including the time needed to treat (TNT) in health technology assessment (HTA) could affect the design of telemedicine services and studies. METHODS We conducted a scoping review by searching clinicaltrials.gov using the search term "telemedicine" and limiting results to randomized trials or observational studies registered between January 2012 and October 2023. We then reviewed trial registration data to determine if any of the outcomes assessed in the trials measured effect on clinicians' time. RESULTS We found 113 studies and of these 78 studies of telemedicine met the inclusion criteria and were included. Nine (12 percent) of the 78 studies had some measure of clinician time as a primary outcome, and 11 (14 percent) as a secondary outcome. Four studies compared direct measures of TNT with telemedicine versus usual care, but no statistically significant difference was found. Of the sixteen studies including indirect measures of clinician time, thirteen found no significant effects, two found a statistically significant reduction, and one found a statistically significant increase. CONCLUSIONS This scoping review found that clinician time is not commonly measured in studies of telemedicine interventions. Attention to telemedicine's TNT in clinical studies and HTAs of telemedicine in practice may bring attention to the organization of clinical workflows and increase the value of telemedicine.
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Affiliation(s)
- Kristian Kidholm
- Center for Innovative Medical Technology, Odense University Hospital and University of Southern Denmark, Denmark
| | - Lise Kvistgaard Jensen
- Center for Innovative Medical Technology, Odense University Hospital and University of Southern Denmark, Denmark
| | - Minna Johansson
- Global Center for Sustainable Healthcare, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Victor M Montori
- Department of Medicine, Mayo Clinic, Knowledge and Evaluation Research Unit, Rochester, MN, USA
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Shih YH, Wang JY, Chou PH, Lin KH. The effects of treatment via telemedicine interventions for patients with depression on depressive symptoms and quality of life: a systematic review and meta-ranalysis. Ann Med 2023; 55:1092-1101. [PMID: 36920229 PMCID: PMC10026747 DOI: 10.1080/07853890.2023.2187078] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Aim: The aim of this systematic review and meta-analysis was to identify, evaluate, and synthesize the evidence from studies that have investigated the treatment effect via telemedicine interventions on depressive symptoms, quality of life, and work and social functioning in patients with depression.Methods: Six electronic databases (MEDLINE [1916-2021], PubMED [1950-2021], PsycINFO [1971-2021], Scopus [2004-2021], Embase [1972-2021], and CINAHL [1937-2021]) were systematically searched in March 2021. Reference lists of identified articles were hand searched. Randomized controlled trials were included if they investigated the treatment effects via telemedicine interventions in patients who had a depression diagnosis. Quality assessment was evaluated using the critical appraisal checklists developed by the Joanna Briggs Institute.Results: Seventeen (17) trials (n = 2,394) met eligibility criteria and were included in the analysis. Eleven (11) randomized controlled trials shared common outcome measures, allowing meta-analysis. The results provided evidence that treatment via telemedicine interventions were beneficial for depressive symptoms (standardized mean difference= -0.44; 95% CI= -0.64 to -0.25; p < .001) and quality of life (standardized mean difference= 0.25, 95% CI -0.01 to 0.49, p = .04) in patients of depression. There were insufficient data for meta-analysis of work and social functioning.Conclusion: This study showed the positive effects of treatment via telemedicine interventions on depressive symptoms and quality of life in patients with depression and supported the idea for clinical practice to establish a well-organized telepsychiatry system.KEY MESSAGESTelemedicine is effective at reducing symptoms of depression.Telemedicine can improve quality of life in persons with depression.
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Affiliation(s)
- Yin-Hwa Shih
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Kuan-Han Lin
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Banbury A, Taylor M, Caffery L, Der Vartanian C, Haydon H, Mendis R, Ng K, Smith A. Consumers' experiences, preferences, and perceptions of effectiveness in using telehealth for cancer care in Australia. Asia Pac J Clin Oncol 2023; 19:752-761. [PMID: 37712136 DOI: 10.1111/ajco.14002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/06/2023] [Accepted: 08/27/2023] [Indexed: 09/16/2023]
Abstract
AIM COVID-19 accelerated telehealth (video and telephone) use for cancer care to reduce disease exposure and transmission. Understanding consumers' health service delivery needs is required to sustain telehealth activity and develop new models of care. We explored consumers' experiences of telehealth in cancer care and their perspectives on improving and sustaining telehealth uptake in the future. METHODS Exploratory design mixed-methods study using the Model for Assessment of Telemedicine (MAST) framework. Consumers affected by cancer completed an online survey and semistructured interviews. Quantitative data were analyzed using descriptive statistics and chi-square. Qualitative data from the MAST consumer domain were thematically analyzed. RESULTS There were 1162 survey respondents and 18 interview participants. Video and telephone were used in cancer care with various providers. Telephone was used more frequently. Most respondents (85%) had reliable internet connections for video, however, 36% were not offered a video consultation. Video compared with telephone users were statistically significantly more likely to be satisfied with the quality of their treatment and perceived their consultation achieved as much as an in-person consultation. Telephone users (51%) compared with video users (31%) were more likely to perceive their concerns would have been better understood by their care provider if they were seen in person. Five themes emerged from the qualitative data. Consumers want modality choice, video provides superior experiences versus telephone, consultation mode preference is fluid, and consultation scheduling and administration need further consideration. CONCLUSION Consumers support telehealth in cancer care. Consumers want consultation mode choices based on their needs and purpose of consultation.
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Affiliation(s)
- Annie Banbury
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Monica Taylor
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Liam Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | | | - Helen Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Roshni Mendis
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Kawai Ng
- Cancer Australia, Sydney, Australia
| | - Anthony Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark
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Agbali RA, Balas EA, Beltrame F, Heboyan V, De Leo G. A review of questionnaires used for the assessment of telemedicine. J Telemed Telecare 2023:1357633X231166161. [PMID: 37032470 DOI: 10.1177/1357633x231166161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Telemedicine is the exchange of medical information from one site to another via electronic communications with the goal of improving a patient's clinical health status. Prior studies have identified the absence of a standardized assessment tool for evaluating telemedicine encounters. This study aims to collect and to analyze questionnaires used for the assessment of audiovisual telemedicine encounters from a patient perspective and aims to identify reasons driving the use of self-developed questionnaires. METHODS We conducted a systematic search in PubMed for studies that used survey questionnaires to assess synchronous audiovisual telemedicine encounters from 2016 to 2021. We categorized questionnaires used into validated and non-validated types, and for each of them, collected questions, response format, author, year, specialty, and country of publication. RESULTS AND DISCUSSION We analyzed a total of 71 articles. We found that only 16 studies used three validated questionnaires. The remaining 55 studies used non-validated questionnaires. Non-validated questionnaires had a high variability in length and used Likert scales, binary responses, multiple choice, and open-ended answers. We found only eight studies in which the authors gave a reason for resorting to designing their own questionnaires. This review reveals insufficient standardized survey questionnaires to be used for the assessment of audiovisual telemedicine encounters. Future research initiatives should focus on developing a standardized and validated instrument well accepted by researchers.
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Affiliation(s)
- Raphael A Agbali
- College of Allied Health Sciences, 1421Augusta University, Augusta, GA, USA
| | - E Andrew Balas
- College of Allied Health Sciences, 1421Augusta University, Augusta, GA, USA
| | - Francesco Beltrame
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genova, Italy
| | - Vahe Heboyan
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Gianluca De Leo
- College of Allied Health Sciences, 1421Augusta University, Augusta, GA, USA
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Cardile D, Corallo F, Cappadona I, Ielo A, Bramanti P, Lo Buono V, Ciurleo R, De Cola MC. Auditing the Audits: A Systematic Review on Different Procedures in Telemedicine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4484. [PMID: 36901491 PMCID: PMC10001883 DOI: 10.3390/ijerph20054484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Telemedicine is a process of delivering health care using information and communication technologies. Audit and feedback (A&F) constitute a systematic intervention that is aimed at collecting data, which are subsequently compared with reference standards and then returned to health care operators through feedback meetings. The aim of this review is to analyse different audit procedures on and by mean of telemedicine services and to identify a practice that is more effective than the others. Systematic searches were performed in three databases evaluating studies focusing on clinical audits performed on and by means of telemedicine systems. Twenty-five studies were included in the review. Most of them focused on telecounselling services with an audit and a maximum duration of one year. Recipients of the audit were telemedicine systems and service users (general practitioners, referring doctors, and patients). Data resulting from the audit were inherent to the telemedicine service. The overall data collected concerned the number of teleconsultations, service activity, reasons for referral, response times, follow-up, reasons why treatment was not completed, technical issues, and other information specific to each telemedicine service. Only two of the considered studies dealt with organizational aspects, and of these, only one analysed communicative aspects. The complexity and heterogeneity of the treatments and services provided meant that no index of uniformity could be identified. Certainly, some audits were performed in an overlapping manner in the different studies, and these show that although attention is often paid to workers' opinions, needs, and issues, little interest was shown in communicative/organizational and team dynamics. Given the importance and influence that communication has in teamwork and care settings, an audit protocol that takes into account intra- and extra-team communication processes could be essential to improving the well-being of operators and the quality of the service provided.
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Leung T, Hsieh HW, Roca J, Cano I. The Assessment of Medical Device Software Supporting Health Care Services for Chronic Patients in a Tertiary Hospital: Overarching Study. J Med Internet Res 2023; 25:e40976. [PMID: 36598817 PMCID: PMC9873251 DOI: 10.2196/40976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/10/2022] [Accepted: 11/25/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Innovative digital health tools are increasingly being evaluated and, in some instances, integrated at scale into health systems. However, the applicability of assessment methodologies in real-life scenarios to demonstrate value generation and consequently foster sustainable adoption of digitally enabled health interventions has some bottlenecks. OBJECTIVE We aimed to build on the process of premarket assessment of 4 digital health interventions piloted at the Hospital Clinic de Barcelona (HCB), as well as on the analysis of current medical device software regulations and postmarket surveillance in the European Union and United States in order to generate recommendations and lessons learnt for the sustainable adoption of digitally enabled health interventions. METHODS Four digital health interventions involving prototypes were piloted at the HCB (studies 1-4). Cocreation and quality improvement methodologies were used to consolidate a pragmatic evaluation method to assess the perceived usability and satisfaction of end users (both patients and health care professionals) by means of the System Usability Scale and the Net Promoter Score, including general questions about satisfaction. Analyses of both medical software device regulations and postmarket surveillance in the European Union and United States (2017-2021) were performed. Finally, an overarching analysis on lessons learnt was conducted considering 4 domains (technical, clinical, usability, and cost), as well as differentiating among 3 different eHealth strategies (telehealth, integrated care, and digital therapeutics). RESULTS Among the participant stakeholders, the System Usability Scale score was consistently higher in patients (studies 1, 2, 3, and 4: 78, 67, 56, and 76, respectively) than in health professionals (studies 2, 3, and 4: 52, 43, and 54, respectively). In general, use of the supporting digital health tools was recommended more by patients (studies 1, 2, 3, and 4: Net Promoter Scores of -3%, 31%, -21%, and 31%, respectively) than by professionals (studies 2, 3, and 4: Net Promoter Scores of -67%, 1%, and -80%, respectively). The overarching analysis resulted in pragmatic recommendations for the digital health evaluation domains and the eHealth strategies considered. CONCLUSIONS Lessons learnt on the digitalization of health resulted in practical recommendations that could contribute to future deployment experiences.
