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Qin J, Chan CW, Dong J, Homma S, Ye S. Telemedicine is associated with reduced socioeconomic disparities in outpatient clinic no-show rates. J Telemed Telecare 2024; 30:1507-1515. [PMID: 36974422 DOI: 10.1177/1357633x231154945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
INTRODUCTION The global pandemic caused by coronavirus (COVID-19) sped up the adoption of telemedicine. We aimed to assess whether factors associated with no-show differed between in-person and telemedicine visits. The focus is on understanding how social economic factors affect patient no-show for the two modalities of visits. METHODS We utilized electronic health records data for outpatient internal medicine visits at a large urban academic medical center, from February 1, 2020 to December 31, 2020. A mixed-effect logistic regression was used. We performed stratified analysis for each modality of visit and a combined analysis with interaction terms between exposure variables and visit modality. RESULTS A total of 111,725 visits for 72,603 patients were identified. Patient demographics (age, gender, race, income, partner), lead days, and primary insurance were significantly different between the two visit modalities. Our multivariable regression analyses showed that the impact of sociodemographic factors, such as Medicaid insurance (OR 1.23, p < 0.01 for in-person; OR 1.03, p = 0.57 for telemedicine; p < 0.01 for interaction), Medicare insurance (OR 1.11, p = 0.04 for in-person; OR 0.95, p = 0.32 for telemedicine; p = 0.03 for interaction) and Black race (OR 1.36, p < 0.01 for in-person; OR 1.20, p < 0.01 for telemedicine; p = 0.03 for interaction), on increased odds of no-show was less for telemedicine visits than for in-person visits. In addition, inclement weather and younger age had less impact on no-show for telemedicine visits. DISCUSSION Our findings indicated that if adopted successfully, telemedicine had the potential to reduce no-show rate for vulnerable patient groups and reduce the disparity between patients from different socioeconomic backgrounds.
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Affiliation(s)
- Jimmy Qin
- Decision, Risk, and Operations Division, Columbia Business School, New York, USA
| | - Carri W Chan
- Decision, Risk, and Operations Division, Columbia Business School, New York, USA
| | - Jing Dong
- Decision, Risk, and Operations Division, Columbia Business School, New York, USA
| | - Shunichi Homma
- Division of Cardiology, Columbia University Irving Medical Center, New York, USA
| | - Siqin Ye
- Division of Cardiology, Columbia University Irving Medical Center, New York, USA
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González MP, Scartascini C. Increasing the use of telemedicine: A field experiment. PNAS NEXUS 2024; 3:pgae239. [PMID: 38966011 PMCID: PMC11223656 DOI: 10.1093/pnasnexus/pgae239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/25/2024] [Indexed: 07/06/2024]
Abstract
Patients are reluctant to use telemedicine health services, compared to its substitute in-person visits. One reason is that telemedicine can be accurately evaluated and compared to its substitute only after the product has been adopted and experienced. As such, an intervention that increases the probability of a first experience can have lasting effects. This article reports the results of a randomized field experiment conducted in collaboration with a health insurance company. During the intervention, half of the households out of 3,469 in the sample received periodic e-mails with information about the available services. It effectively increased the take-up and demand for telemedicine. Within the first 8 months of the experiment, patients assigned to the treatment group were 6 percentage points more likely to have used the service at least once (and had about five times the odds of using telemedicine compared to those in the control group). Eight months after the start of the intervention, the number of virtual consultations by the treatment group was six times larger than that of the control group. These results, even if limited by the sample and context in which the intervention took place, provide additional evidence about how information interventions can increase technological take-up within the health sector and could serve as the stepping stone for evaluating the impact of telemedicine on health outcomes causally.
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Affiliation(s)
- Maria Patricia González
- Digital Inclusion Benchmarks, World Benchmarking Alliance, Prins Hendrikkade 25, 1012 TM Amsterdam, Netherlands
| | - Carlos Scartascini
- Research Department, Inter-American Development Bank, 1300 New York Ave., NW, Washington, DC 20577, USA
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Sánchez-Martín E, Moreno-Sánchez I, Morán-Sánchez M, Pérez-Martín M, Martín-Morales M, García-Ortiz L. Store-and-forward teledermatology in a Spanish health area significantly increases access to dermatology expertise. BMC PRIMARY CARE 2024; 25:227. [PMID: 38914974 PMCID: PMC11197177 DOI: 10.1186/s12875-024-02479-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 06/14/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION Teledermatology is the practice of dermatology through communication technologies. The aim of this study is to analyze its implementation in a Spanish health area during its first two years. METHODS Cross-sectional descriptive study. It included interconsultations between dermatologists and family physicians in the Salamanca Health Area (Spain) after the implementation of the non-face-to-face modality over a period of two consecutive years. A total of 25,424 consultations were performed (20,912 face-to-face and 4,512 non-face-to-face); 1000 were selected by random sampling, half of each modality. MAIN MEASURES referral rate, response time and resolution time, type of pathology, diagnostic concordance, and quality of consultation. RESULTS The annual referral rate was 42.9/1000 inhabitants (35.3 face-to-face and 7.6 non-face- to-face). The rate of face-to-face referrals was higher in urban areas (37.1) and the rate of non- face-to-face referrals in rural areas (10.4). The response time for non-face-to-face consultations was 2.4 ± 12.7 days and 56 ± 34.8 days for face-to-face consultations (p < 0.001). The resolution rate for non-face-to-face consultations was 44%. Diagnostic concordance, assessed by the kappa index, was 0.527 for face-to-face consultations and 0.564 for non-face-to-face consultations. Greater compliance with the quality criteria in the non-attendance consultations. CONCLUSIONS Teledermatology appears to be an efficient tool in the resolution of dermatological problems, with a rapid, effective, and higher quality response for attention to skin pathologies. REGISTRY ClinicalTrials.gov Identifier: NCT05625295. Registered on 21 November 2022 ( https://clinicaltrials.gov/ct2/show/ NCT05625295).
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Affiliation(s)
- Elena Sánchez-Martín
- Centro de salud La Alamedilla, Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia Regional de salud de Castilla y León (SACyL), Avenida de Comuneros 27-31, Salamanca, 37003, Spain.
- Instituto de investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, 58-182, Salamanca, 37007, Spain.
| | - Isabel Moreno-Sánchez
- Centro de salud La Alamedilla, Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia Regional de salud de Castilla y León (SACyL), Avenida de Comuneros 27-31, Salamanca, 37003, Spain
| | - Marta Morán-Sánchez
- Servicio de Pediatría, Hospital La Paz, P.º de la Castellana, 261, Madrid, 28046, España
| | - Miguel Pérez-Martín
- Centro de salud La Alamedilla, Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia Regional de salud de Castilla y León (SACyL), Avenida de Comuneros 27-31, Salamanca, 37003, Spain
| | - Manuel Martín-Morales
- Centro de salud La Alamedilla, Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia Regional de salud de Castilla y León (SACyL), Avenida de Comuneros 27-31, Salamanca, 37003, Spain
| | - Luis García-Ortiz
- Centro de salud La Alamedilla, Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia Regional de salud de Castilla y León (SACyL), Avenida de Comuneros 27-31, Salamanca, 37003, Spain
- Instituto de investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, 58-182, Salamanca, 37007, Spain
- Departamento de Ciencias Biomédicas y del Diagnóstico, Universidad de Salamanca, Calle Alfonso X el Sabio s/n, Salamanca, 37007, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Avenida de Portugal 83, Salamanca, 37005, Spain
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Koch R, Rösel I, Polanc A, Thies C, Sundmacher L, Eigentler T, Martus P, Joos S. TELEDerm: Implementing store-and-forward teledermatology consultations in general practice: Results of a cluster randomized trial. J Telemed Telecare 2024; 30:647-660. [PMID: 35578544 DOI: 10.1177/1357633x221089133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although teledermatology has been proven internationally to be an effective and safe addition to the care of patients in primary care, there are few pilot projects implementing teledermatology in routine outpatient care in Germany. The aim of this cluster randomized controlled trial was to evaluate whether referrals to dermatologists are reduced by implementing a store-and-forward teleconsultation system in general practitioner practices. METHODS Eight counties were cluster randomized to the intervention and control conditions. During the 1-year intervention period between July 2018 and June 2019, 46 general practitioner practices in the 4 intervention counties implemented a store-and-forward teledermatology system with Patient Data Management System interoperability. It allowed practice teams to initiate teleconsultations for patients with dermatologic complaints. In the four control counties, treatment as usual was performed. As primary outcome, number of referrals was calculated from routine health care data. Poisson regression was used to compare referral rates between the intervention practices and 342 control practices. RESULTS The primary analysis revealed no significant difference in referral rates (relative risk = 1.02; 95% confidence interval = 0.911-1.141; p = .74). Secondary analyses accounting for sociodemographic and practice characteristics but omitting county pairing resulted in significant differences of referral rates between intervention practices and control practices. Matched county pair, general practitioner age, patient age, and patient sex distribution in the practices were significantly related to referral rates. CONCLUSIONS While a store-and-forward teleconsultation system was successfully implemented in the German primary health care setting, the intervention's effect was superimposed by regional factors. Such regional factors should be considered in future teledermatology research.
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Affiliation(s)
- Roland Koch
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Inka Rösel
- Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Polanc
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Christian Thies
- School of Informatics, Reutlingen University, Reutlingen, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University Munich, München, Germany
| | - Thomas Eigentler
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital Tübingen, Tübingen, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
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Hu Y, Wang J, Gu Y, Nicholas S, Maitland E, Zhou J. Online medical consultation in China: Demand-side analysis of obese patients' preferences and willingness-to-pay for online obesity consultations. Digit Health 2024; 10:20552076241272525. [PMID: 39119552 PMCID: PMC11307359 DOI: 10.1177/20552076241272525] [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] [Received: 02/17/2024] [Accepted: 07/16/2024] [Indexed: 08/10/2024] Open
Abstract
Objective With obesity a major health concern and call on healthcare resources in China, we explored the preferences and willingness to pay (WTP) for obesity OMC, including the influencing factors behind WTP and preferences. Method We recruited 400 obese participants to undertake a discrete choice experiment (DCE) and the contingent value method (CVM) survey. We used CVM to measure obese participants' WTP for one-click services (OCS) and used DCE to estimate obesity participants' preferences and WTP for OMC with different attributes. Results Obese participants were willing to pay more than RMB80 on average for OCS, and more than 50% of participants had a WTP over RMB50 and 5% had a WTP over RMB300, reflecting the strong willingness of Chinese obese patients to pay for OMC. Educational background, income, ethnicity, previous OMC experience and accessibility to offline hospitals with different levels impacted WTP. The relative importance score of attributes in descending order was cost, doctors' hospital level, doctors' level, online waiting time, consultation time and consultation form. Obese patients preferred lower cost, doctors from higher-level hospitals, doctors with higher expertise levels, shorter waiting time and consultation duration, and telephone consultation were preferred. 30-min waiting time, 15-min consultation duration and telephone consultation were the most economically efficient set we found. Conclusion To maximize health resources, provincial tertiary and municipal hospitals face different paths to developing obesity OMC platforms. We encouraged young doctors to use OMC. OMC regulators should implement consumer protection policies to optimize OMC pricing and address potential 'unfair' pricing.
