The Role of Telemedicine in Voice Therapy

Introduction: During the COVID-19 pandemic, our institution adopted telemedicine for voice therapy (VT) as an alternative to in-person sessions, which has been integrated into our routine practice following the pandemic. This study aims to explore factors influencing completion rates among the 2 methods. Method: A retrospective chart review at a single tertiary care institution between 2019 and 2021 was conducted. Patient zip codes were used to determine Neighborhood Atlas® Area Deprivation Index (ADI) scores and travel distance to our institution. Demographic data, Voice Handicap Index (VHI) scores, and completion status were extracted. Results: Between 2019 and 2021, 521 patients were referred to VT at our institution, with 29% opting for telemedicine VT (TVT) sessions and 71% choosing in-person sessions. Seventy-four percent was female, and average age was 57.1 years (range:10-89 years old). No statistically significant differences were observed between the 2 groups regarding sex, age, employment status, or insurance type. Participants in the TVT group demonstrated notably higher completion rates compared to the in-person group [70.0% vs 31.6% (P < .001)]. The TVT group also comprised of a higher percentage of white patients, reported longer travel distances and times to reach therapy, but had comparable ADI scores to the in-person group. Moreover, there were no significant differences in pretreatment VHI scores between the 2 groups or between those who completed therapy versus those who did not (P = .501). Conclusion: Our findings indicate that patients utilizing the telemedicine platform had significantly higher VT completion rates compared to patients appearing in person. These results highlight the importance of being able to offer telemedicine-based options in the management of voice patients.

Patient and provider perspectives to utilization of telemedicine in surgery

Objectives

Determine patient and provider perspectives on widespread rapid telemedicine implementation, understand the key components of a surgical telemedicine visit and identify factors that affect future telemedicine use.

Summary of background data

Compared to other specialties, the field of surgery heretofore has had limited adoption of telemedicine. During the COVID-19 pandemic Healthcare, including the surgical specialties, saw new widespread use of telemedicine.

Methods

We conducted a prospective cohort study during the COVID-19 California stay-at-home and physical distancing executive orders. Utilization data were collected from clinics and compared to usage data during the same time 1 year later. All patients and providers who participated in a telemedicine visit during the study period were asked to complete a survey after each encounter and the surveys were analyzed for trends in opinions on future use by stakeholders.

Results

Over the 10-week period, the median percentage of telemedicine visits per clinic was 33% (17%-51%) which peaked 3 weeks into implementation. One hundred and ninety-one patients (48% women) with a median age of 64 years (IQR 53-73) completed the patient survey. Patients were first-time participants in telemedicine in 41% (n = 79) of visits. Fifty-seven percent (n = 45) of first-time users preferred that future visits be in-person versus 31% of prior users (p = 0.007). The median travel time from home to the clinic was 40 min (IQR = 20-90). Patients with longer travel times were not more likely to use telemedicine in the future (61% with longer travel vs. 53% shorter, p = 0.11). From the 148 provider responses, 90% of the visits providers were able to create a definitive plan with the telemedicine visit. A physical exam was determined not to be needed in 45% of the visits. An attempt at any physical exam was not performed in 84% of routine follow-up or new-patient visits, compared to 53% of post-op visits (p = 0.001).

Conclusion

Telemedicine is a viable ambulatory visit option for surgical specialists and their patients. During rapid telemedicine deployment, travel distance did not correlate with increased use of telemedicine, and in-person visits are still preferred. However, nearly half of all visits did not need a physical exam, which favors telemedicine use.

