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Oppelaar MC, Emond Y, Bannier MAGE, Reijers MHE, van der Vaart H, van der Meer R, Altenburg J, Conemans L, Rottier BL, Nuijsink M, van den Wijngaart LS, Merkus PJFM, Heinen M, Roukema J. Potential, Pitfalls, and Future Directions for Remote Monitoring of Chronic Respiratory Diseases: Multicenter Mixed Methods Study in Routine Cystic Fibrosis Care. J Med Internet Res 2024; 26:e54942. [PMID: 39106098 PMCID: PMC11336494 DOI: 10.2196/54942] [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: 11/28/2023] [Revised: 04/09/2024] [Accepted: 05/27/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND The current literature inadequately addresses the extent to which remote monitoring should be integrated into care models for chronic respiratory diseases (CRDs). OBJECTIVE This study examined a remote monitoring program (RMP) in cystic fibrosis (CF) by exploring experiences, future perspectives, and use behavior over 3 years, with the aim of developing future directions for remote monitoring in CRDs. METHODS This was a mixed methods, multicenter, observational study in 5 Dutch CF centers following a sequential explanatory design. Self-designed questionnaires using the technology acceptance model were sent out to people with CF who had a minimum of 12 months of experience with the RMP and local health care professionals (HCPs). Questionnaire outcomes were used to inform semistructured interviews with HCPs and people with CF. Qualitative findings were reported following the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Anonymous data on use frequency of all people with CF were analyzed. RESULTS Between the second quarter of 2020 and the end of 2022, a total of 608 people with CF were enrolled in the program, and a total of 9418 lung function tests and 2631 symptom surveys were conducted. In total, 65% (24/37) of HCPs and 89% (72/81) of people with CF responded to the questionnaire, and 7 HCPs and 12 people with CF participated in semistructured interviews. Both people with CF and HCPs were positive about remote monitoring in CF care and found the RMP a good addition to daily care (people with CF: 44/72, 61%; HCPs: 21/24, 88%). Benefits ranged from supporting individual patients to reducing health care consumption. The most valued monitoring tool was home spirometry by both people with CF (66/72, 92%) and HCPs (22/24, 92%). Downsides included the potential to lose sight of patients and negative psychosocial effects, as 17% (12/72) of people with CF experienced some form of stress due to the RMP. A large majority of people with CF (59/72, 82%) and HCPs (22/24, 92%) wanted to keep using the RMP in future, with 79% (19/24) of HCPs and 75% (54/72) of people with CF looking forward to more replacement of in-person care with digital care during periods of well-being. Future perspectives for the RMP were centered on creating hybrid care models, personalizing remote care, and balancing individual benefits with monitoring burden. CONCLUSIONS Remote monitoring has considerable potential in supporting people with CF and HCPs within the CF care model. We identified 4 practice-based future directions for remote monitoring in CF and CRD care. The strategies, ranging from patient driven to prediction driven, can help clinicians, researchers, and policy makers navigate the rapidly changing digital health field, integrate remote monitoring into local care models, and align remote care with patient and clinician needs.
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Affiliation(s)
- Martinus C Oppelaar
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Yvette Emond
- IQ Health Science Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Michiel A G E Bannier
- Department of Paediatric Pulmonology, MosaKids Children's Hospital, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Monique H E Reijers
- Department of Pulmonology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hester van der Vaart
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Josje Altenburg
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Lennart Conemans
- Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
- Division of Respiratory & Age-related Health, Department of Respiratory Medicine, NUTRIM Institute of Nutrition and Translational Research in Metabolism, Maastricht, Netherlands
| | - Bart L Rottier
- Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, Netherlands
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marianne Nuijsink
- Haga Teaching Hospital, Juliana Children's Hospital, The Hague, Netherlands
| | - Lara S van den Wijngaart
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peter J F M Merkus
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Maud Heinen
- IQ Health Science Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jolt Roukema
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
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Aggelidis X, Kritikou M, Makris M, Miligkos M, Papapostolou N, Papadopoulos NG, Xepapadaki P. Tele-Monitoring Applications in Respiratory Allergy. J Clin Med 2024; 13:898. [PMID: 38337592 PMCID: PMC10856055 DOI: 10.3390/jcm13030898] [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: 01/10/2024] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Respiratory allergic diseases affect over 500 million people globally and pose a substantial burden in terms of morbidity, mortality, and healthcare costs. Restrictive factors such as geographical disparities, infectious pandemics, limitations in resources, and shortages of allergy specialists in underserved areas impede effective management. Telemedicine encompasses real-time visits, store-and-forward option triage, and computer-based technologies for establishing efficient doctor-patient communication. Recent advances in digital technology, including designated applications, informative materials, digital examination devices, wearables, digital inhalers, and integrated platforms, facilitate personalized and evidence-based care delivery. The integration of telemonitoring in respiratory allergy care has shown beneficial effects on disease control, adherence, and quality of life. While the COVID-19 pandemic accelerated the adoption of telemedicine, certain concerns regarding technical requirements, platform quality, safety, reimbursement, and regulatory considerations remain unresolved. The integration of artificial intelligence (AI) in telemonitoring applications holds promise for data analysis, pattern recognition, and personalized treatment plans. Striking the balance between AI-enabled insights and human expertise is crucial for optimizing the benefits of telemonitoring. While telemonitoring exhibits potential for enhancing patient care and healthcare delivery, critical considerations have to be addressed in order to ensure the successful integration of telemonitoring into the healthcare landscape.