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Affiliation(s)
- Yaolin Hu
- School of Economics, Peking University, Beijing, China
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
- Center for Health Economics and Management, Economics and Management School, Wuhan University, Wuhan, China
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Stephen Nicholas
- Health Services Research and Workforce Innovation Centre, Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
- Australian National Institute of Management and Commerce, Sydney, Australia
| | | | - Jianbo Zhou
- School of Economics, Peking University, Beijing, China
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Bakaa N, Gross DP, Carlesso LC, MacDermid J, Thomas K, Slomp F, Rushton A, Miciak M, Smeets R, Rampersaud R, Nataraj A, Drew B, Markian P, Guha D, Cenic A, Macedo L. Presurgical rehabilitation program for patients with symptomatic lumbar spinal stenosis: A pilot randomized controlled trial protocol. Can J Pain 2022. [DOI: 10.1080/24740527.2022.2137009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Nora Bakaa
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Douglas P. Gross
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa C. Carlesso
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Joy MacDermid
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Kenneth Thomas
- Surgery and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Florence Slomp
- Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Alison Rushton
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Rob Smeets
- Maastricht, the Netherlands and CIR Revalidatie, Maastricht University, Eindhoven, The Netherlands
| | - Raja Rampersaud
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Nataraj
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Brian Drew
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Pahuta Markian
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Daipayan Guha
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Aleks Cenic
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Luciana Macedo
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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Feldmeier G, Löffler C, Altiner A, Wollny A, von Podewils F, Ritzke M. Audiovisual teleconsultation for patients with epilepsy in primary care in rural Germany: a pilot study on feasibility and acceptance. Pilot Feasibility Stud 2022; 8:213. [PMID: 36131332 PMCID: PMC9490945 DOI: 10.1186/s40814-022-01171-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background In rural areas, epilepsy patients have limited access to specialist secondary care. Substantial travel and waiting times of several hours are common. Communication between general practitioners (GP) and specialist epileptologists regarding diagnosis and treatment is further complicated by the high workload on both sides and the different prioritisation of treatment goals. This study aims to investigate the feasibility of an interprofessional audiovisual patient-doctor teleconsultation, and its acceptance in clinical practice in patients with epilepsy in a rural region in Germany. Method Ten patients participated in telemedicine consultations in their GP practice. The practice was located in a sparsely populated region of Mecklenburg-Western Pomerania, and was equipped with technical equipment specifically procured for the project. An explorative qualitative interview was conducted with all participants. We based this paper on the consolidated criteria for reporting qualitative research (COREQ). Results Despite initial uncertainties on the patients’ side regarding the consultation setting, all participants found the teleconsultation helpful. Some patients were initially intimidated and felt slightly overwhelmed by the attention provided and the technology used (multiple HD cameras, large high-resolution screens). However, during the consultation, they felt supported by their GP and were satisfied that their needs were addressed in an appropriate and timely manner. The hardware used was not felt to be a nuisance or to interfere with the conversation between doctor and patient. Patients also appreciated the time saved and the organisational convenience compared to a visit to a university outpatient clinic. Most consultations led to therapeutic consequences. Some patients seemed to benefit particularly, for example those who needed a medication change. Conclusion This pilot study provides first evidence that teleconsultations between patients, specialists, and GPs are possible in rural areas. Interprofessional collaboration between GPs and epileptologists can improve the care of patients with epilepsy. Further research should investigate the effectiveness and efficiency of interprofessional telemedicine consultations for epilepsy and other conditions.
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Affiliation(s)
- Gregor Feldmeier
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany.
| | - Christin Löffler
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Attila Altiner
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Anja Wollny
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Felix von Podewils
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Greifswald, Germany
| | - Manuela Ritzke
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
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Troisi R, De Simone S, Vargas M, Franco M. The other side of the crisis: organizational flexibility in balancing Covid-19 and non-Covid-19 health-care services. BMC Health Serv Res 2022; 22:1096. [PMID: 36038878 PMCID: PMC9421103 DOI: 10.1186/s12913-022-08486-1] [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] [Received: 03/12/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022] Open
Abstract
Background Many healthcare systems have been unable to deal with Covid-19 without influencing non-Covid-19 patients with pre-existing conditions, risking a paralysis in the medium term. This study explores the effects of organizational flexibility on hospital efficiency in terms of the capacity to deliver healthcare services for both Covid-19 and non-Covid-19 patients. Method Focusing on Italian health system, a two-step strategy is adopted. First, Data Envelope Analysis is used to assess the capacity of hospitals to address the needs of Covid-19 and non-Covid-19 patients relying on internal resource flexibility. Second, two panel regressions are performed to assess external organizational flexibility, with the involvement in demand management of external operators in the health-care service, examining the impact on efficiency in hospital capacity management. Results The overall response of the hospitals in the study was not fully effective in balancing the needs of the two categories of patients (the efficiency score is 0.87 and 0.58, respectively, for Covid-19 and non-Covid-19 patients), though responses improved over time. Furthermore, among the measures providing complementary services in the community, home hospitalization and territorial medicine were found to be positively associated with hospital efficiency (0.1290, p < 0.05 and 0.2985, p < 0.01, respectively, for non-Covid-19 and Covid-19 patients; 0.0026, p < 0.05 and 0.0069, p < 0.01, respectively, for non-Covid-19 and Covid-19). In contrast, hospital networks are negatively related to efficiency in Covid-19 patients (-0.1037, p < 0.05), while the relationship is not significant in non-Covid-19 patients. Conclusions Managing the needs of Covid-19 patients while also caring for other patients requires a response from the entire healthcare system. Our findings could have two important implications for effectively managing health-care demand during and after the Covid-19 pandemic. First, as a result of a naturally progressive learning process, the resource balance between Covid-19 and non-Covid-19 patients improves over time. Second, it appears that demand management to control the flow of patients necessitates targeted interventions that combine agile structures with decentralization. Finally, untested integration models risk slowing down the response, giving rise to significant costs without producing effective results.
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Affiliation(s)
- Roberta Troisi
- Department of Political and Communication Science, University of Salerno, Via Giovanni Paolo II, Fisciano (Salerno), Italy.
| | - Stefania De Simone
- Department of Political Sciences, University of Naples Federico II, Largo S. Marcellino, Naples, Italy
| | - Maria Vargas
- Department of Neurosurgical, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini, Naples, Italy
| | - Massimo Franco
- Department of Political Sciences, University of Naples Federico II, Largo S. Marcellino, Naples, Italy
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Wolf RM, Abramoff MD, Channa R, Tava C, Clarida W, Lehmann HP. Potential reduction in healthcare carbon footprint by autonomous artificial intelligence. NPJ Digit Med 2022; 5:62. [PMID: 35551275 PMCID: PMC9098499 DOI: 10.1038/s41746-022-00605-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/15/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Risa M Wolf
- Department of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael D Abramoff
- Department of Ophthalmology, University of Iowa, Iowa City, IA, USA.
- Digital Diagnostics, Coralville, IA, USA.
| | - Roomasa Channa
- Department of Ophthalmology, University of Wisconsin Madison, Madison, WI, USA
| | - Chris Tava
- Digital Diagnostics, Coralville, IA, USA
| | | | - Harold P Lehmann
- Department of Health Informatics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Elsaie ML, Shehata HA, Hanafi NS, Ibrahim SM, Ibrahim HS, Abdelmaksoud A. Egyptian dermatologists attitude toward telemedicine amidst the COVID19 pandemic: a cross-sectional study. J DERMATOL TREAT 2022; 33:1067-1073. [PMID: 32723123 DOI: 10.1080/09546634.2020.1800576] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Telemedicine involves distant exchange of medical information between health providers and patients via a telecommunication device with/without the aid of an audiovisual interactive assistance. The current COVID 19 pandemic impact on health services mandated an utmost readiness to implement telemedicine which in part is dependent on health care providers willingness to adopt such platforms. AIM The aim of this cross sectional study was to assess knowledge and attitude toward telemedicine Egyptian dermatologists amidst the COVID 19 pandemic. PATIENTS AND METHODS A cross sectional study was designed and data were collected using structured self-administered online questionnaires. RESULTS Dermatologists had a good knowledge about telemedicine (mean 4.17 ± 1.63; p < .05). Of those completing the questionnaire, 193 (68.9%) were familiar with the term 'telemedicine' and 164 (58.6%) were familiar with tools like teleconferencing. The majority of responding dermatologists 227 (81.1%) were confident that the COVID 19 pandemic is a good opportunity to start applying telemedicine protocols however the majority 234 (83.6%) preferred using it on trial basis at first before full implementation. CONCLUSION In conclusion an overall good attitude toward telemedicine was reported with a mean of 3.39 (p < .05). Further large scale studies are required to verify such findings.
