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Brill J, Heymann AD, Zacay G. An After-Hours Telemedicine Urgent Care Service May Not Improve Access to Care for Underserved Populations. Telemed J E Health 2024. [PMID: 38946672 DOI: 10.1089/tmj.2023.0714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Background: After-hours telemedicine services for emergency care are thought to offer a solution for patients who live at a distance from traditional face-to-face emergency services. This study evaluates such a service in a Health Maintenance Organization, focusing on the differences between central and peripheral populations. Methods: In this cross-sectional database study, we collected data regarding the encounter and patient characteristics, including prescriptions, referrals for further evaluation in a traditional emergency department (ED), and the distance from a traditional ED. Other outcome measures included health care utilization after the encounter such as primary care physician (PCP) encounters, additional telemedicine encounters, ED visits, and hospitalization. Results: In total, 45,411 patient visits were analyzed. Medication was prescribed in 25% of the encounters, and a referral to an ED was given in 22%. In total, 17.7% of the patients visited an ED within 24 h of the index encounter. In total, 64.8% of patients visited a PCP in the following 30 days. No further care was needed in 32.4% of the encounters. In multivariable logistic regression, the odds of using the service were lower for low socio-economic status groups and inhabitants of the periphery than the central areas. A weak reverse correlation was observed in Jewish sectors regarding distance from traditional ED, whereas no correlation was found in the Arab sector. Conclusion: It is commonly believed that telemedicine overcomes geographical barriers. The results of this research do not support this hypothesis.
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Affiliation(s)
- Jonathan Brill
- Department of Family Medicine, Meuhedet Health Services, Tel Aviv, Israel
- Faculty of Medicine, Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anthony David Heymann
- Department of Family Medicine, Meuhedet Health Services, Tel Aviv, Israel
- Faculty of Medicine, Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galia Zacay
- Department of Family Medicine, Meuhedet Health Services, Tel Aviv, Israel
- Faculty of Medicine, Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel
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Tureck F, Chioro A, Tofani LFN, Lima CL, Vieira ADCS, Andreazza R. Innovations produced in Primary Health Care during the COVID-19 pandemic: an integrative literature review. CIENCIA & SAUDE COLETIVA 2024; 29:e07022023. [PMID: 38896673 DOI: 10.1590/1413-81232024296.07022023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/08/2023] [Indexed: 06/21/2024] Open
Abstract
Primary Health Care (PHC) proved to be an important part of the prevention, control and treatment measures against COVID-19, a situation in which it was challenged to keep up its provision of regular services as well. This article identifies the main arrangements made to provide PHC care in the context of the COVID-19 pandemic. An integrative literature review of articles found in PubMed, SciELO and LILACS databases was performed using the descriptors "Primary Health Care" and "COVID-19". Findings were analyzed considering three questions: Information and Communication Technologies (ICT), Organizations of Work Processes and Non-COVID Chronic Diseases. The use of different forms of ICT to provide PHC is highlighted regarding patients with respiratory symptoms and chronic patients. Changes in team composition, service flows, physical spaces and working hours were also introduced. Although strategies aimed at monitoring chronic patients and at remote care may have helped minimize deterioration of their health, the decrease in the number of visits performed during this period could have resulted in an increased demand for PHC in post-pandemic years.
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Affiliation(s)
- Fernando Tureck
- Escola de Medicina, Universidade do Contestado. Av. Nereu Ramos 1071, Jardim do Moinho. 89300-000 Mafra SC Brasil.
| | - Arthur Chioro
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Luís Fernando Nogueira Tofani
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Carolina Loyelo Lima
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Amanda da Cruz Santos Vieira
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Rosemarie Andreazza
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
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Haimi M, Wheeler SQ. Safety in Teletriage by Nurses and Physicians in the United States and Israel: Narrative Review and Qualitative Study. JMIR Hum Factors 2024; 11:e50676. [PMID: 38526526 PMCID: PMC11002740 DOI: 10.2196/50676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/25/2023] [Accepted: 02/28/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND The safety of telemedicine in general and telephone triage (teletriage) safety in particular have been a focus of concern since the 1970s. Today, telehealth, now subsuming teletriage, has a basic structure and process intended to promote safety. However, inadequate telehealth systems may also compromise patient safety. The COVID-19 pandemic accelerated rapid but uneven telehealth growth, both technologically and professionally. Within 5-10 years, the field will likely be more technologically advanced; however, these advances may still outpace professional standards. The need for an evidence-based system is crucial and urgent. OBJECTIVE Our aim was to explore ways that developed teletriage systems produce safe outcomes by examining key system components and questioning long-held assumptions. METHODS We examined safety by performing a narrative review of the literature using key terms concerning patient safety in teletriage. In addition, we conducted system analysis of 2 typical formal systems, physician led and nurse led, in Israel and the United States, respectively, and evaluated those systems' respective approaches to safety. Additionally, we conducted in-depth interviews with representative physicians and 1 nurse using a qualitative approach. RESULTS The review of literature indicated that research on various aspects of telehealth and teletriage safety is still sparse and of variable quality, producing conflicting and inconsistent results. Researchers, possibly unfamiliar with this complicated field, use an array of poorly defined terms and appear to design studies based on unfounded assumptions. The interviews with health care professionals demonstrated several challenges encountered during teletriage, mainly making diagnosis from a distance, treating unfamiliar patients, a stressful atmosphere, working alone, and technological difficulties. However, they reported using several measures that help them make accurate diagnoses and reasonable decisions, thus keeping patient safety, such as using their expertise and intuition, using structured protocols, and considering nonmedical factors and patient preferences (shared decision-making). CONCLUSIONS Remote encounters about acute, worrisome symptoms are time sensitive, requiring decision-making under conditions of uncertainty and urgency. Patient safety and safe professional practice are extremely important in the field of teletriage, which has a high potential for error. This underregulated subspecialty lacks adequate development and substantive research on system safety. Research may commingle terminology and widely different, ill-defined groups of decision makers with wide variation in decision-making skills, clinical training, experience, and job qualifications, thereby confounding results. The rapid pace of telehealth's technological growth creates urgency in identifying safe systems to guide developers and clinicians about needed improvements.
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Affiliation(s)
- Motti Haimi
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Health Systems Management Department, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
- Meuhedet Healthcare Services - North District, Tel Aviv, Israel
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4
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Castillo-Rodenas M, Vicente Gómez JÁ, Fuster-Casanovas A, Miró Catalina Q, Vidal-Alaball J, López Seguí F. Impact of COVID-19 on the Pediatric Primary Care Model in Catalonia: Analysis of Changes in the Number and Type of Face-to-Face and Remote Visits. JMIR Pediatr Parent 2024; 7:e49943. [PMID: 38532544 PMCID: PMC11004613 DOI: 10.2196/49943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 03/28/2024] Open
Abstract
Background The outbreak of COVID-19 has turned the care model of health systems around the world upside down. The health care crisis has led to opportunities for digital health to deliver quality care, and the system has been redirected toward telemedicine. In Catalonia, Spain, as of March 2020, the pattern of visits in primary care pediatric consultations changed, such that face-to-face visits decreased in favor of non-face-to-face visits. Objective This study aimed to analyze variations in the types of pediatric visits in primary care centers in Catalonia before and after the onset of COVID-19. Methods This was a descriptive observational study based on administrative data. The number and type of visits to primary care pediatric services in Catalonia between January 2019 and December 2022 were studied. Results A drop of more than 80% in face-to-face visits and an increase of up to 15 times in remote visits were observed as of March 2020 compared to the previous year. Subsequently, the face-to-face attendance rate began to recover, although it did not reach the same rate as before COVID-19. Non-face-to-face visits were maintained, representing more than 20% of the total after more than 2 years of the pandemic. Conclusions COVID-19 has been the trigger for a transition in the types of visits to primary care pediatric services. The COVID-19 pandemic was a clear catalyst for the integration of telemedicine in Catalan pediatric health care. In this context, although face-to-face consultations have recovered in absolute numbers, after the pandemic period, the weight of telemedicine has increased.