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Affiliation(s)
- Xenofon Aggelidis
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (X.A.); (M.M.); (N.P.)
| | - Maria Kritikou
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
| | - Michael Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (X.A.); (M.M.); (N.P.)
| | - Michael Miligkos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
| | - Niki Papapostolou
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (X.A.); (M.M.); (N.P.)
| | - Nikolaos G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
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Stanic T, Saygin Avsar T, Gomes M. Economic Evaluations of Digital Health Interventions for Children and Adolescents: Systematic Review. J Med Internet Res 2023; 25:e45958. [PMID: 37921844 PMCID: PMC10656663 DOI: 10.2196/45958] [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: 01/23/2023] [Revised: 06/13/2023] [Accepted: 08/03/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Digital health interventions (DHIs) are defined as digital technologies such as digital health applications and information and communications technology systems (including SMS text messages) implemented to meet health objectives. DHIs implemented using various technologies, ranging from electronic medical records to videoconferencing systems and mobile apps, have experienced substantial growth and uptake in recent years. Although the clinical effectiveness of DHIs for children and adolescents has been relatively well studied, much less is known about the cost-effectiveness of these interventions. OBJECTIVE This study aimed to systematically review economic evaluations of DHIs for pediatric and adolescent populations. This study also reviewed methodological issues specific to economic evaluations of DHIs to inform future research priorities. METHODS We conducted a database search in PubMed from 2011 to 2021 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. In total, 2 authors independently screened the titles and abstracts of the search results to identify studies eligible for full-text review. We generated a data abstraction procedure based on recommendations from the Panel on Cost-Effectiveness in Health and Medicine. The types of economic evaluations included in this review were cost-effectiveness analyses (costs per clinical effect), cost-benefit analyses (costs and effects expressed in monetary terms as net benefit), and cost-utility analyses (cost per quality-adjusted life year or disability-adjusted life year). Narrative analysis was used to synthesize the quantitative data because of heterogeneity across the studies. We extracted methodological issues related to study design, analysis framework, cost and outcome measurement, and methodological assumptions regarding the health economic evaluation. RESULTS We included 22 articles assessing the cost-effectiveness of DHI interventions for children and adolescents. Most articles (14/22, 64%) evaluated interventions delivered through web-based portals or SMS text messaging, most frequently within the health care specialties of mental health and maternal, newborn, and child health. In 82% (18/22) of the studies, DHIs were found to be cost-effective or cost saving compared with the nondigital standard of care. The key drivers of cost-effectiveness included population coverage, cost components, intervention effect size and scale-up, and study perspective. The most frequently identified methodological challenges were related to study design (17/22, 77%), costing (11/22, 50%), and economic modeling (9/22, 41%). CONCLUSIONS This is the first systematic review of economic evaluations of DHIs targeting pediatric and adolescent populations. We found that most DHIs (18/22, 82%) for children and adolescents were cost-effective or cost saving compared with the nondigital standard of care. In addition, this review identified key methodological challenges directly related to the conduct of economic evaluations of DHIs and highlighted areas where further methodological research is required to address these challenges. These included the need for measurement of user involvement and indirect effects of DHIs and the development of children-specific, generic quality-of-life outcomes.