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Affiliation(s)
- Mohamed L Elsaie
- Department of Dermatology, National Research Centre, Cairo, Egypt
| | - Hany A Shehata
- Department of Dermatology, National Research Centre, Cairo, Egypt
| | - Noha S Hanafi
- Department of Dermatology, National Research Centre, Cairo, Egypt
| | - Shady M Ibrahim
- Department of Dermatology, Al Azhar University, Cairo, Egypt
| | - Hany S Ibrahim
- Department of Dermatology, Al Azhar University, Cairo, Egypt
| | - Ayman Abdelmaksoud
- Mansoura Dermatology, Venerology and Leprology Hospital, Mansoura, Egypt
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Goharinejad S, Hajesmaeel-Gohari S, Jannati N, Goharinejad S, Bahaadinbeigy K. Review of Systematic Reviews in the Field of Telemedicine. Med J Islam Repub Iran 2021; 35:184. [PMID: 36042824 PMCID: PMC9391764 DOI: 10.47176/mjiri.35.184] [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] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Indexed: 11/09/2022] Open
Abstract
Background: Although the systematic reviews regarding telemedicine have increased in recent decades, no comprehensive studies have been conducted to review these systematic reviews. The present study aimed to review the published systematic reviews regarding telemedicine applications for the report and appraisal of several aspects. Methods: The literature search was performed in the PubMed database for the systematic reviews published during January 2010-June 2020 in the field of telemedicine using "telemedicine" Mesh terms. The extracted data from the selected articles were the year of publication, telemedicine specialty, clinical outcomes, cost evaluation, and satisfaction assessment. Data analysis was performed using descriptive statistics. Results: Among 746 retrieved articles, 191 cases were selected and reviewed. Most of the studies were focused on telemedicine (n=35; 18.3%), followed by telerehabilitation (n=22; 11.5%), tele-diabetes (n=18; 9.4%), telecardiology (n=16; 8.3%), home telecare (n=13; 6.8%), telepsychiatry (n=12; 6.3%), teledermatology (n=11; 5.7%), and teleneurology (n=9; 4.7%). The selected studies were primarily focused on clinical outcomes (72.7%), followed by cost-effectiveness (32.4%) and user satisfaction (29.3%). In addition, they mostly indicated that telemedicine services yielded acceptable clinical outcomes (72.5%), cost-effectiveness (67.7%), and healthcare provider/patient satisfaction (83.9%). Conclusion: Although telerehabilitation, tele-diabetes, telecardiology, home telecare, and telepsychiatry were studied further, there are still some specific specialties such as teleradiology, telepathology, and telepediatric that should be considered more. Moreover, investigation of various outcomes could result in a more comprehensive view of this field. Therefore, further investigations in this regard would improve telemedicine applications and encourage potential telemedicine providers to initiate these applications.
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Affiliation(s)
- Saeideh Goharinejad
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Sadrieh Hajesmaeel-Gohari
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nazanin Jannati
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Samira Goharinejad
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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12
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Haleem A, Javaid M, Singh RP, Suman R. Telemedicine for healthcare: Capabilities, features, barriers, and applications. SENSORS INTERNATIONAL 2021; 2:100117. [PMID: 34806053 PMCID: PMC8590973 DOI: 10.1016/j.sintl.2021.100117] [Citation(s) in RCA: 230] [Impact Index Per Article: 76.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022] Open
Abstract
Regular hospital visits can be expensive, particularly in rural areas, due to travel costs. In the era of the Covid-19 Pandemic, where physical interaction becomes risky, people prefer telemedicine. Fortunately, medical visits can be reduced when telemedicine services are used through video conferencing or other virtual technologies. Thus, telemedicine saves both the patient's and the health care provider time and the cost of the treatment. Furthermore, due to its fast and advantageous characteristics, it can streamline the workflow of hospitals and clinics. This disruptive technology would make it easier to monitor discharged patients and manage their recovery. As a result, it is sufficient to state that telemedicine can create a win-win situation. This paper aims to explore the significant capabilities, features with treatment workflow, and barriers to the adoption of telemedicine in Healthcare. The paper identifies seventeen significant applications of telemedicine in Healthcare. Telemedicine is described as a medical practitioner to diagnose and treat patients in a remote area. Using health apps for scheduled follow-up visits makes doctors and patients more effective and improves the probability of follow-up, reducing missing appointments and optimising patient outcomes. Patients should have an accurate medical history and show the doctor any prominent rashes, bruises, or other signs that need attention through the excellent quality audio-video system. Further, practitioners need file management and a payment gateway system. Telemedicine technologies allow patients and doctors both to review the treatment process. However, this technology supplements physical consultation and is in no way a substitute for a physical consultation. Today this technology is a safe choice for patients who cannot go to the doctor or sit at home, especially during a pandemic.
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Affiliation(s)
- Abid Haleem
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Mohd Javaid
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Ravi Pratap Singh
- Department of Industrial and Production Engineering, Dr B R Ambedkar National Institute of Technology, Jalandhar, Punjab, India
| | - Rajiv Suman
- Department of Industrial & Production Engineering, G.B. Pant University of Agriculture & Technology, Pantnagar, Uttarakhand, India
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Assis Acurcio FD, Guerra Junior AA, Marino Calvo MC, Nunes DH, Akerman M, Spinel LF, Garcia MM, Pereira RG, Costa Borysow ID, Silva RR, Azevedo PS, Iacabo Correia Gomes PC, Alvares-Teodoro J. Cost-minimization analysis of teledermatology versus conventional care in the Brazilian National Health System. J Comp Eff Res 2021; 10:1159-1168. [PMID: 34494888 DOI: 10.2217/cer-2021-0124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: Cost-minimization analysis (CMA) comparing the teledermatology service of the State of Santa Catarina, Brazil with the provision of conventional care, from the societal perspective. Patients & methods: All costs related to direct patient care were considered in calculation of outpatient costs. The evaluation was performed using the parameters avoided referrals and profile of hospitalizations. The economic analysis was developed through a decision tree. Results: Totally, 40% of 79,411 tests performed could be managed in primary care, avoiding commuting and expanding the patients' access. The CMA showed the teledermatology service had a cost per patient of US$196.04, and the conventional care of US$245.66. Conclusion: In this scenario, teledermatology proved to be a cost-saving alternative to conventional care, reducing commuting costs.
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Affiliation(s)
- Francisco de Assis Acurcio
- Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde - Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Augusto Afonso Guerra Junior
- Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde - Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Maria Cristina Marino Calvo
- Centro de Ciências da Saúde - Departamento de Saúde Pública, Universidade Federal de Santa Catarina, Florianópolis, Brasil
| | - Daniel Holthausen Nunes
- Serviço de Dermatologia, Hospital Universitário Polyodoro Ernani de São Thiago, Universidade Federal de Santa Catarina, Florianópolis, Brasil
| | - Marco Akerman
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil
| | | | - Marina Morgado Garcia
- Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde - Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Ramon Gonçalves Pereira
- Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde - Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | | | - Pamela Santos Azevedo
- Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde - Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | - Juliana Alvares-Teodoro
- Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde - Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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14
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Blenkinsop S, Foley A, Schneider N, Willis J, Fowler HJ, Sisodiya SM. Carbon emission savings and short-term health care impacts from telemedicine: An evaluation in epilepsy. Epilepsia 2021; 62:2732-2740. [PMID: 34462915 DOI: 10.1111/epi.17046] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Health systems make a sizeable contribution to national emissions of greenhouse gases that contribute to global climate change. The UK National Health Service is committed to being a net zero emitter by 2040, and a potential contribution to this target could come from reductions in patient travel. Achieving this will require actions at many levels. We sought to determine potential savings and risks over the short term from telemedicine through virtual clinics. METHODS During the severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV) pandemic, scheduled face-to-face epilepsy clinics at a specialist site were replaced by remote teleclinics. We used a standard methodology applying conversion factors to calculate emissions based on the total saved travel distance. A further conversion factor was used to derive emissions associated with electricity consumption to deliver remote clinics from which net savings could be calculated. Patients' records and clinicians were interrogated to identify any adverse clinical outcomes. RESULTS We found that enforced telemedicine delivery for over 1200 patients resulted in the saving of ~224 000 km of travel with likely avoided emissions in the range of 35 000-40 000 kg carbon dioxide equivalent (CO2 e) over a six and half month period. Emissions arising directly from remote delivery were calculated to be <200 kg CO2 e (~0.5% of those for travel), representing a significant net reduction of greenhouse gas emissions. Only one direct adverse outcome was identified, with some additional benefits identified anecdotally. SIGNIFICANCE The use of telemedicine can make a contribution toward reduced emissions in the health care sector and, in the delivery of specialized epilepsy services, had minimal adverse clinical outcomes over the short term. However, these outcomes will likely vary with clinic locations, medical specialties and conditions.
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Affiliation(s)
| | - Aideen Foley
- Department of Geography, Birkbeck College University of London, London, UK
| | - Natascha Schneider
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Joseph Willis
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Hayley J Fowler
- School of Engineering, Newcastle University, Newcastle upon Tyne, UK
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Bucks, UK
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15
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Bunnell BE, Kazantzis N, Paige SR, Barrera J, Thakkar RN, Turner D, Welch BM. Provision of Care by "Real World" Telemental Health Providers. Front Psychol 2021; 12:653652. [PMID: 34025519 PMCID: PMC8138039 DOI: 10.3389/fpsyg.2021.653652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022] Open
Abstract
Despite its effectiveness, limited research has examined the provision of telemental health (TMH) and how practices may vary according to treatment paradigm. We surveyed 276 community mental health providers registered with a commercial telemedicine platform. Most providers reported primarily offering TMH services to adults with anxiety, depression, and trauma-and stressor-related disorders in individual therapy formats. Approximately 82% of TMH providers reported endorsing the use of Cognitive Behavioral Therapy (CBT) in their remote practice. The most commonly used in-session and between-session (i.e., homework) exercises included coping and emotion regulation, problem solving, mindfulness, interpersonal skills, relaxation, and modifying and addressing core beliefs. CBT TMH providers had a higher odds of using in-session and homework exercises and assigning them through postal mail, email or fax methods, as compared to non-CBT TMH providers. TMH providers, regardless of treatment paradigm, felt that assigning homework was neither easy nor difficult and they believed their patients were somewhat-to-moderately compliant to their assigned exercises. CBT TMH providers also collected clinical information from their patients more often than non-CBT TMH providers. They reported being less satisfied with their method, which was identified most often as paper-based surveys and forms. Overall, TMH providers employ evidence-based treatments to their patients remotely, with CBT TMH providers most likely to do so. Findings highlight the need for innovative solutions to improve how TMH providers that endorse following the CBT treatment paradigm remotely assign homework and collect clinical data to increase their satisfaction via telemedicine.