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Affiliation(s)
| | - Hsin Wen Hsieh
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Josep Roca
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Isaac Cano
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
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11
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Banbury A, Smith AC, Taylor ML, Der Vartanian C, Ng K, Vitangcol K, Haydon HM, Thomas EE, Caffery LJ. Cancer care and management during COVID-19: A comparison of in-person, video and telephone consultations. J Telemed Telecare 2022; 28:733-739. [PMID: 36346931 PMCID: PMC9646900 DOI: 10.1177/1357633x221123409] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/27/2022] [Indexed: 09/16/2023]
Abstract
In Australia, the COVID-19 pandemic has resulted in the exponential growth in the delivery of telehealth services. Medicare data indicates that the majority of telehealth consultations have used the telephone, despite the known benefits of using video. The aim of this study was to understand the perceived quality and effectiveness of in-person, telephone and videoconsultations for cancer care. Data was collected via online surveys with consumers (n = 1162) and health professionals (n = 59), followed by semi-structured interviews with telehealth experienced health professionals (n = 22) and consumers (n = 18). Data were analysed using descriptive statistics and significance was tested using the chi-square test. A framework analysis and thematic analysis were used for qualitative data. Results indicate telehealth is suitable for use across the cancer care pathway. However, consumers and health professionals perceived videoconsultations facilitated visual communication and improved patients' quality of care. The telephone was appropriate for short transactional consultations such as repeat prescriptions. Consumers were rarely given the choice of consultation modality. The choice of modality depended on a range of factors such as the type of consultation and stage of cancer care. Hybrid models of care utilising in-person, video and telephone should be developed and requires further guidance to promote the adoption of telehealth in cancer care.
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Affiliation(s)
- Annie Banbury
- Centre for Online Health, The University of
Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of
Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of
Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of
Queensland, Brisbane, Australia
- Centre for Innovative Medical
Technology, University of Southern Denmark, Odense, Denmark
| | - Monica L Taylor
- Centre for Online Health, The University of
Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of
Queensland, Brisbane, Australia
| | | | - Kawai Ng
- Cancer Australia, Sydney, Australia
| | - Kathryn Vitangcol
- Centre for Online Health, The University of
Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of
Queensland, Brisbane, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of
Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of
Queensland, Brisbane, Australia
| | - Emma E Thomas
- Centre for Online Health, The University of
Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of
Queensland, Brisbane, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of
Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of
Queensland, Brisbane, Australia
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12
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Fasterholdt I, Naghavi-Behzad M, Rasmussen BSB, Kjølhede T, Skjøth MM, Hildebrandt MG, Kidholm K. Value assessment of artificial intelligence in medical imaging: a scoping review. BMC Med Imaging 2022; 22:187. [PMID: 36316665 PMCID: PMC9620604 DOI: 10.1186/s12880-022-00918-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/22/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Artificial intelligence (AI) is seen as one of the major disrupting forces in the future healthcare system. However, the assessment of the value of these new technologies is still unclear, and no agreed international health technology assessment-based guideline exists. This study provides an overview of the available literature in the value assessment of AI in the field of medical imaging. METHODS We performed a systematic scoping review of published studies between January 2016 and September 2020 using 10 databases (Medline, Scopus, ProQuest, Google Scholar, and six related databases of grey literature). Information about the context (country, clinical area, and type of study) and mentioned domains with specific outcomes and items were extracted. An existing domain classification, from a European assessment framework, was used as a point of departure, and extracted data were grouped into domains and content analysis of data was performed covering predetermined themes. RESULTS Seventy-nine studies were included out of 5890 identified articles. An additional seven studies were identified by searching reference lists, and the analysis was performed on 86 included studies. Eleven domains were identified: (1) health problem and current use of technology, (2) technology aspects, (3) safety assessment, (4) clinical effectiveness, (5) economics, (6) ethical analysis, (7) organisational aspects, (8) patients and social aspects, (9) legal aspects, (10) development of AI algorithm, performance metrics and validation, and (11) other aspects. The frequency of mentioning a domain varied from 20 to 78% within the included papers. Only 15/86 studies were actual assessments of AI technologies. The majority of data were statements from reviews or papers voicing future needs or challenges of AI research, i.e. not actual outcomes of evaluations. CONCLUSIONS This review regarding value assessment of AI in medical imaging yielded 86 studies including 11 identified domains. The domain classification based on European assessment framework proved useful and current analysis added one new domain. Included studies had a broad range of essential domains about addressing AI technologies highlighting the importance of domains related to legal and ethical aspects.
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Affiliation(s)
- Iben Fasterholdt
- grid.7143.10000 0004 0512 5013CIMT – Centre for Innovative Medical Technology, Odense University Hospital, Sdr. Boulevard 29, Entrance 102, 4rd Floor, 5000 Odense C, Denmark
| | - Mohammad Naghavi-Behzad
- grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark ,grid.7143.10000 0004 0512 5013Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Benjamin S. B. Rasmussen
- grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark ,grid.7143.10000 0004 0512 5013Department of Radiology, Odense University Hospital, Odense, Denmark ,grid.7143.10000 0004 0512 5013CAI-X – Centre for Clinical Artificial Intelligence, Odense University Hospital, Odense, Denmark
| | - Tue Kjølhede
- grid.7143.10000 0004 0512 5013CIMT – Centre for Innovative Medical Technology, Odense University Hospital, Sdr. Boulevard 29, Entrance 102, 4rd Floor, 5000 Odense C, Denmark
| | - Mette Maria Skjøth
- grid.7143.10000 0004 0512 5013Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Malene Grubbe Hildebrandt
- grid.7143.10000 0004 0512 5013CIMT – Centre for Innovative Medical Technology, Odense University Hospital, Sdr. Boulevard 29, Entrance 102, 4rd Floor, 5000 Odense C, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark ,grid.7143.10000 0004 0512 5013Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Kristian Kidholm
- grid.7143.10000 0004 0512 5013CIMT – Centre for Innovative Medical Technology, Odense University Hospital, Sdr. Boulevard 29, Entrance 102, 4rd Floor, 5000 Odense C, Denmark
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13
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Vitali A, Ghidotti A, Savoldelli A, Bonometti F, Rizzi C, Bernocchi P, Borghi G, Scalvini S. Definition of a Method for the Evaluation of Telemedicine Platforms in the Italian Context. Telemed J E Health 2022; 29:769-777. [PMID: 36206021 DOI: 10.1089/tmj.2022.0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The COVID-19 outbreak led to the diffusion of several telemedicine solutions. The choice of the correct platform is crucial for ensuring the release of effective assistance. However, there is a lack of an objective method for the assessment of technical features. Objective: This study proposes a methodology for the evaluation of functional requirements of telemedicine platforms. This approach also permits the comparison of solutions in the Italian market by means of defined parameters, thus directing the choice of health care professionals. Methods: The study is divided into three phases. First, a mapping of the telemedicine platforms operating in Italy is performed. Then, the available platforms are selected based on the offered telemedicine activity. Finally, a method for evaluating the investigated platforms is defined. Results: Thirty-three (n = 33) technological systems were identified through an accurate investigation on the web and interviews with IT companies. Fifteen parameters were defined and organized into three categories: (1) usability of the telemedicine platform, (2) security, and (3) technological and organizational aspects. A score between 1 and 4 was assigned to each parameter, proportionally to the completeness of the platform. In particular, 62.96% of platforms reached an average score between 3.01 and 4 points; 33.33% of them had scores between 2.01 and 3, while the remaining 3.70% of solutions obtained a result between 1.01 and 2. Conclusions: The study provides an evaluation approach that is easily usable by health professionals to select the most suitable platform. The number of solutions and quality of information could be updated to obtain a complete tool.
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Affiliation(s)
- Andrea Vitali
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Anna Ghidotti
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Anna Savoldelli
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Francesco Bonometti
- Istituti Clinici Scientifici Maugeri IRCCS Continuity of Care (Telemedicine Service) of the Institute of Lumezzane, Brescia, Italy
| | - Caterina Rizzi
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Palmira Bernocchi
- Istituti Clinici Scientifici Maugeri IRCCS Continuity of Care (Telemedicine Service) of the Institute of Lumezzane, Brescia, Italy
| | - Gabriella Borghi
- Istituti Clinici Scientifici Maugeri IRCCS Continuity of Care (Telemedicine Service) of the Institute of Lumezzane, Brescia, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS Continuity of Care (Telemedicine Service) of the Institute of Lumezzane, Brescia, Italy
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14
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Seidel K, Labor M, Lombard-Vance R, McEvoy E, Cooke M, D’Arino L, Desmond D, Ferri D, Franke P, Gheno I, Grigoleit S, Guerra B, Krukowski A, Pešoutová M, Pietri I, Prendergast D, Maguire R, Manso M, Saris AJ, Sarlio-Siintola S, Silva T, Zarogianni E, MacLachlan M. Implementation of a pan-European ecosystem and an interoperable platform for Smart and Healthy Ageing in Europe: An Innovation Action research protocol. OPEN RESEARCH EUROPE 2022; 2:85. [PMID: 37645338 PMCID: PMC10446093 DOI: 10.12688/openreseurope.14827.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 08/31/2023]
Abstract
As life expectancy continues to increase in most EU Member States, smart technologies can help enable older people to continue living at home, despite the challenges accompanying the ageing process. The Innovation Action (IA) SHAPES 'Smart and Healthy Ageing through People Engaging in Supportive Systems' funded by the EU under the Horizon 2020 Research and Innovation Programme (grant agreement number 857159) attends to these topics to support active and healthy ageing and the wellbeing of older adults. This protocol article outlines the SHAPES project's objectives and aims, methods, structure, and expected outcomes. SHAPES seeks to build, pilot, and deploy a large-scale, EU-standardised interoperable, and scalable open platform. The platform will facilitate the integration of a broad range of technological, organisational, clinical, educational, and social solutions. SHAPES emphasises that the home is much more than a house-space; it entails a sense of belonging, a place and a purpose in the community. SHAPES creates an ecosystem - a network of relevant users and stakeholders - who will work together to scale-up smart solutions. Furthermore, SHAPES will create a marketplace seeking to connect demand and supply across the home, health and care services. Finally, SHAPES will produce a set of recommendations to support key stakeholders seeking to integrate smart technologies in their care systems to mediate care delivery. Throughout, SHAPES adopts a multidisciplinary research approach to establish an empirical basis to guide the development of the platform. This includes long-term ethnographic research and a large-scale pan-European campaign to pilot the platform and its digital solutions within the context of seven distinct pilot themes. The project will thereby address the challenges of ageing societies in Europe and facilitate the integration of community-based health and social care. SHAPES will thus be a key driver for the transformation of healthcare and social care services across Europe.
