Non-use of telemedicine: A scoping review

Telemedicine and Remote Management of Patients with Heart Failure: From Theory to Daily Practice

Background: Heart failure (HF) is responsible for a high number of hospitalizations, caused by a progressive worsening quality of life. Telemedicine allows for better management of patients' complex conditions, improving the care released. However, the risk of remaining at a testing stage often limits the integration of remote care in daily pathways for HF patients. The aim of this study is to outline the steps needed to integrate telemedicine activities into ordinary HF clinic practices. This methodology is applied to observe activities and trend improvements over a 12-month routine phase. Method: Three steps have been defined for an efficient introduction of remote care services in ordinary activities, integrating them with traditional in-person care: (i) introduction of temporary telemedicine projects, (ii) systematization of telemedicine pathways, and (iii) evaluation of monitoring phase. Observational data have been collected from structured interviews to show the rate of telemedicine activities achieved in clinical practice over the last year. Results: The methodology has been proposed in the HF clinic of the Italian hospital ASST Bergamo Est. After an initial testing phase, in which usability and user experience have been tested, four different remote activities were added: (i) telemonitoring for patients with an implantable device, (ii) follow-up televisits, (iii) nursing telephone support, and (iv) high-intensity telesurveillance pathways for patients after an HF acute event. During the last year, 218 telemonitoring pathways, 75 televisits, 500 telephone calls, and nine telesurveillance pathways have been performed. Success rates were high, and patients gave positive feedback. Conclusion: By integrating multiple telemedicine activities, it has been possible to better manage complex patients, keep track of disease progression, and improve their participation in care.

Evolving migraine management: Lithuania's telemedicine experience

Introduction

COVID-19 challenges have underscored the potential of telemedicine in migraine management. This study focuses on assessing patients' telemedicine experience for headache management in Lithuania and identifying key barriers and facilitators for its wider use.

Methods

A nationwide e-survey was conducted in 2023 via the Lithuanian Association of Migraine Patients' website, social media platforms, websites of public and private healthcare facilities, and migraine self-help groups. The survey covered sociodemographics, migraine characteristics, previous experience with teleconsultations for headaches with neurologists and general practitioners (GP), perceived advantages and disadvantages of telehealth, and preferred future consultation types.

Results

Eight hundred and forty seven respondents with a confirmed migraine diagnosis were analyzed. The majority were female (97.2%), with a median age of 35 (IQR 30-42) years and an average of 5 (IQR 3-9) monthly headache days (MHDs). 7.0% of respondents had chronic migraine (CM). Prior teleconsultations for headaches were reported by 35.2% of respondents, 26.2% with a GP and 17.0% with a neurologist (p < 0.0001). Teleconsultation outcomes included continuation of a prescribed treatment (84.7% for GPs and 83.3% for neurologists, p = 0.7295), initiation of new acute medications (12.2% for GPs with 70.4% reported as effective and 27.1% for neurologists with 84.6% effective, p = 0.0005 and p < 0.0001, respectively). Reasons for not undergoing remote neurology consultations: the lack of inquiry (69.7%), unavailability from neurologists (18.1%) and respondent's opposition to remote consultations (12.2%). Patients evaluated their experience with remote neurology services better than that of GPs (p = 0.0289). 67.3% of respondents preferred a mixed-mode approach for future consultations. In-person-only preference (29.0%) correlated with multiple factors, including history of remote primary neurology consultations (OR 5.89, p = 0.0022), lower education (OR 2.20, p = 0.0001), physically demanding work (OR 1.95, p = 0.0001), and number of drawbacks in telemedicine identified (OR 1.30, p < 0.0001), and worse experience of a prior remote GP consultation (OR 0.704, p < 0.0001). The main indicator of preference for remote-only consultations was the perception of fewer telemedicine disadvantages (OR 0.503, p = 0.0007).

Conclusions

Our findings confirm that telemedicine contributes to effective migraine management and is used limitedly in Lithuania. Despite one-third of respondents having experienced teleconsultations, significant barriers remain. Our study highlights a clear preference for a hybrid consultation type.

Patients' perspectives on digital health tools

Objective

Digital technology has changed the way healthcare is delivered and accessed. However, the focus is mostly on technology and clinical aspects. This review aimed to integrate and critically analyse the available knowledge regarding patients' perspectives on digital health tools and identify facilitators and barriers to their uptake.

Methods

A narrative review was conducted using the Scopus and Google Scholar databases. Information related to facilitators and barriers to uptake was synthesised and interpreted using thematic and content analyses, respectively.

Results

Seventy-one out of 1722 articles identified were eligible for inclusion. Patient empowerment, self-management, and personalisation were identified as the main factors that contributed to patient uptake in using digital health tools. Digital literacy, health literacy, and privacy concerns were identified as barriers to the uptake of digital health technology.