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Affiliation(s)
- Brian E. Bunnell
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Doxy.me Research, Doxy.me, Inc., Rochester, NYUnited States
| | - Nikolaos Kazantzis
- Cognitive Behavior Therapy Research Unit, Institute for Social Neuroscience Psychology, Melbourne, VIC, Australia
| | | | - Janelle Barrera
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Doxy.me Research, Doxy.me, Inc., Rochester, NYUnited States
| | - Rajvi N. Thakkar
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Dylan Turner
- Doxy.me Research, Doxy.me, Inc., Rochester, NYUnited States
| | - Brandon M. Welch
- Doxy.me Research, Doxy.me, Inc., Rochester, NYUnited States
- Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
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16
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Graboyes EM, Maurer S, Park Y, Marsh CH, McElligott JT, Day TA, Hornig JD, Sterba KR. Evaluation of a novel telemedicine-based intervention to manage body image disturbance in head and neck cancer survivors. Psychooncology 2020; 29:1988-1994. [PMID: 32350999 PMCID: PMC7606304 DOI: 10.1002/pon.5399] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The study aimed to evaluate the feasibility, acceptability, and preliminary clinical impact of BRIGHT (Building a Renewed ImaGe after Head & neck cancer Treatment), a novel telemedicine-based cognitive-behavioral intervention to manage body image disturbance (BID) in head and neck cancer (HNC) survivors. METHODS Head and neck cancer survivors with BID were enrolled into a single-arm pilot trial. Participants completed study measures at baseline, 1- and 3-months post-BRIGHT to assess its acceptability and clinical impact. Participants completed semi-structured interviews to evaluate the feasibility and acceptability of BRIGHT and refine the intervention. RESULTS Ten HNC survivors with BID were enrolled into the trial of tablet-based BRIGHT. BRIGHT was feasible, as judged by low dropout (n = 1), high session completion rates (100%; 45/45) and low rates of technical issues with the tablet-based delivery (11% minor; 0% major). Ninety percent of participants were highly likely to recommend BRIGHT, reflecting its acceptability. BRIGHT was associated with a 34.5% reduction in mean Body Image Scale scores at 1-month post-BRIGHT (mean difference from baseline = 4.56; 95% CI 1.55, 7.56), an effect that was durable at 3-months post-BRIGHT (mean decrease from baseline = 3.56; 95% CI 1.15-5.96). Program evaluation revealed high levels of satisfaction with BRIGHT, particularly the delivery platform. During the qualitative evaluation, participants highlighted that BRIGHT improved image-related coping behavior. CONCLUSIONS BRIGHT is feasible, acceptable to HNC survivors, and has significant potential as a novel approach to manage BID in HNC survivors. Additional research is necessary to refine BRIGHT and evaluate its clinical efficacy and scalability.
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Affiliation(s)
- Evan M. Graboyes
- Department of Otolaryngology – Head & Neck Surgery, Medical University of South Carolina (MUSC), Charleston, SC
- Hollings Cancer Center, MUSC
| | - Stacey Maurer
- Hollings Cancer Center, MUSC
- Department of Psychiatry and Behavioral Sciences, MUSC
| | - Yeonhee Park
- Hollings Cancer Center, MUSC
- Department of Public Health Sciences, MUSC
| | - Courtney H. Marsh
- Department of Otolaryngology – Head & Neck Surgery, Medical University of South Carolina (MUSC), Charleston, SC
| | | | - Terry A. Day
- Department of Otolaryngology – Head & Neck Surgery, Medical University of South Carolina (MUSC), Charleston, SC
| | - Joshua D. Hornig
- Department of Otolaryngology – Head & Neck Surgery, Medical University of South Carolina (MUSC), Charleston, SC
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Implementation and Patient Satisfaction of Telemedicine in Spine Physical Medicine and Rehabilitation Patients During the COVID-19 Shutdown. Am J Phys Med Rehabil 2020; 99:1079-1085. [PMID: 32969967 DOI: 10.1097/phm.0000000000001600] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the implementation and patient satisfaction of telemedicine visits in a physical medicine and rehabilitation spine practice during COVID-19. DESIGN This is a prospective cohort study. RESULTS Of 172 patients, 97.6% were very satisfied or satisfied (83.7% of the patients were very satisfied) with their telemedicine appointment. In 44.4% of the cases, the physical medicine and rehabilitation physician prescribed medication to the patient, and in 21.6% of the cases, either an injection or radiofrequency ablation was ordered. Most patients (87%) did not have any issues during their encounter. Lastly, 64.5% of the patients preferred telemedicine over in-person appointments, whereas 56.1% of the patients who are 60 yrs and older responded the same. A total of 67.4% of those who had a follow-up visit would choose telemedicine over in-person. CONCLUSIONS The results of this study show that telemedicine can provide very effective and satisfactory care in a physical medicine and rehabilitation spine practice. This was especially notable with follow-up visits where imaging and treatment plan can easily be discussed over telemedicine. Stay-at-home orders and improved reimbursement during the COVID-19 pandemic have spurred adoption of telemedicine with high patient satisfaction. We hope that physical medicine and rehabilitation physicians will be able to continue expanding patient access in the postpandemic world.
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Acceptability of Telemedicine Features to Promote Its Uptake in Practice: A Survey of Community Telemental Health Providers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228525. [PMID: 33212979 PMCID: PMC7698537 DOI: 10.3390/ijerph17228525] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 12/27/2022]
Abstract
Understanding what motivates mental health providers to use telemedicine (i.e., telemental health) is critical for optimizing its uptake, especially during unprecedented times (e.g., the COVID-19 pandemic). Drawing from the Technology Acceptance Model (TAM), this report examined the characteristics of telemental health providers and how the acceptability of telemedicine features contributes to their intention to use the technology more often in practice. Telemental health providers (N = 177) completed an online survey between March and May 2019. Most providers (75%) spent less than 25% of their work-week using telemedicine, but 70% reported an intention to use telemedicine more in the future. The belief that telemedicine affords greater access to patients, work-life balance, flexibility in providing care, and the opportunity to be at the forefront of innovative care were significant predictors of intentions to use the technology more in the future. Other significant predictors included needing assistance to coordinate insurance reimbursements, manage a successful telemedicine practice, and integrate the telemedicine program with other health IT software. Findings have important implications for increasing the frequency of telemedicine use among telemental health providers. Future research and practice should leverage providers' positive beliefs about telemedicine acceptability and consider their needs to enhance its uptake.
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19
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Manabe T, Takasaki M, Ide T, Kitahara K, Sato S, Yunotani S, Hirohashi Y, Iyama A, Taniguchi M, Ogata T, Shimizu S, Noshiro H. Regional education on endoscopic surgery using a teleconference system with high-quality video via the internet: Saga surgical videoconferences. BMC MEDICAL EDUCATION 2020; 20:329. [PMID: 32972399 PMCID: PMC7513322 DOI: 10.1186/s12909-020-02215-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Effective education about endoscopic surgery (ES) is greatly needed for unskilled surgeons, especially at low-volume institutions, to maintain the safety of patients. We have tried to establish the remote educational system using videoconference system through the internet for education about ES to surgeons belonging to affiliate institutions. The aim of this manuscript was to report the potential to establish a comfortable remote educational system and to debate its advantages. METHODS We established a local remote educational conference system by combining the use of a general web conferencing system and a synchronized remote video playback system with annotation function through a high-speed internet. RESULTS During 2014-2019, we conducted 14 videoconferences to review and improve surgeons' skills in performing ES at affiliated institutions. At these conferences, while an uncut video of ES that had been performed at one of the affiliated institutions was shown, the surgical procedure was discussed frankly, and expert surgeons advised improvements. The annotation system is useful for easy, prompt recognition among the audience regarding anatomical structures and procedures that are difficult to explain verbally. CONCLUSIONS This system is of low initial cost and offers easy participation and high-quality videos. It would therefore be a useful tool for regional ES education.
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Affiliation(s)
- Tatsuya Manabe
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Mitsuhiro Takasaki
- Saga University Organization for General Education, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Takao Ide
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Kenji Kitahara
- Department of Surgery, Saga Medical Center Koseikan, 400 Nakabaru, Kasemachi, Saga, 849-8571, Japan
| | - Seiji Sato
- Department of Surgery, Saga Medical Center Koseikan, 400 Nakabaru, Kasemachi, Saga, 849-8571, Japan
| | - Seiji Yunotani
- Department of Surgery, Japanese Red Cross Karatsu Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan
| | - Yoshimi Hirohashi
- Department of Surgery, Takagi Hospital, 141-11 Sakemi, Okawa, Fukuoka, 831-0016, Japan
| | - Akihiro Iyama
- Department of Surgery, Oda Hospital, 4306 Takatsuhara, Kashima, Saga, 849-1311, Japan
| | - Masahiko Taniguchi
- Department of Surgery, Saint Mary Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Toshiro Ogata
- Department of Surgery, Saint Mary Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Shuji Shimizu
- International Medical Department, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hirokazu Noshiro
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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20
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Lopez-Villegas A, Bautista-Mesa RJ, Baena-Lopez MA, Alvarez-Moreno ML, Montoro-Robles JE, Vega-Ramirez FA, Ordoñez-Naranjo I, Hernandez-Montoya CJ, Leal-Costa C, Peiro S. Economic impact and cost savings of teledermatology units compared to conventional monitoring at hospitals in southern Spain. J Telemed Telecare 2020; 28:436-444. [PMID: 32722989 DOI: 10.1177/1357633x20942044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Asynchronous teledermatology (TD) has undergone exponential growth in the past decade, allowing better diagnosis. Moreover, it saves both cost and time and reduces the number of visits involving travel and opportunity cost of time spent on visits to the hospital. The present study performed a cost-saving analysis of TD units and assessed whether they offered a cheaper alternative to conventional monitoring (CM) in hospitals from the perspective of public health-care systems (PHS) and patients. METHODS This study was a retrospective assessment of 7030 patients. A cost-saving analysis comparing TD units to CM for patients at the Hospital de Poniente was performed over a period of one year. The TD network covered the Hospital de Poniente reference area (Spain) linked to 37 primary care (PC) centres that belonged to the Poniente Health District of Almeria. RESULTS We observed a significant cost saving for TD units compared to participants in the conventional follow-up group. From the perspective of a PHS, there was a cost saving of 31.68% in the TD group (€18.59 TD vs. €27.20 CM) during the follow-up period. The number of CM visits to the hospital reduced by 38.14%. From the patients' perspective, the costs were lower, and the cost saving was 73.53% (€5.45 TD vs. €20.58 CM). DISCUSSION The cost-saving analysis showed that the TD units appeared to be significantly cheaper compared to CM.