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Affiliation(s)
- Marta Castillo-Rodenas
- Centre d'Atenció Primària Cardona, Gerència d'Atenció Primària i a la Comunitat Catalunya Central, Institut Català de la Salut, Cardona, Spain
| | | | - Aïna Fuster-Casanovas
- 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, Sant Fruitós de Bages, Spain
| | - Queralt Miró Catalina
- 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, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència d'Atenció Primària i a la Comunitat Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Josep Vidal-Alaball
- 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, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència d'Atenció Primària i a la Comunitat Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Francesc López Seguí
- Chair in ICT and Health, Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVic-UCC), Vic, Spain
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Ahmed A, Mutahar M, Daghrery AA, Albar NH, Alhadidi IQI, Asiri AM, Boreak N, Alshahrani AAS, Shariff M, Shubayr MA, Al Moaleem MM. A Systematic Review of Publications on Perceptions and Management of Chronic Medical Conditions Using Telemedicine Remote Consultations by Primary Healthcare Professionals April 2020 to December 2021 During the COVID-19 Pandemic. Med Sci Monit 2024; 30:e943383. [PMID: 38341609 PMCID: PMC10868410 DOI: 10.12659/msm.943383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/22/2023] [Indexed: 02/12/2024] Open
Abstract
Telemedicine technologies allow distribution of health-related services and information and can include electronic and telecommunication technologies, remote patient and clinician contact, referral and prescribing, patient education, and monitoring. This systematic review aimed to evaluate publications on the perceptions and management of chronic medical conditions using telehealth remote consultations by primary healthcare professionals between April 2020 and December 2021 during the COVID-19 pandemic. Electronic databases, including Cinhal, PubMed, Science Direct, and ProQuest were searched to extract qualitative studies relevant to the topic. Inclusion criteria were developed based on the Population, Exposure, and Outcomes scoping framework. The target population was healthcare professionals working in primary care settings. Included studies encompassed various types of telemedicine, such as synchronous telemedicine, video conferencing, telephone conversations, and smart devices. Eight studies were included. Synchronous telemedicine was highly effective in ensuring the continuity of care and treatment, providing patients with convenience, improved access to treatment, and earlier disease management. Video conferencing and telephone consultations were the most common methods used. Challenges included concerns about patient privacy, technology literacy, and acceptance. Telemedicine was commended for its ability to provide access to immediate expert medical advice and eliminate the need for long-distance travel, contributing to increased patient compliance. Synchronous telemedicine is a promising solution for managing chronic conditions during and after the COVID-19 pandemic, offering benefits to patients and healthcare professionals. To maximize its potential, concerns regarding patient privacy, confidentiality, and technology literacy need to be addressed. Proper legislation and regulations are required for long-term success of telemedicine, making it a valuable component of healthcare systems.
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Affiliation(s)
- Arzaq Ahmed
- Faculty of Health, School of Health Sciences, Birmingham City University, Birmingham, UK
| | - Mahdi Mutahar
- Dental Academy, University of Portsmouth, Portsmouth, UK
| | - Arwa A. Daghrery
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Nassreen H. Albar
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Ismail Qasem I. Alhadidi
- General Dentist, Dental Department, Prince Mohammed bin Nasser Hospital, Ministry of Health, Jazan, Saudi Arabia
| | - Ali Mohammed Asiri
- Dental Department, Restorative Dental Science, Ministry of Health, Abha, Saudi Arabia
| | - Nezar Boreak
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | | | - Mansoor Shariff
- Prosthetic Department, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Mosa A. Shubayr
- Division of Dental Public Health, Preventive Dentistry Department, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Mohammed M. Al Moaleem
- Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan, Saudi Arabia
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Shalom T, Bashkin O, Gamus A, Blachar Y, Yaron S, Netzer D, Nevet A, Lavie G. Evaluation of Telephone Visits in Primary Care: Satisfaction of Pediatricians and Family Physicians and Their Perceptions of Quality of Care and Safety. Healthcare (Basel) 2024; 12:212. [PMID: 38255099 PMCID: PMC10815269 DOI: 10.3390/healthcare12020212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Telehealth has accelerated since the outbreak of the COVID-19 virus. As telephone visits become more common, it is important to examine the challenges involved in using this modality of care. In this study, we examined family physicians' and pediatricians' perceptions regarding three aspects of the use of telephone visits: quality of care, safety of care, and physicians' satisfaction. A total of 342 family physicians and pediatricians responded to an online survey. Respondents were asked to rate their degree of agreement with 17 statements inquiring about quality, safety, and satisfaction with telephone visits on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). This was followed by in-depth interviews between January and April 2023 with 26 physicians. Participants expressed satisfaction (3.66 ± 0.80) with the use of telephone visits and lower assessments of safety (3.03 ± 0.76) and quality (2.27 ± 0.76) of care using the telephone modality. Eighty percent of the respondents think combining a face-to-face visit with a telephone visit is recommended, and 51% noted that the inability to examine patients closely affects and impedes a physician's decision making. Most interviewees indicated that telephone visits are safe only with former patients they had already seen in the clinic. The findings shed light on the perceptions of family physicians and pediatricians regarding telephone visits. The lower assessments of quality and safety compared to the assessment of satisfaction underscore the need for careful use of telephone visits in healthcare. A proper and balanced selection of patients, implementing technological upgrades to the modality, and performing patient education practices are recommended.
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Affiliation(s)
- Tamar Shalom
- Department of Health Systems Management, The College of Law and Business, Ramat Gan 52520, Israel; (A.G.); (Y.B.)
| | - Osnat Bashkin
- Department of Public Health, Ashkelon Academic College, Ashkelon 78211, Israel
| | - Alexander Gamus
- Department of Health Systems Management, The College of Law and Business, Ramat Gan 52520, Israel; (A.G.); (Y.B.)
| | - Yoram Blachar
- Department of Health Systems Management, The College of Law and Business, Ramat Gan 52520, Israel; (A.G.); (Y.B.)
- Division of Community Medical Services, Clalit Health Services, Tel Aviv 62098, Israel; (S.Y.); (D.N.); (A.N.)
| | - Shlomit Yaron
- Division of Community Medical Services, Clalit Health Services, Tel Aviv 62098, Israel; (S.Y.); (D.N.); (A.N.)
| | - Doron Netzer
- Division of Community Medical Services, Clalit Health Services, Tel Aviv 62098, Israel; (S.Y.); (D.N.); (A.N.)