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Affiliation(s)
- Tijana Stanic
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Tuba Saygin Avsar
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Manuel Gomes
- Department of Applied Health Research, University College London, London, United Kingdom
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Faiçal AVB, Mota LR, Correia DDA, Monteiro LP, de Souza EL, Terse-Ramos R. Telehealth for children and adolescents with chronic pulmonary disease: systematic review. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 42:e2024111. [PMID: 37194911 PMCID: PMC10185001 DOI: 10.1590/1984-0462/2024/42/2022111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/07/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To revise the impact of telehealth on the quality of life, reduction in pulmonary exacerbations, number of days using antibiotics, adherence to treatment, pulmonary function, emergency visits, hospitalizations, and the nutritional status of individuals with asthma and cystic fibrosis. DATA SOURCE Four databases were used, MEDLINE, LILACS, Web of Science and Cochrane, as well as manual searches in English, Portuguese and Spanish. Randomized clinical trials, published between January 2010 and December 2020, with participants aged 0 to 20 years, were included. DATA SYNTHESIS Seventy-one records were identified after the removal of duplicates; however, twelve trials were eligible for synthesis. Included trials utilized: mobile phone applications (n=5), web platforms (n= 4), mobile telemedicine unit (n=1), software with an electronic record (n=1), remote spirometer (n=1), and active video games platform (n=1). Three trials used two tools, including telephone calls. Among the different types of interventions, improvement in adherence, quality of life, and physiologic variables were observed for mobile application interventions and game platforms compared to usual care. Visits to the emergency department, unscheduled medical appointments, and hospitalizations were not reduced. There was considerable heterogeneity among studies. CONCLUSIONS The findings suggest that better control of symptoms, quality of life, and adherence to treatment can be attributed to the technological interventions used. Nevertheless, further research is needed to compare telehealth with face-to-face care and to indicate the most effective tools in the routine care of children with chronic lung diseases.
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Wittwer LH, Walters E, Jordan K. Improving Pediatric Asthma Care Through Asthma Apps: A Narrative Review. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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Esposito S, Rosafio C, Antodaro F, Argentiero A, Bassi M, Becherucci P, Bonsanto F, Cagliero A, Cannata G, Capello F, Cardinale F, Chiriaco T, Consolaro A, Dessì A, Di Mauro G, Fainardi V, Fanos V, Guarino A, Li Calzi G, Lodi E, Maghnie M, Manfredini L, Malorgio E, Minuto N, Modena MG, Montori R, Moscatelli A, Patrone E, Pescio E, Poeta M, Ravelli A, Spelta M, Suppiej A, Vai S, Villa L, Zanini R, Botti R, Gaddi AV. Use of Telemedicine Healthcare Systems in Children and Adolescents with Chronic Disease or in Transition Stages of Life: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP) and of the Syndicate of Family Pediatrician Doctors (SIMPeF). J Pers Med 2023; 13:jpm13020235. [PMID: 36836469 PMCID: PMC9965862 DOI: 10.3390/jpm13020235] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Telemedicine is considered an excellent tool to support the daily and traditional practice of the health profession, especially when referring to the care and management of chronic patients. In a panorama in which chronic pathologies with childhood onset are constantly increasing and the improvement of treatments has allowed survival for them into adulthood, telemedicine and remote assistance are today considered effective and convenient solutions both for the chronic patient, who thus receives personalized and timely assistance, and for the doctors, who reduce the need for direct intervention, hospitalizations and consequent management costs. This Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, has the objectives to propose an organizational model based on the relationships between the actors who participate in the provision of a telemedicine service aimed at minors with chronic pathologies, identifying specific project links between the areas of telemedicine in the developmental age from the first 1000 days of life to the age adult. The future scenario will have to be able to integrate digital innovation in order to offer the best care to patients and citizens. It will have to be able to provide the involvement of patients from the very beginning of the design of any care pathway, increasing where possible the proximity of the health service to citizens.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence:
| | | | | | - Alberto Argentiero
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marta Bassi
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | | | | | | | - Giulia Cannata
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Fabio Capello
- UO Territorial Pediatrics, Primary Care Department, AUSL Bologna, 40126 Bologna, Italy
| | - Fabio Cardinale
- UOC of Pediatrics and ED with an Allergy-Pneumological and Immuno-Rheumatological Focus, Giovanni XXIII Pediatric Hospital, University of Bari, 70124 Bari, Italy
| | - Tiziana Chiriaco
- Health Department, ASL Roma 3, 00125 Rome, Italy
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Alessandro Consolaro
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy
| | - Angelica Dessì