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Affiliation(s)
- Katja Seidel
- Department of Anthropology, ALL Institute, National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland
| | - Melanie Labor
- Department of Psychology, ALL Institute, National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland
| | - Richard Lombard-Vance
- Department of Psychology, ALL Institute, National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland
| | - Emma McEvoy
- School of Law and Criminology, ALL Institute, National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland
| | - Michael Cooke
- Edward M Kennedy Institute, Department of Psychology, ALL Institute, Social Sciences Institute (MUSSI), National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland
| | - Lucia D’Arino
- World Federation of the Deafblind, Las Palmas, Gran Canaria, Spain
| | - Deirdre Desmond
- Department of Psychology, ALL Institute, National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland
| | - Delia Ferri
- School of Law and Criminology, Centre for European and Eurasian Studies, ALL Institute, National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland
| | - Philip Franke
- Carus Consilium Sachsen GmbH, Dresden, Saxony, 01309, Germany
| | | | - Sonja Grigoleit
- Fraunhofer Institute for Technological Trend Analysis INT, Fraunhofer Gesellschaft zur Förderung der angewandten Forschung E.V., Munich, Bavaria, Germany
| | | | | | - Marketa Pešoutová
- Palacký University Olomouc, Olomoucký University Social Health Institute, Olomouc, 771 11, Czech Republic
| | - Ilia Pietri
- EDGE, Edgeneering LDA, Lisbon, 2500 218, Portugal
| | - David Prendergast
- Department of Anthropology, ALL Institute, National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland
| | - Rebecca Maguire
- Department of Psychology, ALL Institute, Human Health Institute, National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland
| | - Marco Manso
- Fraunhofer Institute for Technological Trend Analysis INT, Fraunhofer Gesellschaft zur Förderung der angewandten Forschung E.V., Munich, Bavaria, Germany
| | - A. Jamie Saris
- Department of Anthropology, ALL Institute, National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland
| | - Sari Sarlio-Siintola
- Department of Research and Development, Laurea University of Applied Sciences, Vantaa, 01300, Finland
| | - Tatiana Silva
- Department of Research and Development, Treelogic - Tree Technology SA, Madrid, 28020, Spain
| | | | - Malcom MacLachlan
- Department of Psychology, ALL Institute, National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland
| | - SHAPES Consortium
- Department of Anthropology, ALL Institute, National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland
- Department of Psychology, ALL Institute, National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland
- School of Law and Criminology, ALL Institute, National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland
- Edward M Kennedy Institute, Department of Psychology, ALL Institute, Social Sciences Institute (MUSSI), National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland
- World Federation of the Deafblind, Las Palmas, Gran Canaria, Spain
- School of Law and Criminology, Centre for European and Eurasian Studies, ALL Institute, National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland
- Carus Consilium Sachsen GmbH, Dresden, Saxony, 01309, Germany
- AGE Platform Europe, Brussels, 1150, Belgium
- Fraunhofer Institute for Technological Trend Analysis INT, Fraunhofer Gesellschaft zur Förderung der angewandten Forschung E.V., Munich, Bavaria, Germany
- EDGE, Edgeneering LDA, Lisbon, 2500 218, Portugal
- ICOM, Intracom SA Telecom Solutions, PEANIA, 19002, Greece
- Palacký University Olomouc, Olomoucký University Social Health Institute, Olomouc, 771 11, Czech Republic
- Department of Psychology, ALL Institute, Human Health Institute, National University of Ireland, Maynooth, Maynooth, Co. Kildare, Ireland
- Department of Research and Development, Laurea University of Applied Sciences, Vantaa, 01300, Finland
- Department of Research and Development, Treelogic - Tree Technology SA, Madrid, 28020, Spain
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15
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Chelberg GR, Butten K, Mahoney R. Culturally Safe eHealth Interventions With Aboriginal and Torres Strait Islander People: Protocol for a Best Practice Framework. JMIR Res Protoc 2022; 11:e34904. [PMID: 35687420 PMCID: PMC9233256 DOI: 10.2196/34904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/26/2022] [Accepted: 05/20/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is growing global evidence on the adoption and effectiveness of eHealth (including mobile health and telehealth) by First Nation peoples including Aboriginal and Torres Strait Islander people. Although there are frameworks to guide eHealth development, implementation, and evaluation, it is unknown whether they adequately encapsulate the health, cultural, and community-related priorities of Aboriginal and Torres Strait Islander people. OBJECTIVE The aim of this research program is to prepare a best practice framework that will guide the co-design, implementation, and evaluation of culturally safe eHealth interventions within existing models of health care for Aboriginal and Torres Strait Islander people. The framework will be a synthesis of evidence that represents best practices in eHealth, as determined by Aboriginal and Torres Strait Islander people. METHODS Research activities to develop the best practice framework will occur in stepped but overlapping qualitative research phases with governance from an existing multiagency research collaboration (the Collaboration). The research protocol has been informed by key research frameworks such as the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) and Developers of Health Research Reporting Guidelines. The seven phases of research will include the following: systematic literature review, scoping review, theme development, theme consultation, Delphi processes for expert reviews, and dissemination. RESULTS Members of the Collaboration conceived this research program in August 2020, and a draft was produced in June 2021 with subsequent funding obtained in July 2021. The Collaboration approved the protocol in December 2021. Results for several research phases of the best practice framework development are expected by January 2023, commencing with the systematic literature review and the scoping review. CONCLUSIONS The research program outlined in this protocol is a timely response to the growing number of eHealth interventions with Aboriginal and Torres Strait Islander people. A best practice framework is needed to guide the rigorous development and evaluation of eHealth innovations to promote genuine co-design and ensure cultural safety and clinical effectiveness for Aboriginal and Torres Strait Islander people. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34904.
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Affiliation(s)
- Georgina R Chelberg
- Australian E-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Australia.,Centre for Online Health, The University of Queensland, Woolloongabba, Australia
| | - Kaley Butten
- Australian E-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Australia
| | - Ray Mahoney
- Australian E-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Australia.,School of Public Health, The University of Queensland, Herston, Australia
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16
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Nickelsen NCM, Simonsen Abildgaard J. The entwinement of policy, design and care scripts: Providing alternative choice-dependency situations with care robots. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:451-468. [PMID: 35092619 DOI: 10.1111/1467-9566.13434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/17/2021] [Accepted: 01/04/2022] [Indexed: 06/14/2023]
Abstract
The use of robots to assist feeding has become important for people with an impaired arm function. Yet, despite large-scale dissemination strategies, it has proven difficult to sustain the use of this technology. This ethnographic study draws on the script approach to discuss the use of robots to assist feeding. The empirical work was done at locations in Denmark and Sweden. Drawing on document studies, interviews, observation of meals and video footage, we discuss (1) policy strategies promoting ideas such as self-reliance; (2) design visions promoting ideas such as empowerment; (3) and three scripts of care: (a) the script of choice, (b) the script of eating alone and (c) the script of eating together. We argue that scripts entwine and give rise to and prevent the use of robots. The study contributes to the script literature and the care robot literature by substantiating that care robots may generate choice-dependency situations for users. Rather than the somewhat overflowing 'self-reliance' and 'empowerment', alternative configurations of choice and dependency emerge, in which some situations fit users better than others. We conclude that although sustaining the use of feeding robots is difficult, in some cases, useful choices arise for both end-users and care providers.
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Affiliation(s)
| | - Johan Simonsen Abildgaard
- The National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Organization, Copenhagen Business School, Frederiksberg, Denmark
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17
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Charle-Maachi C, Moreau-Gaudry A, Sainati D, Camus D, Adenot I, Barthelemy CE, de Chalus T, Debroucker F, Denis F, Gourio C, Habran E, Kamal N, Le Douarin YM, Rosier A, Schuck S, Thébaut JF, Trancart A, Vercamer V. Les solutions numériques en santé, quelles valeurs apportées, quels mécanismes de financement et quelles évaluations ? Therapie 2022; 77:117-132. [DOI: 10.1016/j.therap.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 11/17/2022]
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18
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Jansen-Kosterink S, Broekhuis M, van Velsen L. Time to act mature—Gearing eHealth evaluations towards technology readiness levels. Digit Health 2022; 8:20552076221113396. [PMID: 35847525 PMCID: PMC9280845 DOI: 10.1177/20552076221113396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022] Open
Abstract
It is challenging to design a proper eHealth evaluation. In our opinion, the evaluation of eHealth should be a continuous process, wherein increasingly mature versions of the technology are put to the test. In this article, we present a model for continuous eHealth evaluation, geared towards technology maturity. Technology maturity can be determined best via Technology Readiness Levels, of which there are nine, divided into three phases: the research, development, and deployment phases. For each phase, we list and discuss applicable activities and outcomes on the end-user, clinical, and societal front. Instead of focusing on a single perspective, we recommend to blend the end-user, health and societal perspective. With this article we aim to contribute to the methodological debate on how to create the optimal eHealth evaluation design.
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Affiliation(s)
- Stephanie Jansen-Kosterink
- eHealth Group, Roessingh Research and Development, Enschede, The Netherlands
- Biomedical Signals and Systems Group, University of Twente, Enschede, The Netherlands
| | - Marijke Broekhuis
- eHealth Group, Roessingh Research and Development, Enschede, The Netherlands
- Biomedical Signals and Systems Group, University of Twente, Enschede, The Netherlands
| | - Lex van Velsen
- eHealth Group, Roessingh Research and Development, Enschede, The Netherlands
- Biomedical Signals and Systems Group, University of Twente, Enschede, The Netherlands
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19
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What value do digital health solutions bring, what are the funding mechanisms and evaluations? Therapie 2022; 77:133-147. [DOI: 10.1016/j.therap.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/20/2022]
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20
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Vilanilam G, Abraham M, Radhakrishnan A, Keni R, Senanayake S, Attanayake D, Muhammed Rumi J, Sai Kiran NA, Varma R, Chowdhury F, Menon R, Thomas B, Venkat E. Telecollaboration: Telementorship for epilepsy surgery services in resource: Challenged lower-middle-income countries environs – A model and proof of concept. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2022. [DOI: 10.4103/amhs.amhs_105_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Model for ASsessing the value of Artificial Intelligence in medical imaging (MAS-AI). Int J Technol Assess Health Care 2022; 38:e74. [DOI: 10.1017/s0266462322000551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objectives
Artificial intelligence (AI) is seen as a major disrupting force in the future healthcare system. However, the assessment of the value of AI technologies is still unclear. Therefore, a multidisciplinary group of experts and patients developed a Model for ASsessing the value of AI (MAS-AI) in medical imaging. Medical imaging is chosen due to the maturity of AI in this area, ensuring a robust evidence-based model.
Methods
MAS-AI was developed in three phases. First, a literature review of existing guides, evaluations, and assessments of the value of AI in the field of medical imaging. Next, we interviewed leading researchers in AI in Denmark. The third phase consisted of two workshops where decision makers, patient organizations, and researchers discussed crucial topics for evaluating AI. The multidisciplinary team revised the model between workshops according to comments.
Results
The MAS-AI guideline consists of two steps covering nine domains and five process factors supporting the assessment. Step 1 contains a description of patients, how the AI model was developed, and initial ethical and legal considerations. In step 2, a multidisciplinary assessment of outcomes of the AI application is done for the five remaining domains: safety, clinical aspects, economics, organizational aspects, and patient aspects.
Conclusions
We have developed an health technology assessment-based framework to support the introduction of AI technologies into healthcare in medical imaging. It is essential to ensure informed and valid decisions regarding the adoption of AI with a structured process and tool. MAS-AI can help support decision making and provide greater transparency for all parties.
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22
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Ward EC, Raatz M, Marshall J, Wishart LR, Burns CL. Telepractice and Dysphagia Management: The Era of COVID-19 and Beyond. Dysphagia 2022; 37:1386-1399. [PMID: 35428923 PMCID: PMC9012247 DOI: 10.1007/s00455-022-10444-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
The COVID-19 pandemic drove rapid and widespread uptake of telepractice across all aspects of healthcare. The delivery of dysphagia care was no exception, with telepractice recognized as a service modality that could support social distancing/infection control, overcome service delivery challenges created by lockdowns/service closures, and address consumer concerns about attending in-person appointments. Now, almost two years since most services first rapidly deployed telepractice, it is time to reflect on the big picture, and consider how telepractice will continue as a service option that is sustained and integrated into mainstream dysphagia care. It is also timely to consider the research agenda needed to support this goal. To this end, in this paper we present 4 discussion topics, which raise key considerations for the current and future use of telepractice within adult and pediatric dysphagia services. These are (1) Dysphagia services must meet consumer and service needs; (2) Aspects of dysphagia services can be safely and reliably provided via telepractice; (3) Telepractice can be used in flexible ways to support the delivery of dysphagia services; and (4) Providing quality dysphagia services via telepractice requires planned implementation and evaluation. Then directions for future research are discussed. These considerations are presented to help shift perspectives away from viewing telepractice as simply a COVID-19 "interim-care solution". Rather, we encourage clinicians, services, and researchers to embrace a future of "integrated care", where traditional dysphagia services are combined with telepractice models, to enhance the quality of care provided to our clients.