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Ayelet Nevet
- Division of Community Medical Services, Clalit Health Services, Tel Aviv 62098, Israel; (S.Y.); (D.N.); (A.N.)
| | - Gil Lavie
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv 62098, Israel;
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 31096, Israel
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King L, Alexander-Gabbadon K, Chin N, Hammond-Gabbadon C, Simmonds-Brooks P, Harris J, Martin H, Witter K, Bartlett R, Knight-Madden J, Asnani M. Telehealth: Navigating the COVID-19 Pandemic and Beyond: The Sickle Cell Unit Experience. Telemed J E Health 2023; 29:1781-1791. [PMID: 37092975 DOI: 10.1089/tmj.2023.0100] [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: 04/25/2023] Open
Abstract
Introduction: To examine the use of telehealth for delivery of health care in persons with sickle cell disease in a resource-constrained country during the COVID-19 pandemic. Methods: This study was a retrospective review of patient encounters at the Sickle Cell Unit (SCU), Jamaica during a 3-year period, March 10, 2019 to March 9, 2022 and a comparison of endpoints between 1 year before and 2 years during the pandemic. Primary endpoints of registration numbers, day-care admissions, and study visits were obtained from logbooks and the electronic medical records. Additional endpoints included well visits, hydroxyurea (HU) visits, and bone pain crisis. Results: Patients registered at the clinic on 17,295 occasions, with 7,820 in the pre-pandemic year decreasing by 43.8% and 35% in the 2 subsequent pandemic years. Overall, study visits increased by 4.9% and 1.3% in the pandemic years. They increased in adults by 13.1% and 8.9% but fell by 3.2% and 6.2% in children. Fewer people were seen in the pandemic years, with children showing a 20.7% decline in numbers. Tele-visits accounted for 31.4% of all study visits during the pandemic years and increased by 23.6% between the pandemic years. There were more well-visits and HU visits, but fewer pain visits and day-care admissions in the pandemic years. Conclusions: The SCU maintained health care delivery for a high-risk population during the pandemic, with tele-visits mitigating the short-fall from in-person visits. Tele-visits may be more acceptable to adults with a chronic illness and may be a suitable alternative for delivering health care.
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Affiliation(s)
- Lesley King
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Kesha Alexander-Gabbadon
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Nicki Chin
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Christine Hammond-Gabbadon
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Patrice Simmonds-Brooks
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - June Harris
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Hopelyn Martin
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Krystal Witter
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Rachel Bartlett
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Jennifer Knight-Madden
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Monika Asnani
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
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Cheng L, Chan WK, Peng Y, Qin H. Towards data-driven tele-medicine intelligence: community-based mental healthcare paradigm shift for smart aging amid COVID-19 pandemic. Health Inf Sci Syst 2023; 11:14. [PMID: 36923686 PMCID: PMC10011761 DOI: 10.1007/s13755-022-00198-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 10/06/2022] [Indexed: 03/18/2023] Open
Abstract
Purpose Telemedicine are experiencing an unprecedented boom globally since the beginning of the COVID-19 pandemic. As the most vulnerable groups amid COVID-19, the digital delivery of healthcare poses great challenges to the elderly population, caregiver, health service providers, and health policy makers. To bridge the service delivery gaps between the telemedicine demand side and supply side, explore evidence-based approach for integrated care, address challenges for aging policy, and build foundation for the development of data-driven and community-based telemedicine, our R&D team applied translational research to design and develop telemedicine "SMART" for enhancing elderly mental health wellbeing amid COVID-19. Our aim is to investigate the preparedness mechanisms of mental health disease including response, intervention, and connection these three healthcare delivery pipelines with the collection, consolidation, and synergy of heath parameters and social determinants, using data analytics approach to achieve Evidence-Based Medicine (EBM). Methods A mix of quantitative and qualitative research design for scientifically rigorous consultation and analysis was conducted from Jan 2020 to June 2021 in Hong Kong. An exploratory and descriptive qualitative design was used in this study. The data were collected through focus group discussions conducted from elderly and their caregivers living in 10 main districts of Hong Kong. Our research pilot tested "SMART" targeting for elderly with mental health improvement needs. Baseline questionnaire with 110 tele-medicine product users includes questions on demographic information, self-rated mental health digital adoption. The follow-up five focus group discussions with 57 users (elderly and their caregivers) further explore the social determinants of telemedicine transformation and help propose the integrated telemedicine paradigm shift framework establishment, development, and enhancement. Results Grounded on the baseline needs assessment and feedbacks collected, it is evident that multi-dimensional health information from the four various streams (community, clinic, home, remote) and customized digital health solutions are playing a key role in addressing elderly mental health digital service needs and bridging digital divide. The designed tele-medicine product lines up health service provider (supplier side) and elderly specific needs (demand side) with our three-level design, enables elderly and their families to follow and control their own health management and connect with the service provider, community of practice (CoP), and health policy makers. Conclusion It's beneficial to involve elderly and gerontechnology stakeholders as part of Community-Based Participatory Research (CBPR) before and throughout the developing and delivery phases an integrated and age-friendly digital intervention. The challenges in applying and disseminating telemedicine reflected by the elderly and caregivers can be used as important input for further development and indicators for the sustainable and integrated elderly primary care framework. Supplementary Information The online version contains supplementary material available at 10.1007/s13755-022-00198-4.
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Affiliation(s)
- Lan Cheng
- Big Data Bio-Intelligence Lab, Big Data Institute, The Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong
| | - WK Chan
- Department of Computer Science and Engineering, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Yi Peng
- School of Government, Nanjing University, Nanjing, China
| | - Harry Qin
- Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Magor D, Berkov E, Siomin D, Karniel E, Lasman N, Waldman LR, Gringauz I, Stern S, Kassif RL, Barkai G, Lewy H, Segal G. Interpretation of Heart and Lungs Sounds Acquired via Remote, Digital Auscultation Reached Fair-to-Substantial Levels of Consensus among Specialist Physicians. Diagnostics (Basel) 2023; 13:3153. [PMID: 37835896 PMCID: PMC10572382 DOI: 10.3390/diagnostics13193153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Technological advancement may bridge gaps between long-practiced medical competencies and modern technologies. Such a domain is the application of digital stethoscopes used for physical examination in telemedicine. This study aimed to validate the level of consensus among physicians regarding the interpretation of remote, digital auscultation of heart and lung sounds. METHODS Seven specialist physicians considered both the technical quality and clinical interpretation of auscultation findings of pre-recorded heart and lung sounds of patients hospitalized in their homes. TytoCareTM system was used as a remote, digital stethoscope. RESULTS In total, 140 sounds (70 heart and 70 lungs) were presented to seven specialists. The level of agreement was measured using Fleiss' Kappa (FK) variable. Agreement relating to heart sounds reached low-to-moderate consensus: the overall technical quality (FK = 0.199), rhythm regularity (FK = 0.328), presence of murmurs (FK = 0.469), appreciation of sounds as remote (FK = 0.011), and an overall diagnosis as normal or pathologic (FK = 0.304). The interpretation of some of the lung sounds reached a higher consensus: the overall technical quality (FK = 0.169), crepitus (FK = 0.514), wheezing (FK = 0.704), bronchial sounds (FK = 0.034), and an overall diagnosis as normal or pathological (FK = 0.386). Most Fleiss' Kappa values were in the range of "fare consensus", while in the domains of diagnosing lung crepitus and wheezing, the values increased to the "substantial" level. CONCLUSIONS Bio signals, as recorded auscultations of the heart and lung sounds serving the process of clinical assessment of remotely situated patients, do not achieve a high enough level of agreement between specialized physicians. These findings should serve as a catalyzer for improving the process of telemedicine-attained bio-signals and their clinical interpretation.