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | | | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Vassilios Fanos
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | - Alfredo Guarino
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giada Li Calzi
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Lodi
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Luca Manfredini
- Pediatric Pain and Palliative Care Service, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | | | - Nicola Minuto
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Maria Grazia Modena
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | - Rossano Montori
- Community Medicine and Primary Care, AUSL Modena, 41124 Modena, Italy
| | - Andrea Moscatelli
- UOC Anesthesia and Intensive Care, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Patrone
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Elena Pescio
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Marco Poeta
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Angelo Ravelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Maddalena Spelta
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Agnese Suppiej
- Pediatric Clinic, University of Ferrara, 44124 Ferrara, Italy
| | | | - Luca Villa
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | | | - Renato Botti
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Antonio Vittorino Gaddi
- Center for Metabolic Diseases and Atherosclerosis, University of Bologna, 40126 Bologna, Italy
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Barbosa MT, Sousa CS, Morais-Almeida M. Telemedicine in the Management of Chronic Obstructive Respiratory Diseases: An Overview. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-respiratory-diseases] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Purpose of Review To review the data supporting the use of telemedicine (TM) and to provide practical guidance for practitioners to optimize the care of their asthmatic patients. Recent Findings Previous to the pandemic, TM was little used in various aspects of asthma care. Since the pandemic, TM has been increasingly used in new ways to care for asthma patients at various locations. In addition to direct-to-consumer visits for asthma care, other forms of telehealth visits have been increasing such as facilitated visits, asynchronous, remote patient monitoring, e-consults, and mHealth. Moreover, patient and provider satisfaction with the use of TM has been increasing and is comparable at times with face-to-face visits. In this review, best practices for starting a telemedicine asthma service with patients at home, distant clinic sites, and various other locations, including school-based asthma programs, are reviewed. Summary TM is a valuable adjunct to face-to-face visits for asthma care. Following the recommended best practices can strengthen the implementation of a telemedicine asthma program (TMAP) into clinical practice. Providers must be vigilant in keeping current with the various nuances required for asthma telemedicine care in preparation for the post-pandemic environment.
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Affiliation(s)
- Yudy K Persaud
- Division of Allergy, BronxCare Hospital Systems, Bronx, NY, USA.
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Drummond D. Outils connectés pour la télésurveillance des patients asthmatiques : gadgets ou révolution? Rev Mal Respir 2022; 39:241-257. [DOI: 10.1016/j.rmr.2022.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
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Oppelaar MC, van den Wijngaart LS, Merkus PJFM, Croonen EA, Hugen CAC, Brouwer ML, Boehmer ALM, Roukema J. It Is Not Just the FEV1 That Matters, but the Personal Goals We Reach Along the Way: Qualitative, Multicenter, Prospective, Observational Study. J Med Internet Res 2021; 23:e29218. [PMID: 34668868 PMCID: PMC8567151 DOI: 10.2196/29218] [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: 03/30/2021] [Revised: 07/08/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background The COVID-19 pandemic has boosted the use of forced expiratory volume in 1 second (FEV1) telemonitoring in pediatric asthma, but a consensus on its most efficient and effective implementation is still lacking. To find answers, it is important to study how such an intervention is perceived, experienced, and used by both patients and health care professionals (HCPs). Objective The aim of this study was to provide perspectives on how FEV1 home monitoring should be used in pediatric asthma. Methods This is a qualitative, multicenter, prospective, observational study which included patients with asthma aged 6-16 and HCPs. Primary outcomes were results of 2 surveys that were sent to all participants at study start and after 3-4 months. Secondary outcomes consisted of FEV1 device usage during 4 months after receiving the FEV1 device. Results A total of 39 participants (26 patients and 13 HCPs) were included in this study. Survey response rates were 97% (38/39) at the start and 87% (34/39) at the end of the study. Both patients and HCPs were receptive toward online FEV1 home monitoring and found it contributive to asthma control, self-management, and disease perception. The main concerns were about reliability of the FEV1 device and validity of home-performed lung function maneuvers. FEV1 devices were used with a median frequency of 7.5 (IQR 3.3-25.5) during the 4-month study period. Conclusions Patients and HCPs are receptive toward online FEV1 home monitoring. Frequency of measurements varied largely among individuals, yet perceived benefits remained similar. This emphasizes that online FEV1 home monitoring strategies should be used as a means to reach individual goals, rather than being a goal on their own.