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Affiliation(s)
- Elizabeth C. Ward
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, PO Box 6053, Buranda, QLD 4102 Australia ,School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia
| | - Madeline Raatz
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,Speech Pathology Department, Queensland Children’s Hospital, Brisbane, QLD Australia
| | - Jeanne Marshall
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,Speech Pathology Department, Queensland Children’s Hospital, Brisbane, QLD Australia
| | - Laurelie R. Wishart
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, PO Box 6053, Buranda, QLD 4102 Australia ,School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia
| | - Clare L. Burns
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,Speech Pathology Department, Royal Brisbane & Women’s Hospital, Metro North Hospital and Health Service, Brisbane, QLD Australia
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23
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Lim SM, Ji S, Kim JS. Physicians’ perception toward using telephone consultations during the COVID-19 pandemic in Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.12.852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: As the world faced a pandemic caused by the coronavirus disease (COVID-19) outbreak in 2019, telemedicine quickly spread and was widely adopted. This was the first instance where telephone consultations were temporarily allowed in Korea. We used data from the 2020 Korean Physician Survey and analyzed the physicians’ perceptions of telephone consultations, the reasons for providing these consultations, and the level of physician satisfaction after providing it.Current Concepts: A total of 6,342 respondents were selected for the final analysis of the research results. Regardless of the COVID-19 pandemic, the data showed that most physicians had a negative perception (77.1%) toward the introduction of the telemedicine system. A third (31.1%) of physicians surveyed had provided medical treatment via telephone consultation. According to the position the physicians held, professors, fellows, self-employed physicians, and public health physicians had the most experience in this method of consultation. The use of telephone consultation was highest in the field of internal medicine (44.5%) treatment. Data also showed that most physicians (83.5%) who provided such consultations experienced difficulties in making a medical judgment that could ensure their patients’ safety.Discussion and Conclusion: The results of this study verified that physicians’ opinions about the telemedicine system differed according to service, area of specialization, region, and type of medical institution. A closer review and establishment of policy alternatives are required to explore the possible expansion of teleconsultations and related medical treatments in the future.
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Aminoff H, Meijer S, Groth K, Arnelo U. User Experience in Remote Surgical Consultation: Survey Study of User Acceptance and Satisfaction in Real-Time Use of a Telemedicine Service. JMIR Hum Factors 2021; 8:e30867. [PMID: 34851302 PMCID: PMC8672288 DOI: 10.2196/30867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/16/2021] [Accepted: 07/23/2021] [Indexed: 01/19/2023] Open
Abstract
Background Teleguidance, a promising telemedicine service for intraoperative surgical consultation, was planned to scale up at a major academic hospital in partnership with 5 other hospitals. If the service was adopted and used over time, it was expected to provide educational benefits and improve clinical outcomes during endoscopic retrograde cholangiopancreatography (ERCP), which is a technically advanced procedure for biliary and pancreatic disease. However, it is known that seemingly successful innovations can play out differently in new settings, which might cause variability in clinical outcomes. In addition, few telemedicine services survive long enough to deliver system-level outcomes, the causes of which are not well understood. Objective We were interested in factors related to usability and user experience of the telemedicine service, which might affect adoption. Therefore, we investigated perceptions and responses to the use and anticipated use of a system. Technology acceptance, a construct referring to how users perceive a technology’s usefulness, is commonly considered to indicate whether a new technology will actually be used in a real-life setting. Satisfaction measures were used to investigate whether user expectations and needs have been met through the use of technology. In this study, we asked surgeons to rate the perceived usefulness of teleguidance, and their satisfaction with the telemedicine service in direct conjunction with real-time use during clinical procedures. Methods We designed domain-specific measures for perceived usefulness and satisfaction, based on performance and outcome measures for the clinical procedure. Surgeons were asked to rate their user experience with the telemedicine service in direct conjunction with real-time use during clinical procedures. Results In total, 142 remote intraoperative consultations were conducted during ERCP procedures at 5 hospitals. The demand for teleguidance was more pronounced in cases with higher complexity. Operating surgeons rated teleguidance to have contributed to performance and outcomes to a moderate or large extent in 111 of 140 (79.3%) cases. Specific examples were that teleguidance was rated as having contributed to intervention success and avoiding a repeated ERCP in 23 cases, avoiding 3 PTC, and 11 referrals, and in 11 cases, combinations of these outcomes. Preprocedure beliefs about the usefulness of teleguidance were generally lower than postprocedure satisfaction ratings. The usefulness of teleguidance was mainly experienced through practical advice from the consulting specialist (119/140, 85%) and support with assessment and decision-making (122/140, 87%). Conclusions Users’ satisfaction with teleguidance surpassed their initial expectations, mainly through contribution to nontechnical aspects of performance, and through help with general assessment. Teleguidance shows the potential to improve performance and outcomes during ERCP. However, it takes hands-on experience for practitioners to understand how the new telemedicine service contributes to performance and outcomes.
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Affiliation(s)
- Hedvig Aminoff
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Sebastiaan Meijer
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Kristina Groth
- The Center for Innovation, Karolinska University Hospital, Stockholm, Sweden
| | - Urban Arnelo
- CLINTEC Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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Trupia DV, Mathieu-Fritz A, Duong TA. The Sociological Perspective of Users' Invisible Work: A Qualitative Research Framework for Studying Digital Health Innovations Integration. J Med Internet Res 2021; 23:e25159. [PMID: 34734832 PMCID: PMC8603174 DOI: 10.2196/25159] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/22/2021] [Accepted: 07/31/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND When new technology is integrated into a care pathway, it faces resistance due to the changes it introduces into the existing context. To understand the success or failure of digital health innovations, it is necessary to pay attention to the adjustments that users must perform to make them work, by reshaping the context and sometimes by altering the ways in which they perform activities. This adaptation work, most of which remains invisible, constitutes an important factor in the success of innovations and the ways in which they transform care practices. OBJECTIVE This work aims to present a sociological framework for studying new health technology uses through a qualitative analysis of the different types of tasks and activities that users, both health professionals and patients, must perform to integrate these technologies and make them work in their daily routine. METHODS This paper uses a three-part method to structure a theoretical model to study users' invisible work. The first part of the method includes a thematic literature review, previously published by one of the coauthors, of major sociological studies conducted on digital health innovations integration into existing care organizations and practices. The second part extends this review to introduce definitions and applications of the users' invisible work concept. The third part consists of producing a theoretical framework to study the concept according to the different contexts and practices of the users. RESULTS The paper proposes four dimensions (organizational, interactional, practical, and experiential), each composed of a set of criteria that allow a comparative analysis of different users' work according to different health technologies. CONCLUSIONS This framework can be applied both as an analytical tool in a research protocol and as an agenda to identify less visible adoption criteria for digital health technologies.
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Affiliation(s)
- Dilara Vanessa Trupia
- LATTS, Univ Gustave Eiffel, CNRS, Ecole des Ponts, Marne-la-Vallée, France.,INSERM, Chaire Avenir Santé Numérique IMRB U955, Équipe 8, University of Paris-Est Créteil, Créteil, France
| | | | - Tu Anh Duong
- INSERM, Chaire Avenir Santé Numérique IMRB U955, Équipe 8, University of Paris-Est Créteil, Créteil, France.,AP-HP, Department of Dermatology, Hôpital Henri-Mondor, Créteil, France
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Haydon HM, Caffery LJ, Snoswell CL, Thomas EE, Taylor M, Budge M, Probert J, Smith AC. Optimising specialist geriatric medicine services by telehealth. J Telemed Telecare 2021; 27:674-679. [PMID: 34726995 DOI: 10.1177/1357633x211041859] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Telehealth can effectively increase access to specialist care and reduce the need for travel. The Geri-Connect service was established in 2017 to support people living in residential aged care facilities in regional Victoria, Australia. Using the Model for the Assessment of Telemedicine, an evaluation of the Geri-Connect service identified service activity patterns and factors associated with uptake. Service activity from 2017 to 2020 and 10 semi-structured, key stakeholder interviews were captured and analysed. Between 2017 and 2020, video consultations were provided to 53 residential aged care facilities. Sustained growth (over 178%) and strong stakeholder acceptance highlight the effectiveness of this telegeriatric service. Four recommendations provide opportunities to further enhance service delivery including: implementation of an integrated health information system; systematic evaluation of service impact on stakeholders and residents, auditing and subsequent provision of targeted training; and regular auditing of software and hardware. Additionally, the need to augment fixed room hardware with mobile telehealth systems would increase access for residents with mobility problems. Dedicated personnel of the centralised team are best suited to implementing the recommendations. Whilst the provision of routine telehealth services into residential aged care facilities is challenging, the Geri-Connect service demonstrates that telehealth can be effectively provided to residential aged care facility residents needing specialist geriatric care.
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Affiliation(s)
- Helen M Haydon
- Centre for Online Health, 1974The University of Queensland, Australia.,Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Liam J Caffery
- Centre for Online Health, 1974The University of Queensland, Australia.,Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Centaine L Snoswell
- Centre for Online Health, 1974The University of Queensland, Australia.,Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Emma E Thomas
- Centre for Online Health, 1974The University of Queensland, Australia.,Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Monica Taylor
- Centre for Online Health, 1974The University of Queensland, Australia.,Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Marc Budge
- Integrated Care Services, Bendigo Health, Australia.,Monash University, Australia
| | - Jacinta Probert
- Integrated Care Services, Bendigo Health, Australia.,Monash University, Australia
| | - Anthony C Smith
- Centre for Online Health, 1974The University of Queensland, Australia.,Centre for Health Services Research, 1974The University of Queensland, Australia.,Centre for Innovative Medical Technology, University of Southern Denmark, Denmark
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Greffin K, Muehlan H, van den Berg N, Hoffmann W, Ritter O, Oeff M, Schomerus G, Schmidt S. Setting-Sensitive Conceptualization and Assessment of Quality of Life in Telemedical Care-Study Protocol of the Tele-QoL Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910454. [PMID: 34639754 PMCID: PMC8507616 DOI: 10.3390/ijerph181910454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
Quality of life (QoL) is a core patient-reported outcome in healthcare research, alongside primary clinical outcomes. A conceptual, operational, and psychometric elaboration of QoL in the context of TM is needed, because standardized instruments to assess QoL do not sufficiently represent essential aspects of intended outcomes of telemedical applications (TM). The overall aim is to develop an instrument that can adequately capture QoL in TM. For that purpose, an extended working model of QoL will be derived. Subsequently, an instrument will be developed and validated that captures those aspects of QoL that are influenced by TM. The initial exploratory study section includes (a) a systematic literature review, (b) a qualitative survey for concept elicitation, and (c) pre-testings using cognitive debriefings with patients and an expert workshop. The second quantitative section consists of an online expert survey and two patient surveys for piloting and validation of the newly developed instrument. The resulting questionnaire will assess central experiences of patients regarding telemedical applications and its impact on QoL more sensitively. Its use as adjunct instrument will lead to a more appropriate evaluation of TM and contribute to the improvement of care tailored to patients’ individual needs.
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Affiliation(s)
- Klara Greffin
- Department of Psychology, University of Greifswald, 17489 Greifswald, Germany; (H.M.); (S.S.)