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Affiliation(s)
- Diana Magor
- HIT—Holon Institute of Technology, Holon 5810201, Israel (H.L.)
| | - Evgeny Berkov
- Internal Medicine Department C, Rabin Medical Center, Sharon Campus, Petah Tikva 494149, Israel; (E.B.); (D.S.)
| | - Dmitry Siomin
- Internal Medicine Department C, Rabin Medical Center, Sharon Campus, Petah Tikva 494149, Israel; (E.B.); (D.S.)
| | - Eli Karniel
- Internal Medicine Department B, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Nir Lasman
- Internal Medicine Department I, Chaim Sheba Medical Center, Tel-Hashomer 5265601, Israel;
| | - Liat Radinsky Waldman
- Internal Medicine Department A, Chaim Sheba Medical Center, Tel-Hashomer 5265601, Israel
| | - Irina Gringauz
- Geriatric Department C, Chaim Sheba Medical Center, Rehabilitation Hospital, Tel-Hashomer 5265601, Israel
| | - Shai Stern
- The Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold St, Safed 1311502, Israel
| | - Reut Lerner Kassif
- Department of Pediatric Intensive Care, The Edmond and Lily Safra Children’s Hospital, Chaim Sheba Medical Center, Tel-Hashomer 5265601, Israel;
| | - Galia Barkai
- Beyond Virtual Hospital, Tele-Medicine Virtual Hospital, Chaim Sheba Medical Center, Tel-Hashomer 5265601, Israel
| | - Hadas Lewy
- HIT—Holon Institute of Technology, Holon 5810201, Israel (H.L.)
| | - Gad Segal
- Beyond Virtual Hospital, Tele-Medicine Virtual Hospital, Chaim Sheba Medical Center, Tel-Hashomer 5265601, Israel
- Education Authority, Chaim Sheba Medical Center, Tel-Hashomer 5265601, Israel
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Hurvitz N, Ilan Y. The Constrained-Disorder Principle Assists in Overcoming Significant Challenges in Digital Health: Moving from "Nice to Have" to Mandatory Systems. Clin Pract 2023; 13:994-1014. [PMID: 37623270 PMCID: PMC10453547 DOI: 10.3390/clinpract13040089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023] Open
Abstract
The success of artificial intelligence depends on whether it can penetrate the boundaries of evidence-based medicine, the lack of policies, and the resistance of medical professionals to its use. The failure of digital health to meet expectations requires rethinking some of the challenges faced. We discuss some of the most significant challenges faced by patients, physicians, payers, pharmaceutical companies, and health systems in the digital world. The goal of healthcare systems is to improve outcomes. Assisting in diagnosing, collecting data, and simplifying processes is a "nice to have" tool, but it is not essential. Many of these systems have yet to be shown to improve outcomes. Current outcome-based expectations and economic constraints make "nice to have," "assists," and "ease processes" insufficient. Complex biological systems are defined by their inherent disorder, bounded by dynamic boundaries, as described by the constrained disorder principle (CDP). It provides a platform for correcting systems' malfunctions by regulating their degree of variability. A CDP-based second-generation artificial intelligence system provides solutions to some challenges digital health faces. Therapeutic interventions are held to improve outcomes with these systems. In addition to improving clinically meaningful endpoints, CDP-based second-generation algorithms ensure patient and physician engagement and reduce the health system's costs.
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Affiliation(s)
| | - Yaron Ilan
- Hadassah Medical Center, Department of Medicine, Faculty of Medicine, Hebrew University, POB 1200, Jerusalem IL91120, Israel;
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11
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AlJaloud AM, Al Suwyed A, Al Zoman KH, Tabbaa MY, Alwin Robert A, Al-Nowaiser AM, Alotaibi F, Alfaifi MA, Almubarak SA. Patient Perceptions and Satisfaction With Virtual Clinics During the COVID-19 Pandemic: A Cross-Sectional Study. Cureus 2023; 15:e42450. [PMID: 37637632 PMCID: PMC10449483 DOI: 10.7759/cureus.42450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Background Virtual clinics played an important role for many patients during the COVID-19 pandemic. We conducted this cross-sectional study to evaluate patient perceptions and their satisfaction with virtual clinics during and after COVID-19 in Saudi Arabia. Methods An online questionnaire-based survey with questions in both Arabic and English was conducted among patients who attended outpatient clinics at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia from May 2021 to September 2021. Demographic variables, the clinic type, and the level of satisfaction with the remote appointments were recorded. Descriptive statistics and logistic regression analysis were used to analyze the data. Results A total of 1274 participants filled out the survey. Of them, 831 (65.23%) were females, and 749 (58.79%) were aged 18 to 30 years old. Of the sample studied, 411 (32.26%) had appointments with their healthcare provider remotely since the beginning of the pandemic; 311 (75.67%) were satisfied or highly satisfied with the remote appointments; and 198 (48.18%) participants desired to continue using virtual services post-COVID-19 pandemic. Logistic regression analysis showed that females were more satisfied with virtual clinics than males (OR= 1.18, 95% CI (1.01, 1.40), p=0.04). The age group of 18 to 30 was more satisfied than other age groups (OR= 53.23, 95% CI (2.01, 1347.18), p=0.02). Conclusion The majority of the participants who used virtual clinics were satisfied with the service. Nearly half of the participants wanted to continue using virtual services even after the COVID-19 pandemic was over. More effort should be made to increase patient awareness and knowledge about virtual clinics.
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Affiliation(s)
| | - Abdulaziz Al Suwyed
- Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Khalid H Al Zoman
- Dentistry, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Mohammad Y Tabbaa
- Dentistry, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | | | | | - Faisal Alotaibi
- Neurological Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Mohammed A Alfaifi
- Emergency Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Sultan A Almubarak
- Innovation and Knowledge Translation, Saudi National Institute of Health, Riyadh, SAU
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Haimi M. The tragic paradoxical effect of telemedicine on healthcare disparities- a time for redemption: a narrative review. BMC Med Inform Decis Mak 2023; 23:95. [PMID: 37193960 DOI: 10.1186/s12911-023-02194-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 05/09/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Telemedicine has become more convenient and advantageous due to the rapid development of the internet and telecommunications. A growing number of patients are turning to telemedicine for health consultations and health-related information. Telemedicine can increase access to medical care by removing geographical and other barriers. In most nations, the COVID-19 pandemic imposed social isolation. This has accelerated the transition to telemedicine, which has become the most commonly utilized method of outpatient care in many places. Telehealth can assist resolve gaps in access to healthcare services and health outcomes, in addition to its primary function of boosting accessibility to remote health services. However, as the benefits of telemedicine become more apparent, so do the limitations of serving vulnerable groups. Some populations may lack digital literacy or internet access. Homeless persons, the elderly, and people with inadequate language skills are also affected. In such circumstances, telemedicine has the potential to exacerbate health inequities. AIM AND METHODS In this narrative review (using the PubMed and Google scholar database), the different benefits and drawbacks of telemedicine are discussed, both globally and in Israel, with particular focus paid to special populations and to the telehealth usage during the Covid-19 period. FINDINGS The contradiction and paradox of using telemedicine to address health inequities yet sometimes making them worse is highlighted. The effectiveness of telemedicine in bridging access to healthcare inequities is explored along with a number of potential solutions. CONCLUSIONS Policy makers should identify barriers among special populations to using telemedicine. They should initiate interventions to overcome these barriers, while adapting them to the needs of these groups.