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Affiliation(s)
- Martinus C Oppelaar
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lara S van den Wijngaart
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peter J F M Merkus
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ellen A Croonen
- Department of Pediatrics, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Cindy A C Hugen
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marianne L Brouwer
- Department of Pediatrics, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | | | - Jolt Roukema
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
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Kumari J, Jat KR, Kabra SK. Role of Telemedicine in Follow-up Care of Children with Respiratory Illnesses at a Tertiary Care Hospital - An Ambispective Observational Study. Indian J Pediatr 2021; 88:974-978. [PMID: 33394296 PMCID: PMC7780214 DOI: 10.1007/s12098-020-03590-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/25/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess if telemedicine can be used successfully for follow-up care of children with respiratory illnesses. The authors also assessed problems faced by the doctors and satisfaction of caregivers of these patients with telemedicine. METHODS The authors conducted an ambispective observational study. Data related to demographic details and diagnoses of patients who had telemedicine consultation (teleconsultation) appointments between 2nd April 2020 to 15th May 2020 were reviewed retrospectively. They noted proportion of patients having successful prescription. To assess problems faced by doctors and satisfaction of caregiver of patients with teleconsultation, a prospective questionnaire was sent via Google Forms 6-10 wk after the initial appointment date. Those who did not respond to Google Forms were called by phone to assess the same. RESULTS A total of 188 patients received teleconsultation during the study period. Team was able to prescribe treatment in 181 (96.3%) patients via teleconsultation and other seven (3.7%) required physical evaluation. Mean (SD) age of patients was 9.7 (4.9) y, range 3 mo to 18 y. There were 117 (62.2%) boys and 71 (37.8%) girls. Majority (58%) of the patients were asthmatics. The team advised refill prescription in 83% patients as symptoms were controlled. Three out of five residents faced minor problems while providing teleconsultation. In satisfaction assessment, 78% of caregivers rated teleconsultation 8 or more, out of 10 points, suggesting that most of them were satisfied with telemedicine. CONCLUSION In majority of children with respiratory illnesses, successful follow-up care can be provided by telemedicine.
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Affiliation(s)
- Jyoti Kumari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Kana Ram Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
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Rakic M, Jaboyedoff M, Bachmann S, Berger C, Diezi M, do Canto P, Forrest CB, Frey U, Fuchs O, Gervaix A, Gluecksberg AS, Grotzer M, Heininger U, Kahlert CR, Kaiser D, Kopp MV, Lauener R, Neuhaus TJ, Paioni P, Posfay-Barbe K, Ramelli GP, Simeoni U, Simonetti G, Sokollik C, Spycher BD, Kuehni CE. Clinical data for paediatric research: the Swiss approach : Proceedings of the National Symposium in Bern, Switzerland, Dec 5-6, 2019. BMC Proc 2021; 15:19. [PMID: 34538238 PMCID: PMC8450032 DOI: 10.1186/s12919-021-00226-3] [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: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Continuous improvement of health and healthcare system is hampered by inefficient processes of generating new evidence, particularly in the case of rare diseases and paediatrics. Currently, most evidence is generated through specific research projects, which typically require extra encounters with patients, are costly and entail long delays between the recognition of specific needs in healthcare and the generation of necessary evidence to address those needs. The Swiss Personalised Health Network (SPHN) aims to improve the use of data obtained during routine healthcare encounters by harmonizing data across Switzerland and facilitating accessibility for research. The project "Harmonising the collection of health-related data and biospecimens in paediatric hospitals throughout Switzerland (SwissPedData)" was an infrastructure development project funded by the SPHN, which aimed to identify and describe available data on child health in Switzerland and to agree on a standardised core dataset for electronic health records across all paediatric teaching hospitals. Here, we describe the results of a two-day symposium that aimed to summarise what had been achieved in the SwissPedData project, to put it in an international context, and to discuss the next steps for a sustainable future. The target audience included clinicians and researchers who produce and use health-related data on children in Switzerland. KEY HIGHLIGHTS The symposium consisted of state-of-the-art lectures from national and international keynote speakers, workshops and plenary discussions. This manuscript summarises the talks and discussions in four sections: (I) a description of the Swiss Personalized Health Network and the results of the SwissPedData project; (II) examples of similar initiatives from other countries; (III) an overview of existing health-related datasets and projects in Switzerland; and (IV) a summary of the lessons learned and future prospective from workshops and plenary discussions. IMPLICATIONS Streamlined processes linking initial collection of information during routine healthcare encounters, standardised recording of this information in electronic health records and fast accessibility for research are essential to accelerate research in child health and make it affordable. Ongoing projects prove that this is feasible in Switzerland and elsewhere. International collaboration is vital to success. The next steps include the implementation of the SwissPedData core dataset in the clinical information systems of Swiss hospitals, the use of this data to address priority research questions, and the acquisition of sustainable funding to support a slim central infrastructure and local support in each hospital. This will lay the foundation for a national paediatric learning health system in Switzerland.