- Correspondence: ; Tel.: +49-3834-420-3808
| | - Holger Muehlan
- Department of Psychology, University of Greifswald, 17489 Greifswald, Germany; (H.M.); (S.S.)
| | - Neeltje van den Berg
- Department of Health Care Epidemiology and Community Health, Institute of Community Medicine, University Medicine Greifswald, 17489 Greifswald, Germany; (N.v.d.B.); (W.H.)
| | - Wolfgang Hoffmann
- Department of Health Care Epidemiology and Community Health, Institute of Community Medicine, University Medicine Greifswald, 17489 Greifswald, Germany; (N.v.d.B.); (W.H.)
| | - Oliver Ritter
- Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany;
- Department of Cardiology, Brandenburg City Hospital, 14770 Brandenburg an der Havel, Germany;
| | - Michael Oeff
- Department of Cardiology, Brandenburg City Hospital, 14770 Brandenburg an der Havel, Germany;
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University Medicine Leipzig, 04103 Leipzig, Germany;
| | - Silke Schmidt
- Department of Psychology, University of Greifswald, 17489 Greifswald, Germany; (H.M.); (S.S.)
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Knapp A, Harst L, Hager S, Schmitt J, Scheibe M. Use of Patient-reported Outcome Measures and Patient-reported Experience Measures within Evaluation Studies of Telemedicine Applications: Systematic Review. J Med Internet Res 2021; 23:e30042. [PMID: 34523604 PMCID: PMC8663685 DOI: 10.2196/30042] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/06/2021] [Accepted: 09/12/2021] [Indexed: 01/08/2023] Open
Abstract
Background With the rise of digital health technologies and telemedicine, the need for evidence-based evaluation is growing. Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are recommended as an essential part of the evaluation of telemedicine. For the first time, a systematic review has been conducted to investigate the use of PROMs and PREMs in the evaluation studies of telemedicine covering all application types and medical purposes. Objective This study investigates the following research questions: in which scenarios are PROMs and PREMs collected for evaluation purposes, which PROM and PREM outcome domains have been covered and how often, which outcome measurement instruments have been used and how often, does the selection and quantity of PROMs and PREMs differ between study types and application types, and has the use of PROMs and PREMs changed over time. Methods We conducted a systematic literature search of the MEDLINE and Embase databases and included studies published from inception until April 2, 2020. We included studies evaluating telemedicine with patients as the main users; these studies reported PROMs and PREMs within randomized controlled trials, controlled trials, noncontrolled trials, and feasibility trials in English and German. Results Of the identified 2671 studies, 303 (11.34%) were included; of the 303 studies, 67 (22.1%) were feasibility studies, 70 (23.1%) were noncontrolled trials, 20 (6.6%) were controlled trials, and 146 (48.2%) were randomized controlled trials. Health-related quality of life (n=310; mean 1.02, SD 1.05), emotional function (n=244; mean 0.81, SD 1.18), and adherence (n=103; mean 0.34, SD 0.53) were the most frequently assessed outcome domains. Self-developed PROMs were used in 21.4% (65/303) of the studies, and self-developed PREMs were used in 22.3% (68/303). PROMs (n=884) were assessed more frequently than PREMs (n=234). As the evidence level of the studies increased, the number of PROMs also increased (τ=−0.45), and the number of PREMs decreased (τ=0.35). Since 2000, not only has the number of studies using PROMs and PREMs increased, but the level of evidence and the number of outcome measurement instruments used have also increased, with the number of PREMs permanently remaining at a lower level. Conclusions There have been increasingly more studies, particularly high-evidence studies, which use PROMs and PREMs to evaluate telemedicine. PROMs have been used more frequently than PREMs. With the increasing maturity stage of telemedicine applications and higher evidence level, the use of PROMs increased in line with the recommendations of evaluation guidelines. Health-related quality of life and emotional function were measured in almost all the studies. Simultaneously, health literacy as a precondition for using the application adequately, alongside proper training and guidance, has rarely been reported. Further efforts should be pursued to standardize PROM and PREM collection in evaluation studies of telemedicine.
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Affiliation(s)
- Andreas Knapp
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, Dresden, DE
| | - Lorenz Harst
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, Dresden, DE
| | - Stefan Hager
- Comprehensive Pain Center, University Hospital Carl Gustav Carus Dresden, Dresden, Germany, Dresden, DE
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, Dresden, DE
| | - Madlen Scheibe
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, Dresden, DE
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Roth CB, Papassotiropoulos A, Brühl AB, Lang UE, Huber CG. Psychiatry in the Digital Age: A Blessing or a Curse? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8302. [PMID: 34444055 PMCID: PMC8391902 DOI: 10.3390/ijerph18168302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 12/23/2022]
Abstract
Social distancing and the shortage of healthcare professionals during the COVID-19 pandemic, the impact of population aging on the healthcare system, as well as the rapid pace of digital innovation are catalyzing the development and implementation of new technologies and digital services in psychiatry. Is this transformation a blessing or a curse for psychiatry? To answer this question, we conducted a literature review covering a broad range of new technologies and eHealth services, including telepsychiatry; computer-, internet-, and app-based cognitive behavioral therapy; virtual reality; digital applied games; a digital medicine system; omics; neuroimaging; machine learning; precision psychiatry; clinical decision support; electronic health records; physician charting; digital language translators; and online mental health resources for patients. We found that eHealth services provide effective, scalable, and cost-efficient options for the treatment of people with limited or no access to mental health care. This review highlights innovative technologies spearheading the way to more effective and safer treatments. We identified artificially intelligent tools that relieve physicians from routine tasks, allowing them to focus on collaborative doctor-patient relationships. The transformation of traditional clinics into digital ones is outlined, and the challenges associated with the successful deployment of digitalization in psychiatry are highlighted.
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Affiliation(s)
- Carl B. Roth
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| | - Andreas Papassotiropoulos
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Birmannsgasse 8, CH-4055 Basel, Switzerland
- Division of Molecular Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, CH-4055 Basel, Switzerland
- Biozentrum, Life Sciences Training Facility, University of Basel, Klingelbergstrasse 50/70, CH-4056 Basel, Switzerland
| | - Annette B. Brühl
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| | - Undine E. Lang
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| | - Christian G. Huber
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
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Özkeskin M, Özden F, Ekmekçi Ö, Yüceyar N. The reliability and validity of the Turkish version of the Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ) and Telemedicine Patient Questionnaire (TPQ) in individuals with multiple sclerosis. Neurol Sci 2021; 43:1921-1927. [PMID: 34342782 PMCID: PMC8328809 DOI: 10.1007/s10072-021-05519-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/25/2021] [Indexed: 12/03/2022]
Abstract
Objective The study was aimed to translate and adapt the Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ) and Telemedicine Patient Questionnaire (TPQ) into Turkish, thereafter to analyze the psychometric properties of both questionnaires. Methods A total of 149 multiple sclerosis (MS) patients were recruited in the study. For 4 years, all patients were supervised by a department clinician using telemedicine. Cronbach’s alpha coefficient was used to assess internal consistency. By evaluating the scores of 41 retested patients 1 week later, the test-retest reliability was determined using the intraclass correlation coefficient (ICC). Pearson’s correlation coefficient was used to assess the construct validity (r). Results A total of 149 patients (103 women, 46 men) with a mean age of 40.9±10.9 years were included in the study. MS duration of the patients was 9.15±6.24 years. Internal consistency of all items and the total score of the TSUQ were excellent (>0.80; ranged 0.971–0.974). On the other hand, the internal consistency of all items and total score of the TPQ was excellent, either (>0.80; ranged 0.878–0.890). The ICC of the TSUQ’s and TPQ’s total score was excellent (>0.80). The correlation between TSUQ and TPQ was strong (r=0.734, p<0.01). In addition, there was moderate relationship between the TSUQ and the Beck Depression Scale (BDS) (r=−0.363, p<0.01). On the other hand, there was low correlation between TPQ and BDS (r=−0.217, p<0.05). Conclusion The Turkish version of the TSUQ and the TPQ is valid and reliable in individuals with MS.
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Affiliation(s)
- Mehmet Özkeskin
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ege University, İzmir, Turkey
| | - Fatih Özden
- Köyceğiz Vocational School of Health Services, Department of Elderly Care, Muğla Sıtkı Koçman University, 48800, Köyceğiz, Muğla, Turkey.
| | - Özgül Ekmekçi
- Faculty of Medicine, Department of Neurology, Ege University, İzmir, Turkey
| | - Nur Yüceyar
- Faculty of Medicine, Department of Neurology, Ege University, İzmir, Turkey
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Al-Khaled T, Valikodath NG, Patel SN, Cole E, Chervinko M, Douglas CE, Tsai ASH, Wu WC, Campbell JP, Chiang MF, Paul Chan RV. Addressing the Third Epidemic of Retinopathy of Prematurity Through Telemedicine and Technology: A Systematic Review. J Pediatr Ophthalmol Strabismus 2021; 58:261-269. [PMID: 34288773 DOI: 10.3928/01913913-20210223-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The rising prevalence of retinopathy of prematurity (ROP) in low- and middle-income countries has increased the need for screening at-risk infants. The purpose of this article was to review the impact of tele-medicine and technology on ROP screening programs. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was performed using PubMed, Pro-Quest, and Google Scholar bibliographic search engine. Terms searched included retinopathy of prematurity, telemedicine, and tele-ophthalmology. Data regarding internet access and gross domestic product per capita were obtained from the World Bank. Information was also obtained about internet access, speeds, and costs in low-income countries. There has been increasing integration of telemedicine and technology for ROP screening and management. Low-income countries are using available internet options and information and communications technology for ROP screening, which can aid in addressing the unique challenges faced by low-income countries. This provides a promising solution to the third epidemic of ROP by expanding and improving screening and management. Although telemedicine systems may serve as a cost-effective approach to facilitate delivery of health care, programs (especially in lowand middle-income countries) require national support to maintain its infrastructure. [J Pediatr Ophthalmol Strabismus. 2021;58(4):261-269.].
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Aranda-Lara JM, Acera SM. [Incorporation of telephone care into the provision of primary care and its effects on patient health and satisfaction: Proposal]. Semergen 2021; 48:129-136. [PMID: 34148783 DOI: 10.1016/j.semerg.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/09/2021] [Accepted: 04/30/2021] [Indexed: 11/26/2022]
Abstract
We present a review, analysis and proposal for the implantation, development and evaluation of telephone attention in primary care, focused as a new modality of offer that responds to standardized requirements of safety, efficacy, efficiency and balance not always easy to achieve, between the interests of users and professionals.
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Affiliation(s)
- J M Aranda-Lara
- Consejería de Salud y Familias, Delegación Territorial de Salud y Familias en Córdoba, Córdoba, España.
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Haridy J, Iyngkaran G, Nicoll A, Hebbard G, Tse E, Fazio T. eHealth Technologies for Screening, Diagnosis, and Management of Viral Hepatitis: A Systematic Review. Clin Gastroenterol Hepatol 2021; 19:1139-1150.e30. [PMID: 32896632 DOI: 10.1016/j.cgh.2020.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND & AIMS Chronic viral hepatitis is a leading cause of worldwide liver-related morbidity and mortality, despite the availability of effective treatments that reduce or prevent complications in most patients. Electronic-health (eHealth) technologies have potential to intervene along the whole cascade of care. We aimed to summarize available literature on eHealth interventions with respect to conventional screening, diagnostic and treatment outcomes in chronic hepatitis B (HBV) and hepatitis C (HCV). METHODS We systematically reviewed MEDLINE, EMBASE, Cochrane Library and international conference abstracts, including studies published from 2009 - 2020. Overall 80 studies were included, covering electronic medical record (EMR) interventions (n=39), telemedicine (n=20), mHealth (n=5), devices (n=4), clinical decision support (n=3), web-based (n=5), social media (n=1) and electronic communication (n=3). RESULTS Compared to standard care, EMR alerts increase screening rates in eligible populations including birth cohort screening in HCV, universal HCV screening in Emergency Departments, ethnic groups with high HBV prevalence, and HBV screening prior to immunosuppression. Direct messaging alerts to providers and automated testing may have a greater effect. No significant difference was found in sustained virological response outcomes between telemedicine and face-to-face management for community, rural and prison cohorts in HCV in the direct acting antiviral era of treatment, with higher patient satisfaction in telemedicine groups. CONCLUSIONS EMR alerts significantly increase screening rates in eligible cohorts in both chronic HBV and HCV. Telemedicine is equally efficacious to face-to-face care in HCV treatment. Other eHealth technologies show promise; however rigorous studies are lacking.