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Affiliation(s)
- Motti Haimi
- Clalit Health Services, Tel Aviv, Israel.
- Rappaport Faculty of Medicine, Technion, Haifa, Israel.
- School of Public Health, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel.
- Health Disparities Working Group, International Society for Telemedicine and E-Health (ISfTeH), Basel, Switzerland.
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13
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Levy R, Cohen R, Lev-Shalem L, Eisenkraft A, Yosef TF. A Retrospective Database Analysis of Before and After Social Distancing in Relation to Pediatric Infection Rate and Healthcare Services Usage During the Coronavirus Disease 2019 Pandemic. Clin Infect Dis 2023; 76:713-719. [PMID: 35724239 PMCID: PMC9278179 DOI: 10.1093/cid/ciac502] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Social distancing policy was introduced in Israel in 2020 to reduce the spread of coronavirus disease 2019 (COVID-19). The aim of this study was to analyze the effect of social distancing on other infections in children, by comparing disease rate and healthcare utilization before and after social distancing. METHODS This was a before-and-after study. Within this retrospective database analysis of parallel periods in 2019 (periods 1 and 2) and 2020 (periods 3 [prelockdown period] and 4 [lockdown period]) we included all pediatric population registered in the electronic medical records of the Maccabi Healthcare Services, Israel, looking at the occurrence of non-COVID-19 infections, antibiotic purchasing, physician visits, ambulatory emergency care center visits, emergency department visits, and hospitalizations. RESULTS A total of 776 828 children were included from 2019, and 777 729 from 2020. We found a lower infection rate in 2020 versus 2019. We did not find a difference in infection rate between periods 1 and 2, while there was a significant difference between periods 3 and 4. We found a significant difference between periods 2 and 4, with a higher RR than for the comparison between periods 1 and 3. There was a modest decrease in ambulatory emergency care center visits in 2020, and lower increases in emergency department visits and hospital admissions. We found decreases in antibiotic purchasing between periods 1 and 3 and between periods 2 and 4, more pronounced in 2020 than in 2019. CONCLUSIONS Analysis of findings before and after social distancing and masking showed reduced prevalence of non-COVID-19 pediatric infections and reduced consumption of healthcare services and antibiotics related with the lockdown period.
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Affiliation(s)
- Ran Levy
- Maccabi Healthcare Services, Israel
| | - Regev Cohen
- Ruth and Bruce Rappaport Faculty of Medicine, Technion University, Haifa, Israel.,Infectious Diseases Unit, Laniado Medical Center, Netanya, Israel.,Infectious Diseases Unit, Hillel-Yaffe Medical Center, Hadera, Israel
| | - Liat Lev-Shalem
- Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Arik Eisenkraft
- Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, and the IDF Medical Corps, Jerusalem, Israel
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Kaufman-Shriqui V, Shani M, Boaz M, Lahad A, Vinker S, Birk R. Opportunities and challenges in delivering remote primary care during the Coronavirus outbreak. BMC PRIMARY CARE 2022; 23:135. [PMID: 35641930 PMCID: PMC9151999 DOI: 10.1186/s12875-022-01750-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/25/2022] [Indexed: 11/18/2022]
Abstract
Background Social distancing and lockdowns were implemented during the first period of the COVID-19 pandemic. Primary care physicians needed to adapt quickly to deliver remote care/telemedicine. Methods A cross-sectional, 47-item online Google Survey was distributed through the Israel Association of Family Physicians (IAFP) mailing list between March 31-May 5, 2020. The questionnaire included demographics, physician characteristics, and information on usage and perceived telemedicine quality. Sampling weights by sex and age groups were applied. Results One hundred fifty-nine primary care physicians (10.6% of registered IAFP members; 63.5% women; mean age 53.4 ± 10.4 years and median professional experience 21.3 years) replied to the survey. The majority (59.7%) of the participants performed a mixture of in-person along with phone counseling. About 40% had no former telemedicine experience. The majority indicated that telephone and video formats were inferior to in-person consultation (68%, 57.1% online and phone, respectively). The overall counseling quality grade (on a 1–10 scale,)median (IQR)) was 6.2 (3) for telephone and 7(2) for video. While 66.9% reported experiencing no challenges, 10% had technical problems, 10% interpersonal problems, 5.6% scheduling difficulties, and 7.5% other difficulties. Majority of 56.6% physicians indicated they prescribed more antibiotics,16.4% sent more blood tests, 24.5% referred more to experts, and 49.7% referred more to imaging in comparison to usual counseling. Higher phone quality score was significantly associated with physicians who indicated not prescribing more antibiotics during the pandemic (OR = 0.30, 95%CI 0.134–0.688, p = 0.004). Higher online quality score was associated with physicians who indicated not sending more blood tests during the pandemic (OR = 0.06 95%CI 0.008–0.378, P = 0.003). Conclusions Our findings suggest telehealth holds considerable promise for counseling in the primary care setting. However, interpersonal challenges raised by physicians should be understood in-depth to develop tailored training and further examine it in randomized trials while integrating patient-reported outcomes. Finally, further research on utility, cost, and cost-efficiency during remote counseling with follow-ups, medical prescribing, and additional referrals is needed.
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15
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Ward K, Vagholkar S, Sakur F, Khatri NN, Lau AYS. Visit Types in Primary Care With Telehealth Use During the COVID-19 Pandemic: Systematic Review. JMIR Med Inform 2022; 10:e40469. [PMID: 36265039 DOI: 10.2196/40469] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/16/2022] [Accepted: 10/02/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Telehealth was rapidly incorporated into primary care during the COVID-19 pandemic. However, there is limited evidence on which primary care visits used telehealth. OBJECTIVE The objective of this study was to conduct a systematic review to assess what visit types in primary care with use of telehealth during the COVID-19 pandemic were reported; for each visit type identified in primary care, under what circumstances telehealth was suitable; and reported benefits and drawbacks of using telehealth in primary care during the COVID-19 pandemic. METHODS This study was a systematic review using narrative synthesis. Studies were obtained from four databases (Ovid [MEDLINE], CINAHL Complete, PDQ-Evidence, and ProQuest) and gray literature (NSW Health, Royal Australian College of General Practitioners guidelines, and World Health Organization guidelines). In total, 3 independent reviewers screened studies featuring telehealth use during the COVID-19 pandemic in primary care. Levels of evidence were assessed according to the Grading of Recommendations Assessment, Development, and Evaluation. Critical appraisal was conducted using the Mixed Methods Appraisal Tool. Benefits and drawbacks of telehealth were assessed according to the National Quality Forum Telehealth Framework. RESULTS A total of 19 studies, predominately cross-sectional surveys or interviews (13/19, 68%), were included. Seven primary care visit types were identified: chronic condition management (17/19, 89%), existing patients (17/19, 89%), medication management (17/19, 89%), new patients (16/19, 84%), mental health/behavioral management (15/19, 79%), post-test result follow-up (14/19, 74%), and postdischarge follow-up (7/19, 37%). Benefits and drawbacks of telehealth were reported across all visit types, with chronic condition management being one of the visits reporting the greatest use because of a pre-existing patient-provider relationship, established diagnosis, and lack of complex physical examinations. Both patients and clinicians reported benefits of telehealth, including improved convenience, focused discussions, and continuity of care despite social distancing. Reported drawbacks included technical barriers, impersonal interactions, and semi-established reimbursement models. CONCLUSIONS Telehealth was used for different visit types during the COVID-19 pandemic in primary care, with most visits for chronic condition management, existing patients, and medication management. Further research is required to validate our findings and explore the long-term impact of hybrid models of care for different visit types in primary care. TRIAL REGISTRATION PROSPERO CRD42022312202; https://tinyurl.com/5n82znf4.