Tradução, adaptação transcultural e validação de questionário de satisfação em telemedicina

Introdução: A telemedicina facilita o acesso ao cuidado para os pacientes. Essa tecnologia tem apresentado bons resultados clínicos e de satisfação dos usuários. A satisfação é um dos principais indicadores de qualidade dos serviços, e sua avaliação permite mudanças na qualidade da prestação de cuidados, identifica problemas e viabiliza a melhor gestão e os melhores comportamentos dos profissionais de saúde. Do aumento do uso da telemedicina no mundo emergiu a necessidade de entendimento da qualidade desse serviço. Objetivo: Traduzir, adaptar culturalmente e validar um questionário para avaliação da satisfação de pacientes atendidos por telemedicina. Métodos: A versão adaptada após a avaliação por um comitê de juízes foi utilizada em pré-teste com 30 pacientes atendidos no projeto TeleOftalmo. Os resultados do pré-teste foram avaliados a fim de se obter uma versão adequada do instrumento. Além disso, o instrumento foi aplicado em uma amostra de 141 pacientes atendidos via telemedicina. Análises de consistência interna e de validação de constructo foram realizadas. Resultados: O coeficiente de validade de conteúdo (CVC) global foi 0,942, demonstrando clareza, pertinência e relevância das questões. O instrumento apresentou consistência interna com alfa de Cronbach estandardizado de 0,6, considerado aceitável. A análise fatorial exploratória apresentou critério de Kaiser-Meyer-Olkin de adequação de amostragem de 0,56 e o teste de esfericidade de Bartlett apresentou valor de 0,001. Conclusões: A versão brasileira do Questionário de Avaliação da Satisfação de Pacientes Atendidos via Telemedicina (QAS-Tele) é um instrumento fácil e viável para a avaliação da satisfação dos pacientes atendidos por telemedicina.

Exploring Quality Differences in Telemedicine Between Hospital Outpatient Departments and Community Clinics: A Cross-Sectional Study

Background

Telemedicine is a care delivery modality that has the potential to broaden the reach and flexibility of health care services. In the United Arab Emirates, telemedicine services are mainly delivered through either integrated hospital outpatient department (OPDs) or community clinics. However, it is unknown if patients’ perceptions of, and satisfaction with, telemedicine services differ between these two types of health care systems during the COVID-19 pandemic.

Objective

We aimed to explore the differences in patients’ perceptions of, and satisfaction with, telemedicine between hospital OPDs and community clinics during the COVID-19 pandemic. We also aimed to identify patient- or visit-related characteristics contributing to patient satisfaction with telemedicine.

Methods

In this cross-sectional study that was conducted at Abu Dhabi health care centers, we invited outpatients aged 18 years or over, who completed a telemedicine visit during the COVID-19 pandemic, to participate in our study. Patients’ perceptions of, and satisfaction with, telemedicine regarding the two system types (ie, hospital OPDs and community clinics) were assessed using an online survey that was sent as a link through the SMS system. Regression models were used to describe the association between patient- and visit-related characteristics, as well as the perception of, and satisfaction with, telemedicine services.

Results

A total of 515 patients participated in this survey. Patients’ satisfaction with telemedicine services was equally high among the settings, with no statistically significant difference between the two setting types (hospital OPDs: 253/343, 73.8%; community clinics: 114/172, 66.3%; P=.19). Video consultation was significantly associated with increased patient satisfaction (odds ratio [OR] 2.57, 95% CI 1.04-6.33; P=.04) and patients’ support of the transition to telemedicine use during and after the pandemic (OR 2.88, 95% CI 1.18-7.07; P=.02). Patients who used video consultations were more likely to report that telemedicine improved access to health care services (OR 3.06, 95% CI 1.71-8.03; P=.02), reduced waiting times and travel costs (OR 4.94, 95% CI 1.15-21.19; P=.03), addressed patients’ needs (OR 2.63, 95% CI 1.13-6.11; P=.03), and eased expression of patients’ medical concerns during the COVID-19 pandemic (OR 2.19, 95% CI 0.89-5.38; P=.09). Surprisingly, middle-aged patients were two times more likely to be satisfied with telemedicine services (OR 2.12, 95% CI 1.09-4.14; P=.03), as compared to any other age group in this study.