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Affiliation(s)
- Milenko Rakic
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Manon Jaboyedoff
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sara Bachmann
- University of Basel Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Christoph Berger
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Manuel Diezi
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | | | - Urs Frey
- University of Basel Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Oliver Fuchs
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alain Gervaix
- Department of Woman, Child and Adolescent, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Amalia Stefani Gluecksberg
- Paediatric Department of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland and Università della Svizzera Italiana, Lugano, Switzerland
| | - Michael Grotzer
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich Heininger
- University of Basel Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | | | - Daniela Kaiser
- Children’s Hospital of Lucerne, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Matthias V. Kopp
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roger Lauener
- Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Thomas J. Neuhaus
- Children’s Hospital of Lucerne, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Paolo Paioni
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Klara Posfay-Barbe
- Department of Woman, Child and Adolescent, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Gian Paolo Ramelli
- Paediatric Department of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland and Università della Svizzera Italiana, Lugano, Switzerland
| | - Umberto Simeoni
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giacomo Simonetti
- Paediatric Department of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland and Università della Svizzera Italiana, Lugano, Switzerland
| | - Christiane Sokollik
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ben D. Spycher
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Claudia E. Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
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Davies B, Kenia P, Nagakumar P, Gupta A. Paediatric and adolescent asthma: A narrative review of telemedicine and emerging technologies for the post-COVID-19 era. Clin Exp Allergy 2021; 51:393-401. [PMID: 33527625 PMCID: PMC8013619 DOI: 10.1111/cea.13836] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/22/2020] [Accepted: 01/16/2021] [Indexed: 01/25/2023]
Abstract
Children and young people with asthma need regular monitoring to maintain good asthma control, prevent asthma attacks and manage comorbidities. The COVID‐19 pandemic has resulted in healthcare professionals making fundamental changes to the way healthcare is delivered and for patients and families adapting to these changes. Comprehensive remotely delivered, technology‐based healthcare, closer to the patients home (reducing hospital footfall and possibly reducing carbon footprint) is likely to be one of the important collateral effects of the pandemic. Telemedicine is anticipated to impact everyone involved in healthcare ‐ providers and patients alike. It is going to bring changes to organization, work areas and work culture in healthcare. Healthcare providers, policymakers and those accessing healthcare services will experience the impact of technology‐based healthcare delivery. Telemedicine can play an exciting role in the management of childhood asthma by delivering high‐quality care closer to the child's home. However, unlike adults, children still need to be accompanied by their carers for virtual care. Policymakers will need to take into account potential additional costs as well as the legal, ethical and cultural implications of large scale use of telemedicine. In this narrative review, we review evidence regarding the role of telemedicine and related emerging technologies in paediatric and adolescent asthma. Although there are gaps in the current knowledge, there is evidence demonstrating the important role of telemedicine in management of childhood and adolescent asthma. However, there is an urgent need for healthcare researchers and policymakers to focus on improving the technologies and address the disparities in accessing novel technology‐based management strategies to improve asthma care.
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Affiliation(s)
- Benjamin Davies
- Department of Paediatric Respiratory Medicine, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK.,Birmingham Acute Care Research, University of Birmingham, Birmingham, UK
| | - Priti Kenia
- Department of Paediatric Respiratory Medicine, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Prasad Nagakumar
- Department of Paediatric Respiratory Medicine, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK.,Birmingham Acute Care Research, University of Birmingham, Birmingham, UK
| | - Atul Gupta
- Department of Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
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Poowuttikul P, Seth D. New Concepts and Technological Resources in Patient Education and Asthma Self-Management. Clin Rev Allergy Immunol 2021; 59:19-37. [PMID: 32215784 DOI: 10.1007/s12016-020-08782-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Asthma is a chronic disease that is associated with significant morbidity and mortality. In general, the use of technology resources or electronic health (e-health) has been shown to have beneficial effects on patients with asthma. E-health can impact a broad section of patients and can be cost-effective and associated with high patient satisfaction. E-health may enable remote delivery of care, as well as timely access to health care, which are some of the common challenges faced by patients with asthma. Web-based asthma self-management systems have been found to improve quality of life, self-reported asthma symptoms, lung function, reduction in asthma symptoms/exacerbations, and self-reported adherence for adults. Social media is commonly being used as a platform to disseminate information on asthma to increase public awareness. It can facilitate asthma self-management in a patient friendly manner and has shown to improve asthma control test scores as well as self-esteem. Text massages reminders can increase awareness regarding asthma treatment and control, thus potentially can improve adherence to medications and asthma outcome. Mobile health applications can support asthma self-management, improve a patient's quality of life, promote medication adherence, and potentially reduce the overall costs for asthma care. Inhaler trackers have shown to be beneficial to asthma outcome in various populations by improving adherence to asthma medications. Barriers such as physician financial reimbursement as well as licensing for rendering tele-healthcare services are important concerns. Other limitations of using technology resources in health care are related to liability, professionalism, and ethical issues such as breach of patient confidentiality and privacy. Additionally, there may be less face-to-face interaction and care of the patient when e-health is used.