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Affiliation(s)
- Kanesha Ward
- Centre for Health Informatics, Australian Institute for Health Innovation, Macquarie University, North Ryde, Australia
| | - Sanjyot Vagholkar
- Primary Care, Faculty of Medicine, Health & Human Sciences, Macquarie University, North Ryde, Australia
| | - Fareeya Sakur
- Centre for Health Informatics, Australian Institute for Health Innovation, Macquarie University, North Ryde, Australia
| | - Neha Nafees Khatri
- Centre for Health Informatics, Australian Institute for Health Innovation, Macquarie University, North Ryde, Australia
| | - Annie Y S Lau
- Centre for Health Informatics, Australian Institute for Health Innovation, Macquarie University, North Ryde, Australia
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17
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The Impact of Telemedicine in the Diagnosis of Erythema Migrans during the COVID Pandemic: A Comparison with In-Person Diagnosis in the Pre-COVID Era. Pathogens 2022; 11:pathogens11101122. [PMID: 36297179 PMCID: PMC9607313 DOI: 10.3390/pathogens11101122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Erythema migrans (EM) is the hallmark manifestation of the Lyme borreliosis (LB), and therefore its presence and recognition are sufficient to make a diagnosis and to start proper antibiotic treatment to attempt to eradicate the infection. Methods: In this study we compared the clinical data of 439 patients who presented an EM either according to the diagnostic modality through physical assessment or through telemedicine. Conclusions: Our data clearly show that telemedicine for EM diagnosis is useful as it enables prompt administration of appropriate antibiotic therapy, which is critical to avoid complications, especially for neurologic and articular entities. Therefore, telemedicine is a tool that could be adopted for the diagnosis of Lyme disease both by specialized centers but also by general practitioners.
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Banning S, Höglinger M, Meyer D, Reich O. Evaluation of the Effect of a Multifunctional Telemedicine Device on Health Care Use and Costs: A Nonrandomized Pragmatic Trial. Telemed J E Health 2022; 29:510-517. [PMID: 36037076 DOI: 10.1089/tmj.2022.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Telemedicine health insurance models are highly prevalent in the Swiss health care system. Nevertheless, the potential of telemedicine is only partly being achieved, since current telemedicine health insurance models are limited to an initial contact by telephone and a gatekeeper role that organizes access to health care providers such as general practitioners, specialists, or hospitals. Against this background, a telemedicine device with diverse visual and auscultatory examination functions was made available to 2,000 telemedicine-insured clients. This device allowed diagnostic information to be sent to a medical care provider and used for telemedical consultation. Objective: To determine whether the additional implementation of a multifunctional telemedicine examination device resulted in fewer physical consultations, reduced service utilization, and lower health care expenditures among telemedicine-insured clients. Methods: Our analysis is based on claims data from 135,636 clients insured in a telemedicine call center model covering the years 2019 and 2020. We compare the use of health care and health care costs of clients who received a telemedicine device with those without such a device, using multivariable regression to adjust for group differences due to self-selection. Results: We found lower total health care expenditures of -229 (Swiss Francs) and lower inpatient costs of -160 (Swiss Francs) on the part of clients with the telemedicine device. However, the implementation of the telemedicine device did not lead to a statistically significant reduction in service utilization. Conclusions: The treatment of telemedicine-insured clients was on average more cost-effective when they received the multifunctional telemedicine device. Accordingly, complementing the existing telemedicine model with telemedicine devices that allow for improved telemedical consultations has the potential to increase the cost-saving potential of the existing telemedicine call center models.
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Affiliation(s)
- Stefan Banning
- Department of Health Sciences, University of Applied Sciences, Fulda, Germany
| | - Marc Höglinger
- Health Services Research, Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Delia Meyer
- Controlling and Swica Health Insurance, Winterthur, Switzerland
| | - Oliver Reich
- Santé24, Swica Health Insurance, Winterthur, Switzerland
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19
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Filip R, Gheorghita Puscaselu R, Anchidin-Norocel L, Dimian M, Savage WK. Global Challenges to Public Health Care Systems during the COVID-19 Pandemic: A Review of Pandemic Measures and Problems. J Pers Med 2022; 12:1295. [PMID: 36013244 PMCID: PMC9409667 DOI: 10.3390/jpm12081295] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/21/2022] [Accepted: 08/05/2022] [Indexed: 12/15/2022] Open
Abstract
Beginning in December 2019, the world faced a critical new public health stressor with the emergence of SARS-CoV-2. Its spread was extraordinarily rapid, and in a matter of weeks countries across the world were affected, notably in their ability to manage health care needs. While many sectors of public structures were impacted by the pandemic, it particularly highlighted shortcomings in medical care infrastructures around the world that underscored the need to reorganize medical systems, as they were vastly unprepared and ill-equipped to manage a pandemic and simultaneously provide general and specialized medical care. This paper presents modalities in approaches to the pandemic by various countries, and the triaged reorganization of medical sections not considered first-line in the pandemic that was in many cases transformed into wards for treating COVID-19 cases. As new viruses and structural variants emerge, it is important to find solutions to streamline medical care in hospitals, which includes the expansion of digital network medicine (i.e., telemedicine and mobile health apps) for patients to continue to receive appropriate care without risking exposure to contagions. Mobile health app development continues to evolve with specialized diagnostics capabilities via external attachments that can provide rapid information sharing between patients and care providers while eliminating the need for office visits. Telemedicine, still in the early stages of adoption, especially in the developing world, can ensure access to medical information and contact with care providers, with the potential to release emergency rooms from excessive cases, and offer multidisciplinary access for patients and care providers that can also be a means to avoid contact during a pandemic. As this pandemic illustrated, an overhaul to streamline health care is essential, and a move towards greater use of mobile health and telemedicine will greatly benefit public health to control the spread of new variants and future outbreaks.