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Affiliation(s)
- James Haridy
- University of Melbourne, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Australia; Department of Gastroenterology and Hepatology, Eastern Health, Melbourne, Australia.
| | - Guru Iyngkaran
- University of Melbourne, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Australia; Department of Gastroenterology, Royal Darwin Hospital, Darwin, Australia
| | - Amanda Nicoll
- Department of Gastroenterology and Hepatology, Eastern Health, Melbourne, Australia; Monash University, Eastern Health Clinical School, Melbourne, Australia
| | - Geoffrey Hebbard
- University of Melbourne, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Australia
| | - Edmund Tse
- Department of Gastroenterology, Royal Darwin Hospital, Darwin, Australia; Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia; University of Adelaide, School of Medicine, Faculty of Health and Medical Sciences, Adelaide, Australia
| | - Timothy Fazio
- University of Melbourne, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Metabolic Diseases Unit, Royal Melbourne Hospital, Melbourne, Australia; Business Intelligence Unit, Royal Melbourne Hospital, Melbourne, Australia
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Parker RA, Padfield P, Hanley J, Pinnock H, Kennedy J, Stoddart A, Hammersley V, Sheikh A, McKinstry B. Examining the effectiveness of telemonitoring with routinely acquired blood pressure data in primary care: challenges in the statistical analysis. BMC Med Res Methodol 2021; 21:31. [PMID: 33568079 PMCID: PMC7877114 DOI: 10.1186/s12874-021-01219-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background Scale-up BP was a quasi-experimental implementation study, following a successful randomised controlled trial of the roll-out of telemonitoring in primary care across Lothian, Scotland. Our primary objective was to assess the effect of telemonitoring on blood pressure (BP) control using routinely collected data. Telemonitored systolic and diastolic BP were compared with surgery BP measurements from patients not using telemonitoring (comparator patients). The statistical analysis and interpretation of findings was challenging due to the broad range of biases potentially influencing the results, including differences in the frequency of readings, ‘white coat effect’, end digit preference, and missing data. Methods Four different statistical methods were employed in order to minimise the impact of these biases on the comparison between telemonitoring and comparator groups. These methods were “standardisation with stratification”, “standardisation with matching”, “regression adjustment for propensity score” and “random coefficient modelling”. The first three methods standardised the groups so that all participants provided exactly two measurements at baseline and 6–12 months follow-up prior to analysis. The fourth analysis used linear mixed modelling based on all available data. Results The standardisation with stratification analysis showed a significantly lower systolic BP in telemonitoring patients at 6–12 months follow-up (-4.06, 95% CI -6.30 to -1.82, p < 0.001) for patients with systolic BP below 135 at baseline. For the standardisation with matching and regression adjustment for propensity score analyses, systolic BP was significantly lower overall (− 5.96, 95% CI -8.36 to − 3.55 , p < 0.001) and (− 3.73, 95% CI− 5.34 to − 2.13, p < 0.001) respectively, even after assuming that − 5 of the difference was due to ‘white coat effect’. For the random coefficient modelling, the improvement in systolic BP was estimated to be -3.37 (95% CI -5.41 to -1.33 , p < 0.001) after 1 year. Conclusions The four analyses provide additional evidence for the effectiveness of telemonitoring in controlling BP in routine primary care. The random coefficient analysis is particularly recommended due to its ability to utilise all available data. However, adjusting for the complex array of biases was difficult. Researchers should appreciate the potential for bias in implementation studies and seek to acquire a detailed understanding of the study context in order to design appropriate analytical approaches. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01219-8.
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Affiliation(s)
| | - Paul Padfield
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Janet Hanley
- School of Health and Social Care. Edinburgh Napier University, Edinburgh, UK
| | | | - John Kennedy
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | | | | | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Hajesmaeel-Gohari S, Bahaadinbeigy K. The most used questionnaires for evaluating telemedicine services. BMC Med Inform Decis Mak 2021; 21:36. [PMID: 33531013 PMCID: PMC7852181 DOI: 10.1186/s12911-021-01407-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/25/2021] [Indexed: 12/13/2022] Open
Abstract
Background Questionnaires are commonly used tools in telemedicine services that can help to evaluate different aspects. Selecting the ideal questionnaire for this purpose may be challenging for researchers. This study aims to review which questionnaires are used to evaluate telemedicine services in the studies, which are most common, and what aspects of telemedicine evaluation do they capture. Methods The PubMed database was searched in August 2020 to retrieve articles. Data extracted from the final list of articles included author/year of publication, journal of publication, type of evaluation, and evaluation questionnaire. Data were analyzed using descriptive statistics. Results Fifty-three articles were included in this study. The questionnaire was used for evaluating the satisfaction (49%), usability (34%), acceptance (11.5%), and implementation (2%) of telemedicine services. Among telemedicine specific questionnaires, Telehealth Usability Questionnaire (TUQ) (19%), Telemedicine Satisfaction Questionnaire (TSQ) (13%), and Service User Technology Acceptability Questionnaire (SUTAQ) (5.5%), were respectively most frequently used in the collected articles. Other most used questionnaires generally used for evaluating the users’ satisfaction, usability, and acceptance of technology were Client Satisfaction Questionnaire (CSQ) (5.5%), Questionnaire for User Interaction Satisfaction (QUIS) (5.5%), System Usability Scale (SUS) (5.5%), Patient Satisfaction Questionnaire (PSQ) (5.5%), and Technology Acceptance Model (TAM) (3.5%) respectively. Conclusion Employing specifically designed questionnaires or designing a new questionnaire with fewer questions and more comprehensiveness in terms of the issues studied provides a better evaluation. Attention to user needs, end-user acceptance, and implementation processes, along with users' satisfaction and usability evaluation, may optimize telemedicine efforts in the future.
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Affiliation(s)
- Sadrieh Hajesmaeel-Gohari
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran.
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Korsgaard F, Hasenkam JM, Vesterby M. Successful implementation of telemedicine depends on personal relations between company representatives and healthcare providers: A qualitative study of business models for Danish home telemonitoring. Health Serv Manage Res 2021; 34:223-233. [PMID: 33508963 DOI: 10.1177/0951484820988628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The struggle to transform telemedicine from project level to daily clinical practice is ongoing. An assessment of the business models of telemedicine applications could provide insights into how to facilitate this transition. Our aim was to identify the qualitative characteristics of business models of long-term operational telemedicine providers in Denmark.A structured interview study design was applied to interviews of representatives from seven Danish companies providing home telemonitoring in long-term operation. Data was analysed using Osterwalder's Business Model Canvas framework.Multiple themes emphasized the importance of strong personal relationships between company representatives and healthcare providers. Personal relations could 1) secure a strong relationship to lead users and clinical ambassadors; 2) facilitate work with healthcare providers to develop, test and revise value propositions; 3) promote user support and education; 4) establish an indirect connection between companies and healthcare managers or decision makers.Thus, a strong personal relationship between company representatives and healthcare providers is of paramount importance when integrating home telemonitoring from project stage into clinical practice. However, this strategy could lack patient involvement, use of data, and business scalability. Additionally, companies with the ability to establish strong personal connections could be favoured over companies which provide strong clinical and economic evidence.
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Affiliation(s)
| | | | - Martin Vesterby
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Kaplan B. REVISITING HEALTH INFORMATION TECHNOLOGY ETHICAL, LEGAL, and SOCIAL ISSUES and EVALUATION: TELEHEALTH/TELEMEDICINE and COVID-19. Int J Med Inform 2020; 143:104239. [PMID: 33152653 PMCID: PMC7831568 DOI: 10.1016/j.ijmedinf.2020.104239] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Information technologies have been vital during the COVID-19 pandemic. Telehealth and telemedicine services, especially, fulfilled their promise by allowing patients to receive advice and care at a distance, making it safer for all concerned. Over the preceding years, professional societies, governments, and scholars examined ethical, legal, and social issues (ELSI) related to telemedicine and telehealth. Primary concerns evident from reviewing this literature have been quality of care, access, consent, and privacy. OBJECTIVES To identify and summarize ethical, legal, and social issues related to information technology in healthcare, as exemplified by telehealth and telemedicine. To expand on prior analyses and address gaps illuminated by the COVID-19 experience. To propose future research directions. METHODS Literature was identified through searches, forward and backward citation chaining, and the author's knowledge of scholars and works in the area. EU and professional organizations' guidelines, and nineteen scholarly papers were examined and categories created to identify ethical, legal, and social issues they addressed. A synthesis matrix was developed to categorize issues addressed by each source. RESULTS A synthesis matrix was developed and issues categorized as: quality of care, consent and autonomy, access to care and technology, legal and regulatory, clinician responsibilities, patient responsibilities, changed relationships, commercialization, policy, information needs, and evaluation, with subcategories that fleshed out each category. The literature primarily addressed quality of care, access, consent, and privacy. Other identified considerations were little discussed. These and newer concerns include: usability, tailoring services to each patient, curriculum and training, implementation, commercialization, and licensing and liability. The need for interoperability, data availability, cybersecurity, and informatics infrastructure also is more apparent. These issues are applicable to other information technologies in healthcare. CONCLUSIONS Clinicians and organizations need updated guidelines for ethical use of telemedicine and telehealth care, and decision- and policy-makers need evidence to inform decisions. The variety of newly implemented telemedicine services is an on-going natural experiment presenting an unparalleled opportunity to develop an evidence-based way forward. The paper recommends evaluation using an applied ethics, context-sensitive approach that explores interactions among multiple factors and considerations. It suggests evaluation questions to investigate ethical, social, and legal issues through multi-method, sociotechnical, interpretive and ethnographic, and interactionist evaluation approaches. Such evaluation can help telehealth, and other information technologies, be integrated into healthcare ethically and effectively.
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Affiliation(s)
- Bonnie Kaplan
- Yale Center for Medical Informatics, Yale Interdisciplinary Center for Bioethics, Yale Information Society Project, Yale Solomon Center for Health Law and Policy, Yale University, 238 Prospect St, New Haven, CT 06511, USA.