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Affiliation(s)
- Pavadee Poowuttikul
- Department of Pediatrics, Division of Allergy/Immunology, Children's Hospital of Michigan, Wayne State University School of Medicine, 3950 Beaubien, 4th Floor, Pediatric Specialty Building, Detroit, MI, 48201, USA.
| | - Divya Seth
- Department of Pediatrics, Division of Allergy/Immunology, Children's Hospital of Michigan, Wayne State University School of Medicine, 3950 Beaubien, 4th Floor, Pediatric Specialty Building, Detroit, MI, 48201, USA
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Bjerg A, Ljungberg H, Dierschke K, Åkerberg-Krook E, Andersson UBK, Olin AC, Lindberg E, Yuan X, Lyström J, Wålinder R, Victor S, Andersson M, Bertilsson H, Carleborg A, Nordlund B. Shorter time to clinical decision in work-related asthma using a digital tool. ERJ Open Res 2020; 6:00259-2020. [PMID: 32963995 PMCID: PMC7487349 DOI: 10.1183/23120541.00259-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/18/2020] [Indexed: 11/05/2022] Open
Abstract
PEF curves are a useful but cumbersome tool in diagnosing work-related asthma. Using a digital spirometer and smartphone app, time to clinical decision could be shortened by 6-7 weeks. Physician's time spent analysing PEF data is also shortened. https://bit.ly/3d5SY78.
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Affiliation(s)
- Anders Bjerg
- Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Martina Children's Hospital, Stockholm, Sweden
| | - Henrik Ljungberg
- Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Lung-Allergy Dept at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,MediTtuner AB, Stockholm, Sweden
| | - Katrin Dierschke
- Occupational and Environmental Medicine, Region Skåne, Kristianstad, Sweden
| | | | - Ulla B K Andersson
- Occupational and Environmental Medicine, Region Skåne, Kristianstad, Sweden
| | - Anna-Carin Olin
- Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Elisabeth Lindberg
- Occupational and Environmental Medicine Centre, Dept of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ximing Yuan
- Occupational and Environmental Medicine Centre, Dept of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jonathan Lyström
- Centre for Occupational and Environmental Medicine in Stockholm, Region Stockholm, Stockholm, Sweden
| | - Robert Wålinder
- Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Susanne Victor
- Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Martin Andersson
- Dept of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umea, Sweden
| | - Helén Bertilsson
- Dept of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umea, Sweden
| | - Anna Carleborg
- Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,MediTtuner AB, Stockholm, Sweden
| | - Björn Nordlund
- Dept of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Lung-Allergy Dept at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,MediTtuner AB, Stockholm, Sweden
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16
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Ross KR, Szefler SJ. Introducing telehealth and adherence monitoring to school-centered asthma management. Pediatr Pulmonol 2020; 55:565-567. [PMID: 31977164 DOI: 10.1002/ppul.24663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Kristie R Ross
- UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Stanley J Szefler
- The Breathing Institute and Section for Pediatric Pulmonary and Sleep Medicine, Children's Hospital Colorado, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado
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eHealth only interventions and blended interventions to support self-management in adolescents with asthma: A systematic review. CLINICAL EHEALTH 2020. [DOI: 10.1016/j.ceh.2020.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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van den Wijngaart LS, Geense WW, Boehmer AL, Brouwer ML, Hugen CA, van Ewijk BE, Koenen-Jacobs MJ, Landstra AM, Niers LE, van Onzenoort-Bokken L, Ottink MD, Rikkers-Mutsaerts ER, Groothuis I, Vaessen-Verberne AA, Roukema J, Merkus PJ. Barriers and Facilitators When Implementing Web-Based Disease Monitoring and Management as a Substitution for Regular Outpatient Care in Pediatric Asthma: Qualitative Survey Study. J Med Internet Res 2018; 20:e284. [PMID: 30377147 PMCID: PMC6239865 DOI: 10.2196/jmir.9245] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 05/17/2018] [Accepted: 06/21/2018] [Indexed: 01/17/2023] Open
Abstract