Conclusion

Digital health technologies have changed the way healthcare is experienced by patients. Research highlights the disconnect between the development and implementation of digital health tools and the patients they are created for. This review may serve as the foundation for future research incorporating patients' perspectives to help increase patients' engagement with emerging technologies.

Innovation

Participatory design approaches have the potential to support the creation of patient-centred digital health tools.

Uptake and Use of Care Companion, a Web-Based Information Resource for Supporting Informal Carers of Older People: Mixed Methods Study

BACKGROUND

Informal carers play a major role in supporting relatives and friends who are sick, disabled, or frail. Access to information, guidance, and support that are relevant to the lives and circumstances of carers is critical to carers feeling supported in their role. When unmet, this need is known to adversely affect carer resilience and well-being. To address this problem, Care Companion was co-designed with current and former carers and stakeholders as a free-to-use, web-based resource to provide access to a broad range of tailored information, including links to local and national resources.

OBJECTIVE

This study aimed to investigate the real-world uptake and use of Care Companion in 1 region of England (with known carer population of approximately 100,000), with local health, community, and social care teams being asked to actively promote its use.

METHODS

The study had a convergent parallel, mixed methods design and drew on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Data included metrics from carers' use of Care Companion, surveys completed by users recruited through general practice, and interviews with carers and health and social care providers regarding their views about Care Companion and their response to it. Quantitative data were analyzed using descriptive statistics. Interview data were analyzed thematically and synthesized to create overarching themes. The qualitative findings were used for in-depth exploration and interpretation of quantitative results.

RESULTS

Despite awareness-raising activities by relevant health, social care, and community organizations, there was limited uptake with only 556 carers (0.87% of the known carer population of 100,000) registering to use Care Companion in total, with median of 2 (mean 7.2; mode 2) visits per registered user. Interviews with carers (n=29) and stakeholders (n=12) identified 7 key themes that influenced registration, use, and perceived value: stakeholders' signposting of carers to Care Companion, expectations about Care Companion, activity levels and conflicting priorities, experience of using Care Companion, relevance to personal circumstances, social isolation and networks, and experience with digital technology. Although many interviewed carers felt that it was potentially useful, few considered it as being of direct relevance to their own circumstances. For some, concerns about social isolation and lack of hands-on support were more pressing issues than the need for information.

CONCLUSIONS

The gap between the enthusiastic views expressed by carers during Care Companion's co-design and the subsequent low level of uptake and user experience observed in this evaluation suggests that the co-design process may have lacked a sufficiently diverse set of viewpoints. Numerous factors were identified as contributing to Care Companion's level of use, some of which might have been anticipated during its co-design. More emphasis on the development and implementation, including continuing co-design support after deployment, may have supported increased use.

Effects of Web-Based and Mobile Self-Care Support in Addition to Standard Care in Patients After Radical Prostatectomy: Randomized Controlled Trial

BACKGROUND

Prostate cancer is a common form of cancer that is often treated with radical prostatectomy, which can leave patients with urinary incontinence and sexual dysfunction. Self-care (pelvic floor muscle exercises and physical activity) is recommended to reduce the side effects. As more and more men are living in the aftermath of treatment, effective rehabilitation support is warranted. Digital self-care support has the potential to improve patient outcomes, but it has rarely been evaluated longitudinally in randomized controlled trials. Therefore, we developed and evaluated the effects of digital self-care support (electronic Patient Activation in Treatment at Home [ePATH]) on prostate-specific symptoms.

OBJECTIVE

This study aimed to investigate the effects of web-based and mobile self-care support on urinary continence, sexual function, and self-care, compared with standard care, at 1, 3, 6, and 12 months after radical prostatectomy.

METHODS

A multicenter randomized controlled trial with 2 study arms was conducted, with the longitudinal effects of additional digital self-care support (ePATH) compared with those of standard care alone. ePATH was designed based on the self-determination theory to strengthen patients' activation in self-care through nurse-assisted individualized modules. Men planned for radical prostatectomy at 3 county hospitals in southern Sweden were included offline and randomly assigned to the intervention or control group. The effects of ePATH were evaluated for 1 year after surgery using self-assessed questionnaires. Linear mixed models and ordinal regression analyses were performed.

RESULTS

This study included 170 men (85 in each group) from January 2018 to December 2019. The participants in the intervention and control groups did not differ in their demographic characteristics. In the intervention group, 64% (53/83) of the participants used ePATH, but the use declined over time. The linear mixed model showed no substantial differences between the groups in urinary continence (β=-5.60; P=.09; 95% CI -12.15 to -0.96) or sexual function (β=-.12; P=.97; 95% CI -7.05 to -6.81). Participants in the intervention and control groups did not differ in physical activity (odds ratio 1.16, 95% CI 0.71-1.89; P=.57) or pelvic floor muscle exercises (odds ratio 1.51, 95% CI 0.86-2.66; P=.15).