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Affiliation(s)
- Antonio Lopez-Villegas
- Social Involvement of Critical and Emergency Medicine, CTS-609 Research Group, Hospital de Poniente, Spain
| | | | | | | | - Jesus E Montoro-Robles
- Poniente Primary Care District, Servicio Andaluz de Salud, Hum-498 Research Group, Spain
| | | | - Isabel Ordoñez-Naranjo
- Poniente Primary Care District, Servicio Andaluz de Salud, Hum-498 Research Group, Spain
| | | | | | - Salvador Peiro
- Health Services Research Unit, FISABIO-Public Health, Spain
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21
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Daggubati LC, Eichberg DG, Ivan ME, Hanft S, Mansouri A, Komotar RJ, D'Amico RS, Zacharia BE. Telemedicine for Outpatient Neurosurgical Oncology Care: Lessons Learned for the Future During the COVID-19 Pandemic. World Neurosurg 2020; 139:e859-e863. [PMID: 32450309 PMCID: PMC7243783 DOI: 10.1016/j.wneu.2020.05.140] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The coronavirus 2019 (COVD-19) pandemic has drastically disrupted the delivery of neurosurgical care, especially for the already at-risk neuro-oncology population. The sudden change to clinic visits has rapidly spurned the implementation of telemedicine. A recommendation care paradigm of neuro-oncologic patients limited by telemedicine has not been reported. METHODS A summary of a multi-institution experience detailing the potential benefits, pitfalls, and the necessary considerations to outpatient care of neurosurgical oncology patients. RESULTS There are limitations and advantages to incorporating telemedicine into the outpatient care of neuro-oncology patients. Telemedicine-specific considerations for each step and stakeholder of the appointment (physician, patient, scheduling, previsit, imaging, and physical examination) are examined. CONCLUSIONS Telemedicine, pushed to prominence during this COVID-19 pandemic, is a powerful and possibly preferential tool for the future of outpatient neuro-oncologic care.
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Affiliation(s)
- Lekhaj C Daggubati
- Department of Neurosurgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - Daniel G Eichberg
- Department of Neurosurgery, University of Miami, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurosurgery, University of Miami, Miami, Florida, USA; Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Simon Hanft
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Alireza Mansouri
- Department of Neurosurgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA; Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Ricardo J Komotar
- Department of Neurosurgery, University of Miami, Miami, Florida, USA; Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Randy S D'Amico
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, New York, USA
| | - Brad E Zacharia
- Department of Neurosurgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA; Penn State Cancer Institute, Hershey, Pennsylvania, USA.
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22
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Marín-Gomez FX, Mendioroz Peña J, Canal Casals V, Romero Mendez M, Darnés Surroca A, Nieto Maclino A, Vidal-Alaball J. Environmental and Patient Impact of Applying a Point-of-Care Ultrasound Model in Primary Care: Rural vs. Urban Centres. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3333. [PMID: 32403439 PMCID: PMC7246434 DOI: 10.3390/ijerph17093333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022]
Abstract
Motor vehicles are a major contributor to air pollution, and the exposure to this human-caused air pollution can lead to harmful health effects. This study evaluates the impact of the provision of point-of-care ultrasounds (POCUS) by primary care (PC) to avoid the patient's need to travel to a specialized service. The study estimates the costs and air pollution avoided during 2019. The results confirm that performing this ultrasound at the point of care reduces the emission of 61.4 gr of carbon monoxide, 14.8 gr of nitric oxide and 2.7 gr of sulfur dioxide on each trip. During the study, an average of 17.8 km, 21.4 min per trip and almost 2000 L of fuel consumed in a year were avoided. Performing POCUS from PC reduces fuel consumption and the emission of air pollutants and also saves time and money. Furthermore, only 0.3% of the scans had to be repeated by radiologists. However, more studies with more participants need to be done to calculate the exact impact that these pollution reductions will have on human health.
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Affiliation(s)
- Francesc X Marín-Gomez
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain; (J.M.P.); (J.V.-A.)
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
- Servei d’Atenció Primària Osona, Gerència Territorial de Barcelona, Institut Català de la Salut, 08500 Vic, Barcelona, Spain
| | - Jacobo Mendioroz Peña
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain; (J.M.P.); (J.V.-A.)
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
| | - Vicenç Canal Casals
- Centre d’Atenció Primària Vic Nord, Gerència Territorial de Barcelona, Institut Català de la Salut, 08500 Vic, Barcelona, Spain;
| | - Marcos Romero Mendez
- Centre d’Atenció Primària St. Quirze de Besora, Gerència Territorial de Barcelona, Institut Català de la Salut, 08580 Sant Quirze de Besora, Barcelona, Spain;
| | - Ana Darnés Surroca
- Centre d’Atenció Primària Manlleu, Gerència Territorial de Barcelona, Institut Català de la Salut, 08560 Manlleu, Barcelona, Spain;
| | - Antoni Nieto Maclino
- Centre d’Atenció Primària Sta. Eugènia de Berga, Gerència Territorial de Barcelona, Institut Català de la Salut, 08507 Santa Eugènia de Berga, Barcelona, Spain;
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain; (J.M.P.); (J.V.-A.)
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
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Bunnell BE, Sprague G, Qanungo S, Nichols M, Magruder K, Lauzon S, Obeid JS, Lenert LA, Welch BM. An Exploration of Useful Telemedicine-Based Resources for Clinical Research. Telemed J E Health 2020; 26:51-65. [PMID: 30785853 PMCID: PMC6948002 DOI: 10.1089/tmj.2018.0221] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 11/12/2022] Open
Abstract
Background: Clinical trials are key to ensuring high-quality, effective, and safe health care interventions, but there are many barriers to their successful and timely implementation. Difficulties with participant recruitment and enrollment are largely affected by difficulties with obtaining informed consent. Teleconsent is a telemedicine- based approach to obtaining informed consent and offers a unique solution to limitations of traditional consent approaches. Methods: We conducted a survey among 134 clinical trial researchers in academic/university-, industry-, and clinically based settings. The survey addressed important aspects of teleconsent, potential teleconsent enhancements, and other telehealth capabilities to support clinical research. Results: The majority of respondents viewed teleconsent as an important approach for obtaining informed consent and indicated that they would likely use teleconsent if available. Consenting participants at remote sites, increasing access to clinical trials, and consenting participants in their homes were viewed as the greatest opportunities for teleconsent. Features for building, validating, and assessing understanding of teleconsent forms, mobile capabilities, three-way teleconsent calls, and direct links to forms via recruitment websites were viewed as important teleconsent enhancements. Other telehealth capabilities to support clinical research, including surveys, file transfer, three-way video, screenshare, and photo capture during telemedicine visits, and proposed telemedicine capabilities such as video call recording, ID information capture, and integration of medical devices, were also viewed as important. Conclusions: Teleconsent and telemedicine are promising solutions to some common challenges to clinical trials. Many barriers to study recruitment and enrollment might be overcome by investing time and resources and further evaluating this technology.
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Affiliation(s)
- Brian E. Bunnell
- Department of Psychiatry and Behavioral Sciences, Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | | | - Suparna Qanungo
- Department of Nursing, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Michelle Nichols
- Department of Nursing, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Kathryn Magruder
- Department of Psychiatry, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Steven Lauzon
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Jihad S. Obeid
- Department of Psychiatry and Behavioral Sciences, Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Leslie A. Lenert
- Department of Psychiatry and Behavioral Sciences, Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Brandon M. Welch
- Department of Psychiatry and Behavioral Sciences, Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
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Gohari SH, Keshvardoost S, Sarabi RE, Bahaadinbeigy K. Travel Avoidance Using Telepediatric by Patients and Healthcare Providers: a Review of the Literature. Acta Inform Med 2020; 28:124-129. [PMID: 32742065 PMCID: PMC7382769 DOI: 10.5455/aim.2020.28.124-129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: Telepediatric is one of the subspecialties of telemedicine that can be defined as the use of information and communication technology tools to offer healthcare services to children at a distance. Aim: The use of telepediatric healthcare services for children living in rural or deserved areas may reduce the cost and time of travel to access these services. This study aims to review published papers that assess the percentage of avoided travel or referrals with the use of telepediatric. Methods: This is a systematic review study. PubMed database was searched in September 2019 to retrieve the published papers. The final 24 retrieved papers were assessed based on the variables such as modality, referral setting, specialty, continent, weight, and percentage of avoided travel. The multivariate linear regression model was used to estimate the percentage of travel avoidance by telepediatric. Results: The linear regression model was determined based on the provided specialty for telepediatric (cardiology, general (multi), and other (rehabilitation, dermatology, psychiatry, respiratory)) with R2 =0.41. The results showed that the mean percentage of avoided travel in cardiology specialty as a baseline was 56%. The use of telepediatric in the general (multi) and other specialties can avoid travel for 26.5% (p=0.02) and 85% (p=0.03) respectively. Conclusion: This study showed that telepediatric could reduce travel at least 26.5% and maximal 85%. These results can be used by healthcare providers to decide on the implementation of successful telepediatric systems to reduce referrals.
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Affiliation(s)
- Sadrieh Hajesmaeel Gohari
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Sareh Keshvardoost
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Roghayeh Ershad Sarabi
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Messagier AL, Blaizot R, Couppié P, Delaigue S. Teledermatology Use in Remote Areas of French Guiana: Experience From a Long-Running System. Front Public Health 2019; 7:387. [PMID: 31921751 PMCID: PMC6930889 DOI: 10.3389/fpubh.2019.00387] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 12/02/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction: French Guiana is an overseas region of France on the north coast of South America and is mostly covered by tropical rainforest. Most human settlements are located along the coast while some settlements are scattered across the hinterland. In 2001, the French public health service launched a telemedicine pilot project between the main hospital in Cayenne and remote health centers in French Guiana to tackle healthcare access inequalities. The aim of the present study was to review dermatology cases of the French Guiana telemedicine network to assess the use of telemedicine in dermatology, in order to evaluate its usefulness and propose ways to improve the system. Methods: A retrospective study was conducted on all dermatology cases referred between July 2015 and December 2016 through the French Guiana platform. The Model for Assessment of Telemedicine (MAST) methodology was used as recommended by the European Union. Results: A total of 254 cases were reviewed by dermatologists at Cayenne hospital over the 18-month study period, with a mean of 14 cases per month. All the 16 peripheral health centers used the telemedicine service during the study. In most cases (202/254, 80%), specialists provided a single diagnosis to the referrers. Infectious diseases represented the main reasons for requests (92/202, 46%) including 32% (29/92) of neglected tropical diseases like leprosy and cutaneous leishmaniasis. A total of 39% (100/258) peripheral centers answered the end-users' survey, and more than 85% found the answer delay was fast, the service useful and with an educational benefit. Overall, the accuracy of the diagnosis increased with the quality of the pictures provided, though the latter was good in only 60% (75/125) of the cases. Most patients for whom a teleconsultations has been required (234/254, 92%) have been managed in the peripheral health centers, while referring the patient to Cayenne was necessary for only 20/254 (8%). Conclusion: The telemedicine system in French Guiana appears to be an interesting solution to the lack of specialists and allowed a better access to specialized dermatology care for people living in the remote areas of this region.