Conclusions

These findings suggest that patient satisfaction was unaffected by the health system setting in which patients received the teleconsultations, whether they were at hospitals or community clinics. Video consultation was associated with increased patient satisfaction with telemedicine services. Efforts should be focused on strategic planning for enhanced telemedicine services, video consultation in particular, for both emergent circumstances, such as the COVID-19 pandemic, and day-to-day health care delivery.

Forecasting care seekers satisfaction with telemedicine using machine learning and structural equation modeling

Many individuals visit rural telemedicine centres to obtain safe and effective health remedies for their physical and emotional illnesses. This study investigates the antecedents of patients’ satisfaction relating to telemedicine adoption in rural public hospitals settings in Bangladesh through the adaptation of Expectation Disconfirmation Theory extended by Social Cognitive Theory. This research advances a theoretically sustained prediction model forecasting patients’ satisfaction with telemedicine to enable informed decision making. A research model explores four potential antecedents: expectations, performance, disconfirmation, and enjoyment; that significantly contribute to predicting patients’ satisfaction concerning telemedicine adoption in Bangladesh. This model is validated using two-staged structural equation modeling and artificial neural network approaches. The findings demonstrate the determinants of patients’ satisfaction with telemedicine. The presented model will assist medical practitioners, academics, and information systems practitioners to develop high-quality decisions in the future application of telemedicine. Pertinent implications, limitations and future research directions are endorsed securing long-term telemedicine sustainability.

Patient and clinician satisfaction with video consultations during the COVID-19 pandemic: an opportunity for a new way of working

OBJECTIVE

To assess satisfaction of patients and clinicians with virtual appointments using Attend Anywhere for their orthodontic consultation and to identify any areas where the technology could be further utilised.

DESIGN

Service evaluation involving descriptive cross-sectional questionnaire.

SETTING

Orthodontic Departments at Royal Blackburn Teaching Hospital and Burnley General Teaching Hospital.

PARTICIPANTS

Patients and clinicians involved in video consultations.

METHODS

Patient- and clinician-specific questionnaires were designed and those involved in virtual clinics were invited to complete these at the end of their consultation. The questionnaires focused on setting up and connecting to the virtual clinic, assessing if the correct types of patients were involved in the clinics and satisfaction with these types of remote consultations.

RESULTS

A total of 121 questionnaires (59 patient and 62 clinician) were completed. Of the patients, 93% found the instructions provided to access the consultation easy to follow and 70% of clinicians did not report any connection issues. In 90% of cases, a virtual appointment was seen to be appropriate by the clinician. Respondents showed a high level of satisfaction with 76% of patients saying a remote consultation was more convenient than face-to-face, and 66% reporting they would, if appropriate, like more appointments like this in the future.

CONCLUSION

The overall satisfaction among patients with virtual clinics introduced during the COVID-19 pandemic was generally high. The majority of patients would, where appropriate, prefer more virtual appointments in the future in comparison to face-to-face appointments and it was found to be more convenient for the patient.

A Conceptual Framework and Pilot Study for Examining Telemedicine Satisfaction Research

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.

The Person-Centred Care Guideline: From Principle to Practice

BACKGROUND

A standardized definition and approach for the delivery of person-centered care (PCC) in cancer care that is agreed upon by all key policy makers and clinicians is lacking. The PCC Guideline defines core PCC principles to outline a level of service that every person accessing cancer services in Ontario, Canada should expect to receive. This article describes the dissemination of the PCC Guideline in practice.

METHODS

Three strategies were utilized: (1) educational intervention via a PCC video, (2) media engagement, and (3) research/knowledge user networks.

RESULTS

As of October 2016, the PCC video has been viewed 7745 times across 92 countries. Significant mean differences pre- and post-PCC video were found for understanding of PCC principles (P < .001) and perceived ability to bring these PCC principles to practice (P < .001). Through content analysis, the PCC Guideline recommendations were referenced 236 times, with "Enabling Patients to Actively Participate in their Care" (n = 81), and "Essential Requirements of Care" (n = 79) being referenced most frequently.