CONCLUSIONS

ePATH did not affect postoperative side effects or self-care but reflected how this support may work in typical clinical conditions. To complement standard rehabilitation, digital self-care support must be adapted to the context and individual preferences for use and effect.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN18055968; https://www.isrctn.com/ISRCTN18055968.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/11625.

Attitude, awareness, and knowledge of telemedicine among medical students: A systematic review of cross‐sectional studies

Background and Aims

The success of every new technology depends on numerous factors, including specialists' knowledge and perceptions of the concept, acquired attitude skills, and work environments. This systematic review aimed to examine medical students' knowledge, attitudes, and perceptions of telemedicine.

Methods

Studies were obtained from the PubMed, Embase, Scopus, and Web of Science databases on June 9, 2022. We followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Cross‐sectional studies that examined medical students' knowledge, attitude, and perceptions of telemedicine approaches were considered inclusion criteria. Titles and abstracts were independently screened based on eligibility criteria. Articles that did not meet the inclusion criteria were excluded from this review. After that, the complete texts were retrieved and screened by two separate researchers based on the eligibility criteria. Disputes were resolved by discussion. The same checklist was used for data extraction. To assess the quality of the studies entering this study, the Joanna Briggs Institute Critical Appraisal Checklist for analytical cross‐sectional studies was used.

Results

In total, 10 eligible articles were found through this review. The sample size of the studies ranged from 60 to 3312 participants, or 6172 participants on the whole. The medical students' attitudes toward telemedicine were evaluated in eight included studies. Many of these studies (seven cases) reported positive and promising perspectives on telemedicine. However, in one study, participants revealed moderate attitudes toward online health information and online health experience sharing (p < 0.05). Students' knowledge of the telemedicine approach was evaluated in eight included studies. Many of these studies (five cases) reported that students possessed an extensively poor knowledge of telemedicine's uses. In three other studies, two reported moderate and one disclosed desirable levels of students' knowledge. All the included studies attributed medical students' poor knowledge to the lack of, and thus failure of, educational courses in this field.

Conclusion

The evidence obtained from this review reveals that medical students possess positive and promising attitudes toward telemedicine technology for education, treatment, and care. However, their knowledge levels were extremely insufficient, and many had not passed any educational courses in this respect. Such results can foreground the health and education policymakers' obligations for planning, training, and empowering digital health and telemedicine literacy among medical students as the primary players in social health.

A Postphenomenological Perspective On the Changing Nature of Work

In this essay, I take a postphenomenological perspective on tracing work transformation during the pandemic, arguing that this perspective helps develop novel sensitivities to the nature of work. Postphenomenology brings into high relief the view on work as reliant on sensory performances and embodied relations, complementing already rich accounts of work being reliant on discursive interactions, social order, and spatiality. The focus of postphenomenology on 'non-neutrality' and the multistability of technology provides a useful lens for revealing a multiplicity of changes, encompassing both augmentations and reductions of work experiences and evaluating their consequences for the actors involved. Finally, its attention to the transparency of technology amidst the embodied experiences gives a handle on the role of materiality in the performance of work and may be taken up as informing design efforts. A case study vignette of physiotherapy work during lockdown is offered as an illustration of applying some of the postphenomenological ideas.

Dentistry website analysis: An overview of the content of formulated questions and answers

Aim

This study aimed to analyze the content of questions and answers posted on dentistry websites.

Subject and methods

A mixed-method study was conducted in 2020. A total of 1354 related questions were included, of which 1182 were answered by dentists. The data was analyzed quantitatively according to the classification of the questions, main complaints of the subjects and length of the questions and answers using Excel₂₀₁₃. A qualitative content analysis was carried out also for data robustness and triangulation.

Results

Of the 1354 questions, 866 of them were categorized into 11 categories according to the main sub-classes of the International Classification of Diseases to Dentistry and Stomatology. Furthermore, the inquiries were allocated to 3 communication styles to present the users' main complaints that included contextual (52.33%), emotional (6.79%) and focal (40.89%) strategies. Results of the qualitative content analysis have led to 6 main themes: seeking the related recommendations of any actions, treatment seeking, information seeking, seeking for causes and reasons, seeking for oral and dental health recommendations and seeking for the dentists' diagnosis or comments.

Conclusions

The present study can be used for designing specific customized websites of dentistry and help the website managers for better optimization of the websites. All these interventions can pave the way for developing teleconsulting in dentistry for middle-income countries.