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Affiliation(s)
- Anne-Laure Messagier
- Dermatology Department, Centre Hospitalier Andrée-Rosemon, Cayenne, French Guiana
| | - Romain Blaizot
- Dermatology Department, Centre Hospitalier Andrée-Rosemon, Cayenne, French Guiana.,EA 3593 Ecosystèmes Amazoniens et Pathologies Tropicales, University of French Guiana, Cayenne, French Guiana
| | - Pierre Couppié
- Dermatology Department, Centre Hospitalier Andrée-Rosemon, Cayenne, French Guiana.,EA 3593 Ecosystèmes Amazoniens et Pathologies Tropicales, University of French Guiana, Cayenne, French Guiana
| | - Sophie Delaigue
- Dermatology Department, Centre Hospitalier Andrée-Rosemon, Cayenne, French Guiana
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Vidal-Alaball J, Franch-Parella J, Lopez Seguí F, Garcia Cuyàs F, Mendioroz Peña J. Impact of a Telemedicine Program on the Reduction in the Emission of Atmospheric Pollutants and Journeys by Road. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4366. [PMID: 31717386 PMCID: PMC6888368 DOI: 10.3390/ijerph16224366] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/27/2019] [Accepted: 11/06/2019] [Indexed: 01/18/2023]
Abstract
This retrospective study evaluates the effect of a telemedicine program developed in the central Catalan region in lowering the environmental footprint by reducing the emission of atmospheric pollutants, thanks to a reduction in the number of hospital visits involving journeys by road. Between January 2018 and June 2019, a total of 12,322 referrals were made to telemedicine services in the primary care centers, avoiding a total of 9034 face-to-face visits. In total, the distance saved was 192,682 km, with a total travel time saving of 3779 h and a total fuel reduction of 11,754 L with an associated cost of €15,664. This represents an average reduction of 3248.3 g of carbon dioxide, 4.05 g of carbon monoxide, 4.86 g of nitric oxide and 3.2 g of sulphur dioxide. This study confirms that telemedicine reduces the environmental impact of atmospheric pollutants emitted by vehicles by reducing the number of journeys made for face-to-face visits, and thus contributing to environmental sustainability.
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Affiliation(s)
- Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
| | - Jordi Franch-Parella
- Faculty of Social Sciences, Universitat de Vic-Universitat Central de Catalunya, 08242 Manresa, Spain
| | - Francesc Lopez Seguí
- TIC Salut Social-Ministry of Health, 08005 Barcelona, Spain
- CRES&CEXS-Pompeu Fabra University, 08005 Barcelona, Spain
| | | | - Jacobo Mendioroz Peña
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
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Coustasse A, Sarkar R, Abodunde B, Metzger BJ, Slater CM. Use of Teledermatology to Improve Dermatological Access in Rural Areas. Telemed J E Health 2019; 25:1022-1032. [PMID: 30741608 DOI: 10.1089/tmj.2018.0130] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Alberto Coustasse
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, West Virginia
| | - Raghav Sarkar
- Health Informatics Program, Marshall University, Huntington, West Virginia
| | - Bukola Abodunde
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, West Virginia
| | - Brandon J. Metzger
- Health Informatics Program, Marshall University, Huntington, West Virginia
| | - Chelsea M. Slater
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, West Virginia
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Zhang X, Zaman BU. Adoption mechanism of telemedicine in underdeveloped country. Health Informatics J 2019; 26:1088-1103. [DOI: 10.1177/1460458219868353] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study is to reveal the influential mechanism on patients’ adoption intention of telemedicine in the underdeveloped areas. Based on 896 patients’ data collected in Pakistan, we found that patients’ adoption intention is a function of traveling cost, attitudes, and perceived usefulness. High traveling cost is found to have the most significant negative influence on adoption intention. Patients with shorter distance prefer more to use telemedicine. Traveling cost, traveling time, and traveling distance have indirect influences on adoption intention through their significant impacts on perceived usefulness and perceived ease of use. Our findings indicate that geographic locations does matter during promotion of telemedicine. This study also helps identify the true barriers and facilitators to large-scale adoption of telemedicine in developing countries and reduce the gap of healthcare equity as concerned by both UN Millennium Development Goals and UN Sustainable Development Goals.
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Affiliation(s)
- Xiang Zhang
- Beijing Institute of Technology, China; Sustainable Development Research Institute for Economy and Society of Beijing, China
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Maia MR, Castela E, Pires A, Lapão LV. How to develop a sustainable telemedicine service? A Pediatric Telecardiology Service 20 years on - an exploratory study. BMC Health Serv Res 2019; 19:681. [PMID: 31547824 PMCID: PMC6757431 DOI: 10.1186/s12913-019-4511-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/04/2019] [Indexed: 12/04/2022] Open
Abstract
Background Telemedicine services are promoting more access to healthcare. Portugal was an early adopter of telemedicine to overcome both its geological barriers and the shortage of healthcare professionals. The Pediatric Cardiology Service (PCS) at Coimbra University Hospital Centre (CHUC) has been using telemedicine to increase access and coverage since 1998. Their Pediatric Telecardiology Service has been daily connecting CHUC with 13 other Portuguese national hospitals, and regularly connecting with Portuguese-speaking African countries, through a teleconsultation platform. Methods This study aims at exploring the Pediatric Telecardiology Service’s evolution, through a comprehensive assessment of the PCS’s development, evolution and impact in public health, to better understand the critical factors for implementation and sustainability of telemedicine, in the context of healthcare services digitalization. A case study was performed, with cost-benefit, critical factors and organizational culture assessment. Finally, the Kingdon’s framework helped to understand the implementation and scale-up process and the role of policy-making. Results With the total of 32,685 out-patient teleconsultations, growing steadily from 1998 to 2016, the Pediatric Telecardiology Service has reached national and international recognition, being a pioneer and an active promotor of telemedicine. This telemedicine service has saved significant resources, about 1.1 million euros for the health system (e.g. in administrative and logistic costs) and approximately 419 euros per patient (considering an average of 1777 patients per year). PCS presents a dominant “Clan” culture. The Momentum’s critical factors for telemedicine service implementation enabled us to understand how barriers were overcome (e.g. political forces). Willingness, perseverance and teamwork, allied with partnership with key stakeholders, were the foundation for professionals’ engagement and service networking development. Its positive results, new regulations and the increasing support from the hospital board, set up a window of opportunity to establish a sustainable telemedicine service. Conclusion The Pediatric Telecardiology Service enables real-time communication and the sharing of clinical information, overcoming many barriers (from geographical ones to shortage of healthcare professionals), improving access to specialized care both in Portugal and Africa. Motivation and teamwork, and perseverance, were key for the Pediatric Telecardiology Service to tackle the window of opportunity which created conditions for sustainability.
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Affiliation(s)
- Mélanie Raimundo Maia
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008, Lisboa, Portugal.
| | - Eduardo Castela
- Pediatric Hospital, Centro Hospitalar e Universitário de Coimbra, CHUC, 3000-075, Coimbra, Portugal
| | - António Pires
- Pediatric Hospital, Centro Hospitalar e Universitário de Coimbra, CHUC, 3000-075, Coimbra, Portugal
| | - Luís Velez Lapão
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008, Lisboa, Portugal
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Ranganathan C, Balaji S. Key Factors Affecting the Adoption of Telemedicine by Ambulatory Clinics: Insights from a Statewide Survey. Telemed J E Health 2019; 26:218-225. [PMID: 30874484 DOI: 10.1089/tmj.2018.0114] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Despite demonstrated benefits and improved demand for telemedicine, adoption rates by U.S. ambulatory clinics remain low. There is a critical need to identify why telemedicine adoption rates remain low among ambulatory providers. Introduction: The aim of this study is to evaluate key predictors of telemedicine adoption by ambulatory clinics and assess salient differences between adopters and nonadopters. Three categories of predictors namely clinic characteristics, health information technology (HIT)-related factor, and organizational variables were examined. Materials and Methods: The study used data from a survey of 1,285 clinics in Minnesota (MN) that was collected by Minnesota Department of Health (MDH) in 2016. Exploratory statistical analyses as well as binary logistic regression analyses were carried out using SPSS software. Results: Fifty-five percent of ambulatory clinics in Minnesota had adopted telemedicine. Real-time consultations were adopted in over 26% clinics, remote patient monitoring in 15% clinics, and store-and-forward consultations in about 7% clinics. Originating site teleconsulting was prevalent in 27% clinics, whereas primary care and specialist services through teleconsulting were adopted by 23% clinics. Logistic regression revealed health system-owned clinics, rural clinics, and primary care ones to exhibit higher levels of telemedicine adoption. Clinics with paperless electronic health record (EHR) systems, health information exchange (HIE)-enablement, and better technological infrastructure had higher odds of telemedicine adoption. Furthermore, clinics that had redesigned their workflows also exhibited higher odds of telemedicine adoption. Clinics that faced high costs of telemedicine equipment, lack of demand had lower adoption levels. Clinics that faced high costs for hosting and staffing were more likely to adopt store-and-forward telemedicine and real-time patient monitoring rather than other high-end telemedicine services. Clinics that reported inadequate coverage or reimbursement were more likely to adopt a restrictive set of telemedicine services. Discussion: Telemedicine is not yet very prevalent among Minnesota ambulatory clinics. Over 45% of the clinics do not offer any telemedicine services. The barriers to adoption vary widely and pertain to HIT as well as organizational factors. Conclusion: With increased demand for telemedicine services, policy changes aimed at improving the reimbursement models, digital infrastructure for telemedicine, HIE capabilities, organizational efforts to move toward paperless EHR systems, and redesigning workflows can facilitate in accelerating telemedicine adoption.
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Affiliation(s)
- C Ranganathan
- Department of Information & Decision Sciences, University of Illinois at Chicago, Chicago Illinois
| | - S Balaji
- Department of Information Technology and Supply Chain Management, University of Wisconsin-Whitewater, Whitewater, Wisconsin
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Mehrtens SH, Shall L, Halpern SM. A 14-year review of a UK teledermatology service: experience of over 40 000 teleconsultations. Clin Exp Dermatol 2019; 44:874-881. [PMID: 30767255 DOI: 10.1111/ced.13928] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a paucity of published evidence of established teledermatology (TD) services in the UK. An in-house TD service using store-and-forward technology was set up at a large regional dermatology department in 2004. AIM To review the TD service at our centre, including teleconsultation numbers, coding of diagnoses and patient outcomes. METHODS Retrospective data were retrieved using the electronic patient database, from 31 July 2004 to 31 July 2018. More detailed information on patient outcomes was obtained from patient notes and histology records. A paper questionnaire was distributed to 100 patients to obtain patient feedback. RESULTS In total, 40 201 teleconsultations were made over 14 years, and 64% of cases were coded (n = 25 555), of which 77% were lesions. The most common coded lesions were benign naevus (25%), seborrhoeic keratosis (22%) and basal cell carcinoma (19%). Of the total number of cases, 50% were discharged to their general practitioner with advice, 34% were booked for surgery and 16% were booked for a face-to-face appointment. In the survey, 82% of patients surveyed felt that the service was 'good' or 'very good'. A detailed study between 1 January 2015 and 1 January 2016 showed that there were 383 patients (10%) with no diagnosis made following teleconsultation, suggesting diagnostic uncertainty. Reasons for this included lack of diagnostic features, possibility of malignancy and service factors. Within this cohort, there was 68% diagnostic concordance. CONCLUSIONS We have set up a successful TD service at a UK centre, which has prevented 16 282 face-to-face appointments over 14 years. Patient feedback has been very good. Review of cases with diagnostic uncertainty provides important information for service improvement and has not previously been documented.