Background Despite their potential benefits, many electronic health (eHealth) innovations evaluated in major studies fail to integrate into organizational routines, and the implementation of these innovations remains problematic. Objective The purpose of this study was to describe health care professionals’ self-identified perceived barriers and facilitators for the implementation of a Web-based portal to monitor asthmatic children as a substitution for routine outpatient care. Also, we assessed patients’ (or their parents) satisfaction with this eHealth innovation. Methods Between April and November 2015, we recruited 76 health care professionals (from 14 hospitals). During a period of 6 months, participants received 3 questionnaires to identify factors that facilitated or impeded the use of this eHealth innovation. Questionnaires for patients (or parents) were completed after the 6-month virtual asthma clinic (VAC) implementation period. Results Major perceived barriers included concerns about the lack of structural financial reimbursement for Web-based monitoring, lack of integration of this eHealth innovation with electronic medical records, the burden of Web-based portal use on clinician workload, and altered patient-professional relationship (due to fewer face-to-face contacts). Major perceived facilitators included enthusiastic and active initiators, a positive attitude of professionals toward eHealth, the possibility to tailor care to individual patients (“personalized eHealth”), easily deliverable care according to current guidelines using the VAC, and long-term profit and efficiency. Conclusions The implementation of Web-based disease monitoring and management in children is complex and dynamic and is influenced by multiple factors at the levels of the innovation itself, individual professionals, patients, social context, organizational context, and economic and political context. Understanding and defining the barriers and facilitators that influence the context is crucial for the successful implementation and sustainability of eHealth innovations.
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Affiliation(s)
- Lara S van den Wijngaart
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wytske W Geense
- IQ Healthcare, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | | | - Marianne L Brouwer
- Department of Pediatrics, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Cindy Ac Hugen
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bart E van Ewijk
- Department of Pediatrics, Tergooi Hospital, Blaricum, Netherlands.,Department of Pediatrics, Tergooi Hospital, Hilversum, Netherlands
| | | | | | - Laetitia Em Niers
- Department of Pediatrics, Maxima Medical Center, Veldhoven, Netherlands
| | | | - Mark D Ottink
- Department of Pediatrics, Medical Spectrum Twente Hospital, Enschede, Netherlands
| | | | - Iris Groothuis
- Department of Pediatric Pulmonology, Juliana Children's Hospital, Haga Hospital, The Hague, Netherlands
| | | | - Jolt Roukema
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peter Jfm Merkus
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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Yilmaz SK, Horn BP, Fore C, Bonham CA. An economic cost analysis of an expanding, multi-state behavioural telehealth intervention. J Telemed Telecare 2018; 25:353-364. [DOI: 10.1177/1357633x18774181] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Introduction In this paper the economic costs associated with a growing, multi-state telepsychiatry intervention serving rural American Indian/Alaska Native populations were compared to costs of travelling to provide/receive in-person treatment. Methods Telepsychiatry costs were calculated using administrative, information-technology, equipment and technology components, and were compared to travel cost models. Both a patient travel and a psychiatrist travel model were estimated utilising ArcGIS software and unit costs gathered from literature and government sources. Cost structure and sensitivity analysis was also calculated by varying modeling parameters and assumptions. Results and Discussion It is estimated that per-session costs were $93.90, $183.34, and $268.23 for telemedicine, provider-travel, and patient-travel, respectively. Restricting the analysis to satellite locations with a larger number of visits reduced telemedicine per-patient encounter costs (50 or more visits: $83.52; 100 or more visits: $80.41; and 150 or more visits: $76.25). The estimated cost efficiencies of telemedicine were more evident for highly rural communities. Finally, we found that a multi-state centre was cheaper than each state operating independently. Conclusions Consistent with previous research, this study provides additional evidence of the economic efficiency associated with telemedicine interventions for rural American Indian/Alaska Native populations. Our results suggest that there are economies of scale in providing behavioural telemedicine and that bigger, multi-state telemedicine centres have lower overall costs compared to smaller, state-level centres. Additionally, results suggest that telemedicine structures with a higher number of per-satellite patient encounters have lower costs, and telemedicine centres delivering care to highly rural populations produce greater economic benefits.
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Affiliation(s)
| | - Brady P Horn
- Department of Economics, University of New Mexico, USA
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, USA
| | - Chris Fore
- Indian Health Service, Telebehavioral Health Center of Excellence, USA
| | - Caroline A Bonham
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, USA
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