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Bonten TN, Rauwerdink A, Wyatt JC, Kasteleyn MJ, Witkamp L, Riper H, van Gemert-Pijnen LJ, Cresswell K, Sheikh A, Schijven MP, Chavannes NH. Online Guide for Electronic Health Evaluation Approaches: Systematic Scoping Review and Concept Mapping Study. J Med Internet Res 2020. [PMID: 32784173 DOI: 10.2196/1777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Despite the increase in use and high expectations of digital health solutions, scientific evidence about the effectiveness of electronic health (eHealth) and other aspects such as usability and accuracy is lagging behind. eHealth solutions are complex interventions, which require a wide array of evaluation approaches that are capable of answering the many different questions that arise during the consecutive study phases of eHealth development and implementation. However, evaluators seem to struggle in choosing suitable evaluation approaches in relation to a specific study phase. OBJECTIVE The objective of this project was to provide a structured overview of the existing eHealth evaluation approaches, with the aim of assisting eHealth evaluators in selecting a suitable approach for evaluating their eHealth solution at a specific evaluation study phase. METHODS Three consecutive steps were followed. Step 1 was a systematic scoping review, summarizing existing eHealth evaluation approaches. Step 2 was a concept mapping study asking eHealth researchers about approaches for evaluating eHealth. In step 3, the results of step 1 and 2 were used to develop an "eHealth evaluation cycle" and subsequently compose the online "eHealth methodology guide." RESULTS The scoping review yielded 57 articles describing 50 unique evaluation approaches. The concept mapping study questioned 43 eHealth researchers, resulting in 48 unique approaches. After removing duplicates, 75 unique evaluation approaches remained. Thereafter, an "eHealth evaluation cycle" was developed, consisting of six evaluation study phases: conceptual and planning, design, development and usability, pilot (feasibility), effectiveness (impact), uptake (implementation), and all phases. Finally, the "eHealth methodology guide" was composed by assigning the 75 evaluation approaches to the specific study phases of the "eHealth evaluation cycle." CONCLUSIONS Seventy-five unique evaluation approaches were found in the literature and suggested by eHealth researchers, which served as content for the online "eHealth methodology guide." By assisting evaluators in selecting a suitable evaluation approach in relation to a specific study phase of the "eHealth evaluation cycle," the guide aims to enhance the quality, safety, and successful long-term implementation of novel eHealth solutions.
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Affiliation(s)
- Tobias N Bonten
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Anneloek Rauwerdink
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, Netherlands
| | - Jeremy C Wyatt
- Wessex Institute, University of Southampton, Southampton, United Kingdom
| | - Marise J Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Leonard Witkamp
- Department of Medical Informatics, Amsterdam UMC, Amsterdam, Netherlands
- Ksyos Health Management Research, Amstelveen, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Lisette Jewc van Gemert-Pijnen
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Enschede, Netherlands
| | - Kathrin Cresswell
- Centre of Medical Informatics, Usher Institute, The University of Edinburgh, Medical School, Edinburgh, United Kingdom
| | - Aziz Sheikh
- Centre of Medical Informatics, Usher Institute, The University of Edinburgh, Medical School, Edinburgh, United Kingdom
| | - Marlies P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
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Bonten TN, Rauwerdink A, Wyatt JC, Kasteleyn MJ, Witkamp L, Riper H, van Gemert-Pijnen LJ, Cresswell K, Sheikh A, Schijven MP, Chavannes NH. Online Guide for Electronic Health Evaluation Approaches: Systematic Scoping Review and Concept Mapping Study. J Med Internet Res 2020; 22:e17774. [PMID: 32784173 PMCID: PMC7450369 DOI: 10.2196/17774] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/09/2020] [Accepted: 06/03/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Despite the increase in use and high expectations of digital health solutions, scientific evidence about the effectiveness of electronic health (eHealth) and other aspects such as usability and accuracy is lagging behind. eHealth solutions are complex interventions, which require a wide array of evaluation approaches that are capable of answering the many different questions that arise during the consecutive study phases of eHealth development and implementation. However, evaluators seem to struggle in choosing suitable evaluation approaches in relation to a specific study phase. OBJECTIVE The objective of this project was to provide a structured overview of the existing eHealth evaluation approaches, with the aim of assisting eHealth evaluators in selecting a suitable approach for evaluating their eHealth solution at a specific evaluation study phase. METHODS Three consecutive steps were followed. Step 1 was a systematic scoping review, summarizing existing eHealth evaluation approaches. Step 2 was a concept mapping study asking eHealth researchers about approaches for evaluating eHealth. In step 3, the results of step 1 and 2 were used to develop an "eHealth evaluation cycle" and subsequently compose the online "eHealth methodology guide." RESULTS The scoping review yielded 57 articles describing 50 unique evaluation approaches. The concept mapping study questioned 43 eHealth researchers, resulting in 48 unique approaches. After removing duplicates, 75 unique evaluation approaches remained. Thereafter, an "eHealth evaluation cycle" was developed, consisting of six evaluation study phases: conceptual and planning, design, development and usability, pilot (feasibility), effectiveness (impact), uptake (implementation), and all phases. Finally, the "eHealth methodology guide" was composed by assigning the 75 evaluation approaches to the specific study phases of the "eHealth evaluation cycle." CONCLUSIONS Seventy-five unique evaluation approaches were found in the literature and suggested by eHealth researchers, which served as content for the online "eHealth methodology guide." By assisting evaluators in selecting a suitable evaluation approach in relation to a specific study phase of the "eHealth evaluation cycle," the guide aims to enhance the quality, safety, and successful long-term implementation of novel eHealth solutions.
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Affiliation(s)
- Tobias N Bonten
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Anneloek Rauwerdink
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, Netherlands
| | - Jeremy C Wyatt
- Wessex Institute, University of Southampton, Southampton, United Kingdom
| | - Marise J Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Leonard Witkamp
- Department of Medical Informatics, Amsterdam UMC, Amsterdam, Netherlands
- Ksyos Health Management Research, Amstelveen, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Lisette Jewc van Gemert-Pijnen
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Enschede, Netherlands
| | - Kathrin Cresswell
- Centre of Medical Informatics, Usher Institute, The University of Edinburgh, Medical School, Edinburgh, United Kingdom
| | - Aziz Sheikh
- Centre of Medical Informatics, Usher Institute, The University of Edinburgh, Medical School, Edinburgh, United Kingdom
| | - Marlies P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
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Kernebeck S, Busse TS, Böttcher MD, Weitz J, Ehlers J, Bork U. Impact of mobile health and medical applications on clinical practice in gastroenterology. World J Gastroenterol 2020; 26:4182-4197. [PMID: 32848328 PMCID: PMC7422538 DOI: 10.3748/wjg.v26.i29.4182] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/09/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
Mobile health apps (MHAs) and medical apps (MAs) are becoming increasingly popular as digital interventions in a wide range of health-related applications in almost all sectors of healthcare. The surge in demand for digital medical solutions has been accelerated by the need for new diagnostic and therapeutic methods in the current coronavirus disease 2019 pandemic. This also applies to clinical practice in gastroenterology, which has, in many respects, undergone a recent digital transformation with numerous consequences that will impact patients and health care professionals in the near future. MHAs and MAs are considered to have great potential, especially for chronic diseases, as they can support the self-management of patients in many ways. Despite the great potential associated with the application of MHAs and MAs in gastroenterology and health care in general, there are numerous challenges to be met in the future, including both the ethical and legal aspects of applying this technology. The aim of this article is to provide an overview of the current status of MHA and MA use in the field of gastroenterology, describe the future perspectives in this field and point out some of the challenges that need to be addressed.
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Affiliation(s)
- Sven Kernebeck
- Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, Witten 58455, Germany
| | - Theresa S Busse
- Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, Witten 58455, Germany
| | - Maximilian D Böttcher
- Department of GI-, Thoracic- and Vascular Surgery, Dresden Technical University, University Hospital Dresden, Dresden 01307, Germany
| | - Jürgen Weitz
- Department of GI-, Thoracic- and Vascular Surgery, Dresden Technical University, University Hospital Dresden, Dresden 01307, Germany
| | - Jan Ehlers
- Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, Witten 58455, Germany
| | - Ulrich Bork
- Department of GI-, Thoracic- and Vascular Surgery, Dresden Technical University, University Hospital Dresden, Dresden 01307, Germany
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Timpel P, Oswald S, Schwarz PEH, Harst L. Mapping the Evidence on the Effectiveness of Telemedicine Interventions in Diabetes, Dyslipidemia, and Hypertension: An Umbrella Review of Systematic Reviews and Meta-Analyses. J Med Internet Res 2020; 22:e16791. [PMID: 32186516 PMCID: PMC7113804 DOI: 10.2196/16791] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/26/2019] [Accepted: 12/15/2019] [Indexed: 12/22/2022] Open
Abstract
Background Telemedicine is defined by three characteristics: (1) using information and communication technologies, (2) covering a geographical distance, and (3) involving professionals who deliver care directly to a patient or a group of patients. It is said to improve chronic care management and self-management in patients with chronic diseases. However, currently available guidelines for the care of patients with diabetes, hypertension, or dyslipidemia do not include evidence-based guidance on which components of telemedicine are most effective for which patient populations. Objective The primary aim of this study was to identify, synthesize, and critically appraise evidence on the effectiveness of telemedicine solutions and their components on clinical outcomes in patients with diabetes, hypertension, or dyslipidemia. Methods We conducted an umbrella review of high-level evidence, including systematic reviews and meta-analyses of randomized controlled trials. On the basis of predefined eligibility criteria, extensive automated and manual searches of the databases PubMed, EMBASE, and Cochrane Library were conducted. Two authors independently screened the studies, extracted data, and carried out the quality assessments. Extracted data were presented according to intervention components and patient characteristics using defined thresholds of clinical relevance. Overall certainty of outcomes was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Results Overall, 3564 references were identified, of which 46 records were included after applying eligibility criteria. The majority of included studies were published after 2015. Significant and clinically relevant reduction rates for glycated hemoglobin (HbA1c; ≤−0.5%) were found in patients with diabetes. Higher reduction rates were found for recently diagnosed patients and those with higher baseline HbA1c (>8%). Telemedicine was not found to have a significant and clinically meaningful impact on blood pressure. Only reviews or meta-analyses reporting lipid outcomes in patients with diabetes were found. GRADE assessment revealed that the overall quality of the evidence was low to very low. Conclusions The results of this umbrella review indicate that telemedicine has the potential to improve clinical outcomes in patients with diabetes. Although subgroup-specific effectiveness rates favoring certain intervention and population characteristics were found, the low GRADE ratings indicate that evidence can be considered as limited. Future updates of clinical care and practice guidelines should carefully assess the methodological quality of studies and the overall certainty of subgroup-specific outcomes before recommending telemedicine interventions for certain patient populations.