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Affiliation(s)
- Roxana Filip
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- BK Laboratory, SuceavaCounty Emergency Hospital, 720224 Suceava, Romania
| | - Roxana Gheorghita Puscaselu
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- Integrated Center for Research, Development and Innovation in Advanced Materials, Nanotechnologies, and Distributed Systems for Fabrication and Control, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
| | - Liliana Anchidin-Norocel
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
| | - Mihai Dimian
- Integrated Center for Research, Development and Innovation in Advanced Materials, Nanotechnologies, and Distributed Systems for Fabrication and Control, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- Department of Computers, Electronics and Automation, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
| | - Wesley K. Savage
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- Integrated Center for Research, Development and Innovation in Advanced Materials, Nanotechnologies, and Distributed Systems for Fabrication and Control, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
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Danino D, Ben-Shimol S, Sharf A, Greenberg D, Givon-Lavi N. Remote Versus In-person Outpatient Clinic Visits and Antibiotic Use Among Children During the COVID-19 Pandemic. Pediatr Infect Dis J 2022; 41:636-641. [PMID: 35544725 PMCID: PMC9281428 DOI: 10.1097/inf.0000000000003570] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The proportion of remote clinic visits was expected to increase among children during the COVID-19 pandemic which might result in antibiotic overuse. METHODS In southern Israel, 2 ethnic groups, Jewish and Bedouin, live side-by-side. Computerized data on visits for children <18 years were examined from clinics with ≥50 insured children, active both pre-COVID-19 and during the COVID-19 pandemic. Visits were divided into in-person and remote. Monthly infectious diagnoses and dispensed antibiotic prescription rates were calculated by age (<5, 5-17 years) and ethnic groups. Mean monthly rates of 2 parallel seasons (pre-COVID-19 and COVID-19 periods) were compared. RESULTS Overall 2,120,253 outpatient clinic visits were recorded. Remote clinic visit rates (per 1000 children) increased from 97.04 and 33.86 in the pre-COVID-19 to 179.75 and 50.05 in the COVID-19 period in Jewish and Bedouin children, respectively ( P < 0.01) along with a reduction of in-person visit rates in both populations. Comparing pre-COVID-19 and COVID-19 periods, the rates of overall infectious diagnoses in remote visits increased. Nevertheless, dispensed antibiotic prescription rates in remote visits (per 1000 visits) remained unchanged (9.84 vs. 8.67, P = 0.70, in the Jewish population and 14.32 vs. 14.17, P = 1.00, in the Bedouin population in the pre-COVID-19 and COVID-19 periods, respectively) with a similar distribution of antibiotic categories. CONCLUSIONS COVID-19 pandemic resulted in an expansion of remote visits of children <18 years with an increase in infectious diagnoses. However, remote dispensed antibiotic prescription rates remained unchanged. These dynamics were more accentuated in Jewish children, characterized by higher socio-economic conditions, compared to Bedouin children.
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Affiliation(s)
- Dana Danino
- From the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- From the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Amir Sharf
- Economics and Data Analysis, Clalit HMO South district, Israel
| | - David Greenberg
- From the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Noga Givon-Lavi
- From the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
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21
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Hsu J. Personalized Digital Health Beyond the Pandemic. J Nurse Pract 2022; 18:709-714. [PMID: 35645634 PMCID: PMC9130337 DOI: 10.1016/j.nurpra.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The effectiveness of telehealth and personalized digital health became evident during the coronavirus disease 2019 pandemic. This article defines what personalized digital health is and provides selected examples of the various personalized digital health devices patients may be using. The article also delves into how to implement and incorporate these personalized digital health devices in practice and presents suggestions on political actions that nurse practitioners need to advocate for with regard to telehealth and personalized digital health policy.
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22
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Shapira B, Rosca P. Transformation of substance use disorder treatment services during COVID-19 - A lasting change? JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2070875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Barak Shapira
- Division of Enforcement and Inspection, Israel Ministry of Health, Jerusalem, Israel
| | - Paola Rosca
- Department for the Treatment of Substance Abuse, Israel Ministry of Health, Jerusalem, Israel
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23
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Haskel O, Itelman E, Zilber E, Barkai G, Segal G. Remote Auscultation of Heart and Lungs as an Acceptable Alternative to Legacy Measures in Quarantined COVID-19 Patients-Prospective Evaluation of 250 Examinations. SENSORS (BASEL, SWITZERLAND) 2022; 22:3165. [PMID: 35590854 PMCID: PMC9103963 DOI: 10.3390/s22093165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/16/2022] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic accelerated the assimilation of telemedicine platforms into medical practice. Nevertheless, research-based evidence in this field is still accumulating. This was a prospective, cross-sectional comparative assessment of a remote physical examination device used mainly for heart and lung digital auscultation. We analyzed usage patterns, user (physician) subjective appreciation and compared it to legacy measures. Eighteen physicians (median age 36 years (IQR 32-45): two interns, seven residents and nine senior physicians; eleven internists, five geriatricians and two pediatricians) executed over 250 remote physical examinations. Their median work duration with quarantined patients was 60 days (IQR 45-60). The median number of patients examined by a single physician was 17 (IQR 10-34). Regarding overall estimation, all participants tended to prefer the remote examination in the setting of quarantined patients (median 6, IQR 3.75-8), while no statistically significant difference was demonstrated compared to the indifference value (p = 0.122). Internists preferred tele-medical examination over non-internists, with significant differences between groups regarding heart auscultation, (median 7, (IQR 3-7) vs. median 2, (IQR 1-5, respectively)), p = 0.044. In the setting of quarantined patients, from the physicians' perspective, a digital platform for remote auscultation of heart and lungs was considered as an acceptable alternative to legacy measures.
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Affiliation(s)
- Or Haskel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (O.H.); (E.I.); (E.Z.); (G.B.)
| | - Edward Itelman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (O.H.); (E.I.); (E.Z.); (G.B.)
- Internal Medicine “I”, Sheba Medical Center, Ramat-Gan 52621, Israel
| | - Eyal Zilber
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (O.H.); (E.I.); (E.Z.); (G.B.)
- Internal Medicine “I”, Sheba Medical Center, Ramat-Gan 52621, Israel
| | - Galia Barkai
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (O.H.); (E.I.); (E.Z.); (G.B.)
- Beyond, Virtual Hospital, Sheba Medical Center, Ramat-Gan 52621, Israel
| | - Gad Segal
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (O.H.); (E.I.); (E.Z.); (G.B.)
- Internal Medicine “I”, Sheba Medical Center, Ramat-Gan 52621, Israel
- Beyond, Virtual Hospital, Sheba Medical Center, Ramat-Gan 52621, Israel
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Can Teledentistry Replace Conventional Clinical Follow-Up Care for Minor Dental Surgery? A Prospective Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063444. [PMID: 35329133 PMCID: PMC8953526 DOI: 10.3390/ijerph19063444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: Born out of necessity, the implementation of digital processes experienced significant increase during the COVID-19 pandemic. Here, telemedicine offered a bridge to care and now an opportunity to reinvent virtual and hybrid care models, with the goal of improved healthcare access, outcomes, and affordability. The aim of this monocentric prospective, randomized trial was to compare conventional to telephone follow-up after minor dentoalveolar surgery on the basis of special aftercare questionnaires. (2) Methods: Sixty patients who underwent dentoalveolar surgery under local anesthesia were randomly assigned to both groups. After an average of four days, either telephone follow-up (test) or conventional personal aftercare (control) was performed. Based on the questionnaire, the following subject areas were evaluated: symptoms, complications, satisfaction with practitioner, travel, and waiting time, as well as the preferred form of follow-up care. (3) Results: There was no statistically significant difference regarding frequency of symptoms or complication rate. Patients who were assigned to the test group showed a clear tendency to prefer telephone follow-up (83.3%) to conventional aftercare (16.7%, p = 0.047). (4) Conclusions: The data suggest high acceptance of telephone-only follow-up after dentoalveolar surgery. The implementation of telemedicine could be a time- and money-saving alternative for both patients and healthcare professionals and provide healthcare access regardless of time and space.