CONCLUSIONS

These strategies are an effective way to target multiple PCC stakeholders in the health-care system to increase awareness of the PCC Guideline, in order to further impart knowledge of PCC behaviors.

Advice to give advice

Matthew L. Stevens, Chung-Wei C. Lin, Flavia A. de Carvalho, Kevin Phan, Bart Koes, Chris G. Maher. Advice for acute low back pain: A comparison of what research supports and what guidelines recommend. The Spine Journal, In Press.

Successes and challenges in a field-based, multi-method study of home telehealth

We are conducting a three-year study of telehealth in 11 home care offices that serve rural clients in Alberta. Three hundred and twenty palliative home care clients are being recruited to participate in a randomized controlled trial (RCT) to answer three questions about the use of video-phones and their effect on symptom management, quality of life and cost, as well as readiness to use the technology. Both successes and challenges have been identified in three main areas: technology, people/organizational issues and study design. Maintaining study integrity has been the key factor in decision making, as adjustments from the original proposal are made. It is already clear that field-based RCTs are feasible, but require commitment and flexibility on the part of researchers and community partners to work through the study implementation.

Patient perceptions of preoperative anaesthesia assessment at a distance

We investigated patient perceptions of a pilot telemedicine preoperative evaluation clinic. Thirteen patients scheduled for elective surgery participated in an outpatient clinic-based preoperative evaluation using telemedicine. The clinic was 80 km from the tertiary care surgical centre. At the clinic, there was an anaesthesia nurse practitioner. An anaesthetist evaluated electrocardiograms, medical records and physical findings via a videoconferencing link. The subjects completed a 15–item, 5–point Likert scale questionnaire. The mean score in the technical quality domain (five items) was 1.7. The mean score in the efficacy perception domain (four items) was 1.6. The mean score in the affective experience domain (three items) was 4.4 (negative perception questions). The mean score in the patient preference domain (three items) was 1.3. The present study confirms that patients accepted remote preoperative anaesthesia services, with positive perceptions in the four domains examined.

Opioid use disorder patients' perceptions of healthcare delivery platforms

OBJECTIVES

To assess the acceptability and quality of web-based videoconferencing telemedicine consultation platform in the treatment of opioid use disorder at TrueNorth Medical Centre.

METHODS

We conducted an interview based quality improvement initiative using an investigator-designed questionnaire. The questionnaire consisted of 17 Agree/Disagree questions, measured on a 7-point Likert scale and 2 questions where patients had the ability to elaborate qualitatively on their perceptions and experiences with their telemedicine service. Content-style analysis was performed on qualitative responses.

RESULTS

The majority of patients (n=14; 47%) preferred face-to-face over telemedicine consultations. The number of patients that preferred telemedicine consultations over face-to-face consultations was lower (n=6; 20%). A notable number of patients (n=10; 33%) indicated no specific preference for either telemedicine or face-to-face consultations. Patients preferring face-to-face consultations rated their clinical outcome and patient-physician relationship following telemedicine consultations similarly as those who preferred telemedicine consultations. Patients preferring telemedicine rated their experience and overall perceptions of the service significantly higher than those preferring face-to-face consultations. Patients who preferred telemedicine consultations identified the efficient and timesaving nature of telemedicine consultations as primary advantages whereas those preferring face-to-face consultations reported lower levels of empathy from their physician during telemedicine consultations as a major disadvantage.

CONCLUSIONS

The majority of patients at TrueNorth Medical Centre viewed telemedicine consultations as an acceptable treatment modality. Patients preferring telemedicine consultations and those preferring face-to-face consultations evaluated the majority of the measured indices of care in a similar fashion.