Telerehabilitation improves physical function and reduces dyspnoea in people with COVID-19 and post-COVID-19 conditions: a systematic review

QUESTION

How effective and safe is telerehabilitation for people with COVID-19 and post-COVID-19 conditions?

DESIGN

Systematic review of randomised trials.

PARTICIPANTS

People with COVID-19 and post-COVID-19 conditions.

INTERVENTION

Any type of telerehabilitation.

OUTCOME MEASURES

Satisfaction, quality of life, adverse events, adherence to telerehabilitation, dyspnoea, functional performance, readmissions, mortality, pulmonary function and level of independence.

RESULTS

Database searches retrieved 2,962 records, of which six trials with 323 participants were included in the review. Breathing exercises delivered via telerehabilitation improved 6-minute walk distance (MD 101 m, 95% CI 61 to 141; two studies), 30-second sit-to-stand test performance (MD 2.2 repetitions, 95% CI 1.5 to 2.8; two studies), Multidimensional Dyspnoea-12 questionnaire scores (MD -6, 95% CI -7 to -5; two studies) and perceived effort on the 0-to-10 Borg scale (MD -2.8, 95% CI -3.3 to -2.3; two studies), with low certainty of evidence. Exercise delivered via telerehabilitation improved 6-minute walk distance (MD 62 m, 95% CI 42 to 82, four studies), 30-second sit-to-stand test performance (MD 2.0 repetitions, 95% CI 1.3 to 2.7; two studies) and Multidimensional Dyspnoea-12 scores (MD -1.8, 95% CI -2.5 to -1.1; one study), with low certainty of evidence. Adverse events were almost all mild or moderate and occurred with similar frequency in the telerehabilitation group (median 0 per participant, IQR 0 to 2.75) as in the control group (median 0 per participant, IQR 0 to 2); Hodges-Lehmann median difference 0 (95% CI 0 to 0), with low certainty of evidence.

CONCLUSION

Telerehabilitation may improve functional capacity, dyspnoea, performance and physical components of quality of life and does not substantially increase adverse events.

REGISTRATION

PROSPERO CRD42021271049.

An empirical study of factors influencing e-health services adoption among public in Saudi Arabia

Until now most of the studies concerning eHealth in Saudi Arabia are about the exploration of the national benefits from eHealth and the technical and infrastructural challenges in implementing eHealth rather than finding the factors influencing the users in adopting eHealth services. Further, the eHealth adoption rate in Saudi Arabia is low despite the scope of potential growth for the eHealth market. In this study, the authors added Trust, Privacy and System Quality factors to Technology Acceptance Model by considering the research context to examine the factors influencing eHealth services adoption. The proposed model was empirically tested based on the data collected, through survey questionnaire from 314 responses in Saudi Arabia. Structural Equation Modelling was followed to analysis and validates the proposed model based on partial least squares method using SmartPLS. Based on the findings, Perceived Usefulness in addition to Privacy significantly affect eHealth adoption. Moreover, Perceived Ease of Use factor has indirect effect on people perception toward eHealth services. Furthermore, the results show that System Quality and Trust are not influencing factors. This study is important for the healthcare policymakers for getting direction for future studies to avail the maximum benefits of eHealth in Saudi Arabia.

Long-Term Effects of a Video-Based Smartphone App ("VIDEA Bewegt") to Increase the Physical Activity of German Adults: A Single-Armed Observational Follow-Up Study

As physical inactivity is one of the four leading risk factors for mortality, it should be intensively treated. Therefore, this one-year follow-up study aimed to evaluate the long-term effects of a preventive app to increase physical activity in German adults under real-life circumstances. Data collection took place from July 2019 to July 2021 and included six online questionnaires. Physical activity was studied as the primary outcome based on MET-minutes per week (metabolic equivalent). Secondary outcomes included health-related quality of life based on a mental (MCS) and physical health component summary score (PCS). At the time of publication, 46/65 participants completed the study (median 52 years, 81.5% women). A significant increase of physical activity was observed in people with a low/moderate baseline activity during the first four months of follow-up (median increase by 490 MET-minutes per week, p < 0.001, r = 0.649). Both MCS (median increase by 2.8, p = 0.006, r = 0.344) and PCS (median increase by 2.6, p < 0.001, r = 0.521) significantly increased during the first two months and the BMI significantly decreased during the first six months after the intervention (median decrease by 0.96 kg/m2, p < 0.001, r = 0.465). Thus, this study provides evidence for the medium-term impact of the app, since the effects decreased over time. However, due to the chosen study design and a sizeable loss to follow-up, the validity of these findings is limited.