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Affiliation(s)
- Patrick Timpel
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sarah Oswald
- Master Program Health Sciences / Public Health at the Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine at the University Clinic Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Paul Langerhans Institute Dresden, Helmholtz Center Munich, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,German Center for Diabetes Research (DZD e V), Neuherberg, Germany
| | - Lorenz Harst
- Research Association Public Health Saxony / Center for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Telemonitoring and experimentation in telemedicine for the improvement of healthcare pathways (ETAPES program). Sustainability beyond 2021: What type of organisational model and funding should be used? Therapie 2020; 75:43-56. [DOI: 10.1016/j.therap.2019.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/28/2019] [Indexed: 11/19/2022]
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le Douarin Y, Traversino Y, Graciet A, Josseran A, Bili AB, Blaise L, Chatellier G, Coulonjou H, Delval C, Detournay B, Zaleski ID, Forest J, Saidani N, Vandenbergue J. Télésurveillance et expérimentations ETAPES. Quelle pérennité après 2021 : quel modèle organisationnel et financement ? Therapie 2020; 75:29-42. [DOI: 10.1016/j.therap.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022]
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Anastasiadou D, Folkvord F, Serrano-Troncoso E, Lupiañez-Villanueva F. Mobile Health Adoption in Mental Health: User Experience of a Mobile Health App for Patients With an Eating Disorder. JMIR Mhealth Uhealth 2019; 7:e12920. [PMID: 31199329 PMCID: PMC6592393 DOI: 10.2196/12920] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/19/2019] [Accepted: 04/23/2019] [Indexed: 12/19/2022] Open
Abstract
Background Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits for both patients and health care providers, the overall adoption levels of mHealth tools by health professionals remain relatively low. Objective This study aimed (1) to investigate attitudes of health care providers and mHealth experts toward mHealth tools in the health context in general, and this study aimed (2) to test the acceptability and feasibility of a specific mHealth tool for patients with an eating disorder (ED), called TCApp, among patients and ED specialists. Methods To this purpose, we conducted an explorative qualitative study with 4 in-depth group discussions with several groups of stakeholders: our first focus group was conducted with 11 experts on mHealth from the Catalan Association of Health Entities; the second focus group included 10 health care professionals from the Spanish College of Doctors of Barcelona; the third focus group involved 9 patients with an ED who had used the TCApp over a 12-week period, and the fourth and last focus group involved 8 ED specialists who had monitored such ED patients on the Web. Results The focus groups showed that health care providers and mHealth experts reported barriers for mHealth adoption more often than facilitators, indicating that mHealth techniques are difficult to obtain and use. Most barriers were attributed to external factors relating to the human or organizational environment (ie, lack of time because of workload, lack of direct interest on a legislative or political level) rather than being attributed to internal factors relating to individual obstacles. The results of the mHealth intervention study indicate that the TCApp was considered as easy to use and useful, although patients and the ED specialists monitoring them on the Web reported different adoption problems, such as the inability to personalize the app, a lack of motivational and interactive components, or difficulties in adhering to the study protocol. Conclusions In general, this paper indicates that both health professionals and patients foresee difficulties that need to be addressed before comprehensive adoption and usage of mHealth techniques can be effectively implemented. Such findings are in line with previous studies, suggesting that although they acknowledge their possible benefits and cost-effectiveness, health care providers are quite resistant and conservative about integrating mHealth technologies in their daily practice.
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Affiliation(s)
- Dimitra Anastasiadou
- Department of Information and Communication Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,Open Evidence Research, Barcelona, Spain
| | - Frans Folkvord
- Open Evidence Research, Barcelona, Spain.,School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | - Eduardo Serrano-Troncoso
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Barcelona, Spain.,Children and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Francisco Lupiañez-Villanueva
- Department of Information and Communication Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,Open Evidence Research, Barcelona, Spain
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Allner R, Wilfling D, Kidholm K, Steinhäuser J. [Telemedicine projects in rural areas of Germany. A systematic evaluation with the "Model for Assessment of Telemedicine"]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2019; 141-142:89-95. [PMID: 30962133 DOI: 10.1016/j.zefq.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/27/2019] [Accepted: 03/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The term telemedicine describes the delivery of healthcare services through the use of information and communication technologies in a situation where the actors are at different locations. While telemedical applications are piloted in research projects in Germany, they have rarely become part of everyday care. In order to find indications as to why the transfer of knowledge into practice has so far been slow, it is necessary to examine telemedical projects for aspects of implementation science. METHODS A systematic search looking for telemedical projects in Germany was conducted in the electronic databases PubMed, Web of Science and ACM Digital Library using a complex search strategy. The criteria and domains of the Model for Assessment of Telemedicine (MAST) were used to evaluate the publications. RESULTS A total of 336 publications were identified, 16 of which were ultimately included in the analysis. Much of the work deals with stroke and the implementation of telemedicine networks. The analysis according to MAST shows that most publications omit essential considerations. CONCLUSION Publications on telemedical projects are often characterized by unsystematic approaches. The MAST instrument identifies areas where the approaches to telemedical projects could be extended in the future to ensure the sustainability and feasibility of these prototypical telemedical applications.
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Affiliation(s)
- Raphael Allner
- Institut für Telematik, Universität zu Lübeck, Lübeck, Germany.
| | - Denise Wilfling
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Jost Steinhäuser
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Abimbola S, Li C, Mitchell M, Everett M, Casburn K, Crooks P, Hammond R, Milling H, Ling L, Reilly A, Crawford A, Cane L, Hopp D, Stolp E, Davies S, Martiniuk A. On the same page: Co-designing the logic model of a telehealth service for children in rural and remote Australia. Digit Health 2019; 5:2055207619826468. [PMID: 30729024 PMCID: PMC6350127 DOI: 10.1177/2055207619826468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/05/2019] [Indexed: 11/21/2022] Open
Abstract
The value of programme logic models as a tool for planning, evaluation, and
communication is well recognised. However, the value of its development
process is less discussed. In this paper, we describe how
we used a combination of literature review and organisational stakeholder
consultations to develop a logic model for a telehealth programme for children
in rural and remote Australia. Our aim was to use this process to further embed
the programme within its implementing organisation, and by so doing to promote
its sustainability and scale-up; a major challenge of telehealth programmes,
especially those involving reorganisation of processes. Our efforts to describe
the components of this complex intervention on the one-page logic model allowed
for debates and discussions within the implementing organisation which then
facilitated an improved cross-organisational understanding of the telehealth
programme; a real time face-to-face (video-link) service which requires the
reorganisation of existing service delivery platforms. The process helped to
embed the telehealth programme within existing services. We conclude that
stakeholder engagement in developing logic models can transform them from being
only a tool that provides the picture of why and how a programme works, to one
that plays a role in embedding programmes within implementing organisations.
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Affiliation(s)
- Seye Abimbola
- School of Public Health, The University of Sydney, Australia
| | - Clare Li
- School of Public Health, The University of Sydney, Australia
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A Conceptual Framework and Pilot Study for Examining Telemedicine Satisfaction Research. J Med Syst 2019; 43:51. [PMID: 30684065 DOI: 10.1007/s10916-019-1161-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 01/08/2019] [Indexed: 12/20/2022]
Abstract
Stakeholder satisfaction is often considered a key to the success of telemedicine systems. However, it can be difficult to understand and compare satisfaction evaluations because of variations in reporting and study designs. This research will contribute to the knowledge by developing a conceptual framework around key concepts that relate to understanding studies on telemedicine satisfaction. The framework is built based on a developmental review of the telemedicine and telehealth literature obtained from searches of PubMed and Google Scholar. Using a conceptual matrix, researchers have synthesized the results into a framework that includes: satisfaction dimensions, stakeholders, type of care, type of system, context and methodologies. This research expands these concepts by discussing attributes of each and tests the framework by conducting a pilot study that identifies the concepts in primary study sources. The results of the framework and the pilot study are reported.
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Schellong J, Lorenz P, Weidner K. Proposing a standardized, step-by-step model for creating post-traumatic stress disorder (PTSD) related mobile mental health apps in a framework based on technical and medical norms. Eur J Psychotraumatol 2019; 10:1611090. [PMID: 31143412 PMCID: PMC6522973 DOI: 10.1080/20008198.2019.1611090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/01/2019] [Accepted: 04/15/2019] [Indexed: 12/30/2022] Open
Abstract
Background: Prevalence of post-traumatic stress disorder (PTSD) is a problem all over the world. There are high barriers for entry into formal psychotherapy, which results in a lack of mental health care for a significant part of the population. Mobile mental Health (mMHealth) applications (apps) seem to be a promising new development for countering this lack of care, building on the success of mHealth (Mobile Health) apps in general. Unfortunately, the overall quality of such apps stands in high contrast to their number. The aim of this manuscript is to propose a standard for creating PTSD-related mMHealth apps incorporating a process for evaluation and assessment of their usability and impact. Methods: This is done by first defining each step of the process and its relation to the other steps. The steps themselves, divided into those concerned with development, evaluation and implementation, are bound to the established medical and technical norms pertaining to them. Existing protocols from recent literature have been integrated into these steps. Results: As a result, a comprehensive model covering the process of creating, assessing and implementing an mMHealth app from start to finish was developed. The model may be adapted to other disorders or specialized for certain symptoms of PTSD. Conclusion: Adopting such a model could result in a 'blueprint' for creating mMHealth apps in a standardized way, thereby facilitating the testing and comparing of such apps.
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Affiliation(s)
- Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Patrick Lorenz
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Garne Holm K, Brødsgaard A, Zachariassen G, Smith AC, Clemensen J. Parent perspectives of neonatal tele-homecare: A qualitative study. J Telemed Telecare 2018; 25:221-229. [PMID: 29792079 DOI: 10.1177/1357633x18765059] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Neonatal homecare for preterm infants is a method of supporting families and monitoring infant growth in the home setting. Telehealth may be used to deliver specialist neonatal care remotely, using online communication methods. This study explored parental experiences with neonatal tele-homecare (NTH). METHODS Semi-structured interviews were conducted with 49 parents whose preterm infants had received NTH from a neonatal intensive care unit (NICU) in Denmark. Interview transcripts were analysed using Malterud's systematic text condensation. RESULTS Parents experienced NTH as a personalised method for linking to specialist staff in the NICU. NTH promoted the parent's role as the primary care provider, further strengthening the parent-infant relationship. DISCUSSION From the perspective of parents with preterm infants requiring specialist care, NTH is a useful method of supporting families in the home. Telehealth provides effective communication links with NICU specialists and encourages family-centred care.
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Affiliation(s)
- Kristina Garne Holm
- 1 Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,2 Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Anne Brødsgaard
- 3 Department of Pediatrics, Copenhagen University Hospital Amager Hvidovre, Capital Region of Denmark, Denmark.,4 Department of Nursing Science, Faculty of Public Health, Aarhus University, Denmark
| | - Gitte Zachariassen
- 1 Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,2 Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Anthony C Smith
- 5 Centre for Online Health, University of Queensland, Brisbane, Australia
| | - Jane Clemensen
- 1 Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,2 Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,6 Centre of Innovative Medical Technology, Odense University Hospital, Odense, Denmark
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Garne Holm K, Brødsgaard A, Zachariassen G, Smith AC, Clemensen J. Participatory design methods for the development of a clinical telehealth service for neonatal homecare. SAGE Open Med 2017; 5:2050312117731252. [PMID: 28975028 PMCID: PMC5613838 DOI: 10.1177/2050312117731252] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/17/2017] [Indexed: 11/20/2022] Open
Abstract
Objectives: Neonatal homecare delivered during home visits by neonatal nurses is a common method for supporting families of preterm infants following discharge. Telehealth has been introduced for the provision of neonatal homecare, resulting in positive feedback from parents of preterm infants. While the benefits are beginning to be realised, widespread uptake of telehealth has been limited due to a range of logistical challenges. Understanding user requirements is important when planning and developing a clinical telehealth service. We therefore used participatory design to develop a clinical telehealth service for neonatal homecare. Methods: The study adopted a participatory design approach to engage users in the development and design of a new telehealth service. Participatory design embraces qualitative research methods. Creative and technical workshops were conducted as part of the study. Tests of the telehealth service were conducted in the neonatal unit. Participants in this study were former and current parents of preterm infants eligible for neonatal homecare, and clinical staff (medical and nursing) from the neonatal unit. Preterm infants accompanied their parents. Results: Based on the results obtained during the workshops and subsequent testing, we developed an application (app), which was integrated into the medical record at the neonatal unit. The app was used to initiate videoconferences and chat messages between the family at home and the neonatal unit, and to share information regarding infant growth and well-being. Conclusion: Results obtained from the workshops and testing demonstrated the importance of involving users when developing new telehealth applications. The workshops helped identify the challenges associated with delivery of the service, and helped instruct the design of a new telehealth service for neonatal homecare based on the needs of parents and clinical staff.
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Affiliation(s)
- Kristina Garne Holm
- HCA Research, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Anne Brødsgaard
- Paediatric Department, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Section for Nursing, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Gitte Zachariassen
- HCA Research, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Anthony C Smith
- Centre for Online Health, University of Queensland, Brisbane, QLD, Australia.,Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Jane Clemensen
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
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