The Meaning of ‘Satisfaction’ for People with Dermatological Problems: Reassessing Approaches to Qualitative Health Psychology Research

A qualitative study was undertaken to explore descriptions of satisfaction with health care, with 30 dermatology patients. The relevance and usefulness of the approach chosen to analyse the data-interpretative phenomenological analysis (IPA) was also retrospectively evaluated. The findings suggest that ‘satisfaction’ is a complex and fluid construct, which is defined, redefined and re-evaluated by participants throughout the interview process. IPA was useful in guiding the analysis. However, in order to build upon this approach, it is suggested that more attention be paid to the sequential nature of an individual account/interview, which might lead to a more informed understanding of the meaning of patient satisfaction.

Health information technology and dynamic capabilities

BACKGROUND

Health information technology (HIT) purports to increase quality and efficiency in health care organizations. However, health care organizations are situated in constantly changing environments. They need dynamic capabilities to implement HIT effectively.

PURPOSES

This article builds on the dynamic capabilities perspective and generates propositions about implementing HIT in dynamic environments. Specifically, I identify the (1) the necessary resources and capabilities for organizations to implement HIT; (2) the organizational capabilities and benefits that can be enhanced by HIT; and (3) the similarities and differences between three distinct forms of HIT.

APPROACH

I synthesized the literature on dynamic capabilities and HIT to identify dynamic capabilities that are associated with (1) electronic medical records, (2) telemedicine, and (3) social media. In addition, I discuss the benefits of these HITs for improving the dynamic capabilities of health care organizations. PROPOSITIONS/FINDINGS: This article generates three sets of propositions that can be tested empirically. First, I am concerned with how organizational size and human resources affect successful implementation of HIT. In addition, I argue that three technology-specific factors--hospital type, medical specialty, and socially desirable technical features--may affect the implementation of HIT.

PRACTICAL IMPLICATIONS

To cope with constantly changing environmental pressures, health administrators need to deploy, modify, and/or acquire organizational resources skillfully. Practitioners need to identify dynamic capabilities to support specific forms of HIT and understand how HIT enables health care organizations in turn. The concept of evolutionary fitness in the dynamic capabilities perspective may be developed to measure HIT implementation.

Women's experience of telehealth cancer genetic counseling

Telegenetics offers an alternative model of delivering genetic counseling to rural and outreach areas; however there is a dearth of qualitative research into the patient's experience. Twelve women who had received telemedicine genetic counseling for hereditary breast and/or ovarian cancer (HBOC) within the previous 12 months participated in a semi-structured telephone interview. The interview explored women's experience with telegenetics, satisfaction, perceived advantages and disadvantages and quality of the interaction with their genetic professionals. Overall women were highly satisfied with telegenetics. Telegenetics offered them convenience and reduced travel and associated costs. The majority of women described feeling a high degree of social presence, or rapport, with the off-site genetic clinician. One woman with a recent cancer diagnosis, reported that telemedicine was unable to meet her needs for psychosocial support. This finding highlights the need to be mindful of the psychosocial support needs of women with a recent diagnosis being seen via telegenetics. Patients attending for HBOC genetic counseling are generally highly satisfied with the technology and the interaction. Care should be taken, however, with patients with more complex psychosocial needs.

Views on technology among people in need of health care at home

OBJECTIVES

The aim of this study was to describe how people in need of health care at home view technology.

STUDY DESIGN

A qualitative approach was used based on qualitative interviews, followed by qualitative content analysis.

METHODS

District nurses (DNs) from 4 health care centres in Northern Sweden had access to different kinds of distance-spanning technology with mobile devices and who used it in their health care at home. Persons in whose home the technology was being used were asked to participate in an interview. The interviewed persons were selected consecutively.

RESULTS

The results fall into 2 categories: (1) The well-known technology at hospital is new at home, (2) the new technology opens up possibilities but it also has limitations, with seven adherent subcategories.

CONCLUSIONS

The participants viewed the technology at home as something good and as something that could open up possibilities. At the same time, they placed the use of the technology in the hands of the staff which indicates some degree of dissociation from the technology. The importance of personal meetings between patient and caregiver was very clearly stressed even when distance meetings could be performed and accepted. The participants expressed immense trust in the nursing staff and considered them responsible for the new technology at home.