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Affiliation(s)
- S H Mehrtens
- Medway NHS Foundation Trust, Gillingham, Kent, UK
| | - L Shall
- Medway NHS Foundation Trust, Gillingham, Kent, UK
| | - S M Halpern
- Medway NHS Foundation Trust, Gillingham, Kent, UK
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REAL-WORLD CLINICAL EVALUATION AND COSTS OF TELEMEDICINE FOR CHRONIC WOUND MANAGEMENT. Int J Technol Assess Health Care 2018; 34:567-575. [PMID: 30369340 DOI: 10.1017/s0266462318000685] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Chronic wounds are frequent, affect quality of life, and increase care costs. Telemedicine provides potential for effective wound care management, especially for the monitoring of complex wounds at home. OBJECTIVES The objective of the present study was to determine the clinical effects and costs of telemedicine for the follow-up of complex chronic wounds from the perspective of the public health insurance. The study ran over a period of 9 months. METHODS We conducted a prospective, pragmatic, open-label, observational study and carried out a cost-effectiveness analysis. A total of 116 patients with chronic wounds were assigned to their choice of two groups: telemedicine (N = 77) and traditional follow-up (control; N = 39). The primary outcome was the time to healing. Secondary outcomes included percentage of wounds reaching target objective, percentage of wounds healed completely, outpatient care costs, travel costs, and hospitalizations. RESULTS Time to healing was shorter in the telemedicine group than in the control group (137 versus 174 days; p .05). Outpatient care and hospitalization costs were not significantly different. The main results in terms of economic savings were medical transport costs reimbursed by the French public health insurance, which were significantly lower in the telemedicine group. Telemedicine costs were found to be €4,583 less per patient compared with standard practice over 9 months. CONCLUSIONS This trial suggests that telemedicine saves travel costs and results in a shorter healing time than traditional follow-up.
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Koch R, Polanc A, Haumann H, Kirtschig G, Martus P, Thies C, Sundmacher L, Gaa C, Witkamp L, Joos S. Improving cooperation between general practitioners and dermatologists via telemedicine: study protocol of the cluster-randomized controlled TeleDerm study. Trials 2018; 19:583. [PMID: 30355358 PMCID: PMC6201508 DOI: 10.1186/s13063-018-2955-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Internationally, teledermatology has proven to be a viable alternative to conventional physical referrals. Travel cost and referral times are reduced while patient safety is preserved. Especially patients from rural areas benefit from this healthcare innovation. Despite these established facts and positive experiences from EU neighboring countries like the Netherlands or the United Kingdom, Germany has not yet implemented store-and-forward teledermatology in routine care. METHODS The TeleDerm study will implement and evaluate store-and-forward teledermatology in 50 general practitioner (GP) practices as an alternative to conventional referrals. TeleDerm aims to confirm that the possibility of store-and-forward teledermatology in GP practices is going to lead to a 15% (n = 260) reduction in referrals in the intervention arm. The study uses a cluster-randomized controlled trial design. Randomization is planned for the cluster "county". The main observational unit is the GP practice. Poisson distribution of referrals is assumed. The evaluation of secondary outcomes like acceptance, enablers and barriers uses a mixed-methods design with questionnaires and interviews. DISCUSSION Due to the heterogeneity of GP practice organization, patient management software, information technology service providers, GP personal technical affinity and training, we expect several challenges in implementing teledermatology in German GP routine care. Therefore, we plan to recruit 30% more GPs than required by the power calculation. The implementation design and accompanying evaluation is expected to deliver vital insights into the specifics of implementing telemedicine in German routine care. TRIAL REGISTRATION German Clinical Trials Register, DRKS00012944 . Registered prospectively on 31 August 2017.
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Affiliation(s)
- Roland Koch
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Osianderstraße 5, 72076, Tübingen, Germany.
| | - Andreas Polanc
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Osianderstraße 5, 72076, Tübingen, Germany
| | - Hannah Haumann
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Osianderstraße 5, 72076, Tübingen, Germany
| | - Gudula Kirtschig
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Osianderstraße 5, 72076, Tübingen, Germany.,AOK Baden-Württemberg Hauptverwaltung, Fachbereich Integriertes Leistungsmanagement, Presselstraße 19, 70191, Stuttgart, Germany
| | - Peter Martus
- University Hospital Tübingen, Institute for Clinical Epidemiology and Applied Biometry, Silcherstraße 5, 72076, Tübingen, Germany
| | - Christian Thies
- Reutlingen University, School of Informatics, Alteburgstraße 150, 72762, Reutlingen, Germany
| | - Leonie Sundmacher
- Ludwig-Maximilians-University München, Fachbereich Health Services Management, Schackstraße 4, 80539, Munich, Germany
| | - Carmen Gaa
- AOK Baden-Württemberg Hauptverwaltung, Fachbereich Integriertes Leistungsmanagement, Presselstraße 19, 70191, Stuttgart, Germany
| | - Leonard Witkamp
- Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.,KSYOS TeleMedisch Centrum, Bavinckhouse, Professor J.H. Bavincklaan 2-4, 1183 AT, Amstelveen, the Netherlands
| | | | - Stefanie Joos
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Osianderstraße 5, 72076, Tübingen, Germany
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Romero G, de Argila D, Ferrandiz L, Sánchez M, Vañó S, Taberner R, Pasquali P, de la Torre C, Alfageme F, Malvehy J, Moreno-Ramírez D. Practice Models in Teledermatology in Spain: Longitudinal Study, 2009-2014. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Romero G, de Argila D, Ferrandiz L, Sánchez M, Vañó S, Taberner R, Pasquali P, de la Torre C, Alfageme F, Malvehy J, Moreno-Ramírez D. Modelos de práctica de la teledermatología en España. Estudio longitudinal 2009-2014. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:624-630. [DOI: 10.1016/j.ad.2018.03.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/24/2018] [Accepted: 03/25/2018] [Indexed: 10/16/2022] Open
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Romero-Aguilera G, Ferrandiz L, Moreno-Ramírez D. Urban Teledermatology: Concept, Advantages, and Disadvantages. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Teoh J, Hsueh A, Mariño R, Manton D, Hallett K. Economic Evaluation of Teledentistry in Cleft Lip and Palate Patients. Telemed J E Health 2018; 24:449-456. [DOI: 10.1089/tmj.2017.0138] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Jonathan Teoh
- School of Population Health, University of Melbourne, Melbourne, Australia
| | - Arthur Hsueh
- School of Population Health, University of Melbourne, Melbourne, Australia
| | - Rodrigo Mariño
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - David Manton
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Kerrod Hallett
- Royal Children's Hospital Melbourne, Melbourne, Australia
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Urban Teledermatology: Concept, Advantages, and Disadvantages. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:471-475. [PMID: 29650220 DOI: 10.1016/j.ad.2018.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/09/2018] [Indexed: 11/20/2022] Open
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Abstract
Telemedicine is slowly transforming the way in which healthcare is delivered and has the potential to improve access to subspecialty expertise, reduce healthcare costs, and improve the overall quality of care. While many subspecialty fields within medicine today have either experimented with or begun to implement telemedicine platforms to enable remote consultation and care, dermatology is particularly suited for this care system as skin disorders are uniquely visible to the human eye. Through teledermatology, diagnostic images of skin disorders with accompanying clinical histories can be remotely reviewed by teledermatologists by any number of modalities, such as photographic clinical images or live video teleconferencing. Diagnoses and treatment recommendations can then be rendered and implemented remotely. The evidence to date supports both its diagnostic and treatment accuracy and its cost effectiveness. Administrative, regulatory, privacy, and reimbursement policies surrounding this dynamic field continue to evolve. In this review, we examine the history, evidence, and administrative landscape surrounding teledermatology and discuss current practice guidelines and ongoing controversies.
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Affiliation(s)
- Jonathan J Lee
- Department of Dermatology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Joseph C English
- Department of Dermatology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.
- Teledermatology, UPMC North Hills Dermatology, 9000 Brooktree Rd Suite 200, Wexford, PA, 15044, USA.
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State of the art of the telemedicine. Where are we and what is pending to be done? Med Clin (Barc) 2018; 150:150-154. [PMID: 28870421 DOI: 10.1016/j.medcli.2017.06.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 06/28/2017] [Indexed: 11/20/2022]
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Mehrtens S, Halpern S. Changing use and attitudes towards teledermatology in the U.K. over 10 years: results of the 2016 National Survey. Br J Dermatol 2017; 178:286-288. [DOI: 10.1111/bjd.15606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S.H. Mehrtens
- Medway NHS Foundation Trust Windmill Rd Gillingham Kent ME7 5NY U.K
| | - S.M. Halpern
- Medway NHS Foundation Trust Windmill Rd Gillingham Kent ME7 5NY U.K
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Saadi A, Mateen FJ. International Issues: Teleneurology in humanitarian crises: Lessons from the Médecins Sans Frontières experience. Neurology 2017; 89:e16-e19. [PMID: 28716879 DOI: 10.1212/wnl.0000000000004114] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Humanitarian emergencies defined by armed conflict, political strife, famine, or natural disaster can devastate populations rapidly. Neurologic disorders accompany these complex humanitarian emergencies but often go unheeded, exacerbated by a scarcity of neurologists. Teleneurology offers the promise of neurologic care remotely in the face of this inadequate local clinician supply. We describe our experiences as voluntary neurology teleconsultants with Médecins Sans Frontières in order to highlight both the promises and challenges of teleneurology in humanitarian contexts. We identified the major advantages of this service as (1) minimal resources and incurred costs while (2) changing a patient's clinical course favorably, and (3) creating a community for the field referrer and neurology specialist. Current challenges include (1) limited diagnostic resources and difficult diagnostic and therapeutic decision-making, (2) need for greater continuity and familiarity between the field site and neurologist, (3) gaps in the US neurology curriculum to provide expertise for all sites, (4) lack of follow-up and feedback from the field to advise future cases, and (5) low frequency of consultations. Growth opportunities include eventual expansion to the development of a community of neurologists who can provide context-specific care and maximize use of multimedia at low Internet bandwidth. Lessons from our experience may help optimize teleneurology's effect and reduce disparities in neurologic care, particularly in humanitarian crises.