Technical and patient performance using a virtual reality-integrated telerehabilitation system: preliminary finding

Telerehabilitation is the provision of rehabilitation services at a distance by a therapist at a remote location. Integration with virtual reality (VR) is a relatively new addition to this field. This paper describes the technical and patient performance of a telerehabilitation application the remote console (ReCon) that is integrated with a VR system. The VR system consists of the Rutgers Ankle prototype robot, a local PC which is connected with a remote PC connected over the Internet. Six individuals in the chronic phase poststroke participated in a four week training program. They used the robot to interact with two VR simulations, while the therapist was in the same room during the first three weeks or in another room during the fourth week. Technical and patient performance was assessed in the transition from the third to the fourth week of training. Technical performance of the system was assessed based on bandwidth and lag of message transmission, which were found to be suitable for clinic-to-clinic communication. Patient performance (in terms of accuracy of ankle movement, exercise duration and training efficiency, mechanical power of the ankle, and number of repetitions) did not decrease during telerehabilitation in the fourth week. These preliminary findings over a short telerehabilitation intervention support the feasibility of remote monitoring of VR-based telerehabilitation without adverse effects on patient performance.

Moving research into practice: A decision framework for integrating home telehealth into chronic illness care

Home telehealth is an effective alternative for some aspects of traditional care in chronic illnesses such as diabetes, congestive heart failure and asthma. However, in spite of evidence to support use of home telehealth technologies, they have not been adopted as predicted. A significant challenge for decision-makers is applying results from multiple small studies to the care of large numbers of clients in a health region. Aside from the technology, this complex decision must also include expected client outcomes, variations in nursing resources and their deployment in service delivery. This paper presents research evidence supporting the effectiveness of home telehealth for diabetes care, with attention to the range of technologies and outcome measures reported. It also discusses implications of a recently released national study on "Homecare Indicators" that reported resource allocation and outcomes in home care. The burden of illness, evidence of technology effectiveness and proposed home care outcome indicators are considered together in a decision framework to demonstrate an approach for decision-makers and practitioners to transfer home telehealth research into practice. The resulting decision framework is applied to diabetes care within one large health region in Canada to illustrate its utility as a research transfer strategy.

Limitations of patient satisfaction studies in telehealthcare: a systematic review of the literature

The objective of this study is to provide a systematic review of studies on patient satisfaction with telemedicine. The review included empirical studies that investigated patient satisfaction with that telemedicine service. The search strategy involved matching at least one of 11 'telemedicine' terms with one of 5 'satisfaction' terms. The following databases were searched: Telemedicine Information Exchange (TIE) database, MEDLINE, Science Citation Index (SCI), Social Science Citation Index (SSCI), Psycinfo, and Citation Index of Nursing and Allied Health (CINAHL). A highly structured instrument was used for data extraction. The review included 93 studies. Telepsychiatry represents the largest portion of these studies (25%), followed by multispecialty care (14%), nursing (11%), and dermatology (8%). Real-time videoconferencing was used in 88% of these studies. Only 19 (20%) included an independent control group, including 9 (10%) randomized control trial (RCT) studies. One third of studies were based on samples of less than 20 patients, and only 21% had samples of over 100 patients. Aspects of patient satisfaction most commonly assessed were: professional-patient interaction, the patient's feeling about the consultation, and technical aspects of the consultation. Only 33% of the studies included a measure of preference between telemedicine and face-to-face consultation. Almost half the studies measured only 1 or 2 dimensions of satisfaction. Reported levels of satisfaction with telemedicine are consistently greater than 80%, and frequently reported at 100%. Progression of telemedicine services from "trial" status to routine health service must be supported by improved research into patients' satisfaction with telemedicine. Further investigation of factors that influence patient acceptance of telemedicine is indicated.