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Affiliation(s)
- Altaf Saadi
- From Partners Neurology Residency (A.S.), Massachusetts General Hospital (F.J.M.) and Brigham and Woman's Hospital; and Harvard Medical School (F.J.M.), Boston, MA.
| | - Farrah J Mateen
- From Partners Neurology Residency (A.S.), Massachusetts General Hospital (F.J.M.) and Brigham and Woman's Hospital; and Harvard Medical School (F.J.M.), Boston, MA
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Robinson JD, Prochaska JD, Yngve DA. Pre-surgery evaluations by telephone decrease travel and cost for families of children with cerebral palsy. SAGE Open Med 2017; 5:2050312117720046. [PMID: 28839936 PMCID: PMC5528192 DOI: 10.1177/2050312117720046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 06/14/2017] [Indexed: 01/18/2023] Open
Abstract
Introduction: Children with cerebral palsy need highly specialized care. This can be very burdensome for families, particularly in large rural states, due to the need for long-distance travel to appointments. In this study, children undergoing the selective percutaneous myofascial lengthening surgery utilized a telephone-based telemedicine evaluation to assess for surgical eligibility. The goal was to avoid a separate preoperative clinic visit weeks before the surgery. If possible, eligibility was determined by telephone, and then, the patient could be scheduled for a clinic visit and possible surgery the next day, saving the family a trip. The purposes of the study were to calculate estimated reductions in miles traveled, in travel expenses, and in carbon emissions and to determine whether the telephone assessment was accurate and effective in determining eligibility for surgery. Methods: From 2010 to 2012, 279 patients were retrospectively reviewed, and of those, 161 mailed four-page questionnaire and anteroposterior pelvis X-ray followed by a telephone conference. Geographic information system methods were used to geocode patients by location. Savings in mileage and travel costs were calculated. From 2014 to 2015, 195 patients were additionally studied to determine accuracy and effectiveness. Results: The telephone prescreening method saved 106,070 miles in transportation over 3 years, a 38% reduction with US$55,326 in savings. Each family saved an average of 658 (standard deviation = 340) miles of travel and US$343.64 (standard deviation = US$178) in travel expenses. For each increase of 10 miles in distance from the health center, the odds of a patient utilizing telephone screening increased by 10% (odds ratio: 1.101, 95% confidence interval: 1.073–1.129, p < 0.001). After the telephone prescreening, 86% were determined to be likely candidates for the procedure. For 14%, a clinic visit only was scheduled, and they were not scheduled for surgery. Conclusion: Families seeking specialized surgical care for their disabled children particularly benefited from this approach.
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Affiliation(s)
- John D Robinson
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - John D Prochaska
- Department of Preventive Medicine & Community Health, The University of Texas Medical Branch, Galveston, TX, USA
| | - David A Yngve
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
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Agnisarman SO, Chalil Madathil K, Smith K, Ashok A, Welch B, McElligott JT. Lessons learned from the usability assessment of home-based telemedicine systems. APPLIED ERGONOMICS 2017; 58:424-434. [PMID: 27633239 DOI: 10.1016/j.apergo.2016.08.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 07/19/2016] [Accepted: 08/02/2016] [Indexed: 06/06/2023]
Abstract
At-home telemedicine visits are quickly becoming an acceptable alternative for in-person patient visits. However, little work has been done to understand the usability of these home-based telemedicine solutions. It is critical for user acceptance and real-world applicability to evaluate available telemedicine solutions within the context-specific needs of the users of this technology. To address this need, this study evaluated the usability of four home-based telemedicine software platforms: Doxy.me, Vidyo, VSee, and Polycom. Using a within-subjects experimental design, twenty participants were asked to complete a telemedicine session involving several tasks using the four platforms. Upon completion of these tasks for each platform, participants completed the IBM computer system usability questionnaire (CSUQ) and the NASA Task Load Index test. Upon completing the tasks on all four platforms, the participants completed a final post-test subjective questionnaire ranking the platforms based on their preference. Of the twenty participants, 19 completed the study. Statistically significant differences among the telemedicine software platforms were found for task completion time, total workload, mental demand, effort, frustration, preference ranking and computer system usability scores. Usability problems with installation and account creation led to high mental demand and task completion time, suggesting the participants preferred a system without such requirements. Majority of the usability issues were identified at the telemedicine initiation phase. The findings from this study can be used by software developers to develop user-friendly telemedicine systems.
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Affiliation(s)
| | | | - Kevin Smith
- Medical University of South Carolina, Department of Public Health Sciences, 135 Cannon Street Suite 303, MSC 835, Charleston, SC 29425-8350, United States
| | - Aparna Ashok
- Clemson University, 110 Freeman Hall, Clemson, SC 29634, United States
| | - Brandon Welch
- Medical University of South Carolina, Department of Public Health Sciences, 135 Cannon Street Suite 303, MSC 835, Charleston, SC 29425-8350, United States
| | - James T McElligott
- Medical University of South Carolina, South Carolina Telehealth Alliance, 135 Rutledge Ave., Charleston, SC 29425-8350, United States
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Snoswell C, Smith AC, Scuffham PA, Whitty JA. Economic evaluation strategies in telehealth: Obtaining a more holistic valuation of telehealth interventions. J Telemed Telecare 2016; 23:792-796. [DOI: 10.1177/1357633x16671407] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Telehealth is an emerging area of medical research. Its translation from conception, to research and into practice requires tailored research and economic evaluation methods. Due to their nature telehealth interventions exhibit a number of extra-clinical benefits that are relevant when valuing their costs and outcomes. By incorporating methods to measure societal values such as patient preference and willingness-to-pay, a more holistic value can be placed on the extra-clinical outcomes associated with telehealth and evaluations can represent new interventions more effectively. Cost-benefit analysis is a method by which relevant costs and outcomes in telehealth can be succinctly valued and compared. When health economic methods are conducted using holistic approaches such as cost-benefit analysis they can facilitate the translation of telehealth research into policy and practice.
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Affiliation(s)
- Centaine Snoswell
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Paul A Scuffham
- School of Medicine & the Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Jennifer A Whitty
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- School of Medicine & the Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
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Zanaboni P, Wootton R. Adoption of routine telemedicine in Norwegian hospitals: progress over 5 years. BMC Health Serv Res 2016; 16:496. [PMID: 27644324 PMCID: PMC5028940 DOI: 10.1186/s12913-016-1743-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 09/13/2016] [Indexed: 11/25/2022] Open
Abstract
Background Although Norway is well known for its early use of telemedicine to provide services for people in rural and remote areas in the Arctic, little is known about the pace of telemedicine adoption in Norway. The aim of the present study was to explore the statewide implementation of telemedicine in Norwegian hospitals over time, and analyse its adoption and level of use. Methods Data on outpatient visits and telemedicine consultations delivered by Norwegian hospitals from 2009 to 2013 were collected from the national health registry. Data were stratified by health region, hospital, year, and clinical specialty. Results All four health regions used telemedicine, i.e. there was 100 % adoption at the regional level. The use of routine telemedicine differed between health regions, and telemedicine appeared to be used mostly in the regions of lower centrality and population density, such as Northern Norway. Only Central Norway seemed to be atypical. Twenty-one out of 28 hospitals reported using telemedicine, i.e. there was 75 % adoption at the hospital level. Neurosurgery and rehabilitation were the clinical specialties where telemedicine was used most frequently. Despite the growing trend and the high adoption, the relative use of telemedicine compared to that of outpatient visits was low. Conclusions Adoption of telemedicine is Norway was high, with all the health regions and most of the hospitals reporting using telemedicine. The use of telemedicine appeared to increase over the 5-year study period. However, the proportion of telemedicine consultations relative to the number of outpatient visits was low. The use of telemedicine in Norway was low in comparison with that reported in large-scale telemedicine networks in other countries. To facilitate future comparisons, data on adoption and utilisation over time should be reported routinely by statewide or network-based telemedicine services.
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Affiliation(s)
- Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, P.O. Box 35, 9038, Tromsø, Norway.
| | - Richard Wootton
- Norwegian Centre for E-health Research, University Hospital of North Norway, P.O. Box 35, 9038, Tromsø, Norway.,Faculty of Health Sciences, The Arctic University of Norway, Langnes, P.O. Box 6050, 9037, Tromsø, Norway
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Kacetl J, Maresova P. Legislative and ethical aspects of introducing new technologies in medical care for senior citizens in developed countries. Clin Interv Aging 2016; 11:977-84. [PMID: 27499618 PMCID: PMC4959584 DOI: 10.2147/cia.s104433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The majority of developed countries are currently experiencing demographic aging. The most frequently expressed concerns related to the changing age structure are the increased costs of social and medical care, a lack of labor force in the job market, and financial sustainability of the pension system. These concerns are often based on the pessimistic view of population aging. This view understands aging as a prolonged period of illness and suffering. On the other hand, optimists believe that a longer life span is a result of increased quality of life and better health care. The quality of life may be improved not only by medicaments, but also by rapidly developing area of medical devices, which allow better care for seniors in many areas. Aim This contribution aims to assess the legislative environment and ethical questions related to the use of medical devices, especially medical devices, in medical care for senior citizens. Methods The methods used in this study are literature reviews of legislative and ethical environment in the European Union (EU) and the US. Results Main findings of this study result from assessing the state of medical device regulations in Europe and the US. Namely, the US regulation seems to be better arranged, which is probably due to the fact that there is only one responsible body – the US Food and Drug Administration, which is responsible for all medical device regulations. On the other hand, in the EU, talks about new legislation are led by ministers from all the EU member states and it may take a long time before all the EU countries come to an agreement.
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Affiliation(s)
| | - Petra Maresova
- Department of Economics, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, Czech Republic
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O'Gorman LD, Hogenbirk JC. Driving Distance to Telemedicine Units in Northern Ontario as a Measure of Potential Access to Healthcare. Telemed J E Health 2016; 22:269-75. [DOI: 10.1089/tmj.2015.0133] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Laurel D. O'Gorman
- Center for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada
| | - John C. Hogenbirk
- Center for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada
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