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Use of telemedicine for initial outpatient subspecialist consultative visit: A national survey of general pediatricians and pediatric subspecialists. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2022; 10:100600. [PMID: 34875456 PMCID: PMC8881319 DOI: 10.1016/j.hjdsi.2021.100600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Evidence-based strategies are needed to support appropriate use of telemedicine for initial outpatient subspecialty consultative visits. To inform such strategies we performed a survey of general pediatricians and pediatric subspecialists about use of telemedicine for patients newly referred for pediatric subspecialty care. METHODS We developed and fielded an e-mail and postal survey of a national sample of 840 general pediatricians and 840 pediatric subspecialists in May and June 2020. RESULTS Of 266 completed surveys (17% response rate), 204 (76%) thought telemedicine should be offered for some and 29 (11%) thought telemedicine should be offered for all initial subspecialist visits. Most respondents who indicated telemedicine should be offered for some initial consultations believed this decision should be made by subspecialty attendings (176/204, 86%). Respondents prioritized several data elements to inform this decision, including clinical information and family-based contextual information (e.g., barriers to in-person care, interest in telemedicine, potential communication barriers). Factors perceived to reduce appropriateness of telemedicine for subspecialty consultation included need for interpreter services and prior history of frequent no-shows. Responses from generalists and subspecialists rarely differed significantly. CONCLUSIONS Survey results suggest potential opportunities to support the appropriate use of telemedicine for initial outpatient pediatric subspecialty visits through structured transfer of specific clinical and contextual information at the time of referral and through strategies to mitigate perceived communication or engagement barriers. IMPLICATION Pediatric physician beliefs about telemedicine for initial outpatient subspecialty consultative visits may inform future interventions to support appropriate telemedicine use. LEVEL OF EVIDENCE Survey of a national sample of clinicians.
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Haklai Z, Applbaum Y, Myers V, Saban M, Gordon ES, Luxenburg O, Wilf-Miron R. The effect of the COVID-19 pandemic on non-COVID respiratory ED visits in Israel. Am J Emerg Med 2022; 53:215-221. [PMID: 35074685 PMCID: PMC8747783 DOI: 10.1016/j.ajem.2022.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background The COVID 19 pandemic has had a crucial effect on the patterns of disease and treatment in the healthcare system. This study examines the effect of the COVID-19 pandemic on respiratory ED visits and admissions broken down by age group and respiratory diagnostic category. Methods Data on non-COVID related ED visits and hospitalizations from the ED were obtained in a retrospective analysis for 29 acute care hospitals, covering 98% of ED beds in Israel, and analyzed by 5 age groups: under one-year-old, 1–17, 18–44, 45–74 and 75 and over. Diagnoses were classified into three categories: Upper respiratory tract infections (URTI), pneumonia, and COPD or asthma. Data were collected for the whole of 2020, and compared for each month to the average number of cases in the three pre-COVID years (2017–2019). Results In 2020 compared to 2017–2019, there was a decrease of 34% in non-COVID ED visits due to URTI, 40% for pneumonia and a 35% decrease for COPD and asthma. Reductions occurred in most age groups, but were most marked among infants under a year, during and following lockdowns, with an 80% reduction. Patients over 75 years old displayed a marked drop in URTI visits. Pediatric asthma visits fell during lockdowns, but spiked when restrictions were lifted, accompanied by a higher proportion admitted. The percent of admissions from the ED visits remained mostly stable for pneumonia; the percent of young adults admitted with URTI decreased significantly from March to October. Conclusions Changing patterns of ED use were probably due to a combination of a reduced rate of viral diseases, availability of additional virtual services, and avoidance of exposure to the ED environment. Improved hygiene measures during peaks of respiratory infections could be implemented in future to reduce respiratory morbidity; and continued provision of remote health services may reduce overuse of ED services for mild cases.
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Affiliation(s)
- Ziona Haklai
- Division of Health Information, Ministry of Health, Jerusalem, Israel
| | - Yael Applbaum
- Division of Health Information, Ministry of Health, Jerusalem, Israel
| | - Vicki Myers
- Gertner Insititute of Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel.
| | - Mor Saban
- Gertner Insititute of Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | | | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
| | - Rachel Wilf-Miron
- Gertner Insititute of Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel; School of Public Health, Tel Aviv University, Tel Aviv, Israel
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Koren O, Shachar M, Shahar A, Barbour M, Rozner E, Benhamou D, Rosenberg AL, Turgeman Y, Naami R, Naami E, Mader E, Rajab SA. Profile Trends of Non-COVID Patients Admitted to the Cardiac Intensive Care Unit during the 2020 COVID Pandemic. Am J Med Sci 2022; 364:168-175. [PMID: 35235812 PMCID: PMC8882251 DOI: 10.1016/j.amjms.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/27/2021] [Accepted: 02/24/2022] [Indexed: 11/30/2022]
Abstract
Background During the COVID-19 outbreak, numerous reports indicated a higher mortality rate among cardiovascular patients. We investigated how this trend applied to patients admitted to the cardiac intensive care unit (CICU). Methods We retrospectively compared CICU patients admitted during the initial peak of the COVID outbreak between February and May 2020 (Covid Era, CE group) to a control group in pre-pandemic time in 2019. We interviewed patients to determine the symptom onset time and the time interval between symptomology and hospital arrival. Results The data of 292 patients were used in the analysis (119 patients in the CE group and 173 in the control group). CE patients had a higher incidence of ischemic heart disease (IHD) (p<.03), heart failure (p<.04), and psychiatric disorders (p<.001). During COVID time, more patients were hospitalized with myocarditis (OR: 26.45), arrhythmias (OR: 2.88), and new heart failure (HF) (p<.001) and less with STEMI (OR: 0.39; 95% CI: 0.24–0.63). Fewer PCIs were performed in the CE group (p<.001), with an overall lower success rate (p<.05) than reported in the control group. Patients in the CE group reported a longer period between symptom onset to hospital arrival (p<.001, χ2 = 12.42). The six-month survival rate was significantly lower in CE patients (χ2 = 7.01, P = 0.008). Conclusions Among CICU patients admitted to our center during the initial period of the COVID pandemic, STEMI events were less frequent while cases of newly diagnosed HF sharply increased. Patients waited longer after symptom onset before seeking medical care during the pandemic. The delay may have resulted in clinical deterioration that could explain the high mortality rate and the new HF admission rate.
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28
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Marom T, Pitaro J, Shah UK, Torretta S, Marchisio P, Kumar AT, Barth PC, Tamir SO. Otitis Media Practice During the COVID-19 Pandemic. Front Cell Infect Microbiol 2022; 11:749911. [PMID: 35071032 PMCID: PMC8777025 DOI: 10.3389/fcimb.2021.749911] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/07/2021] [Indexed: 12/23/2022] Open
Abstract
The global coronavirus disease-2019 (COVID-19) pandemic has changed the prevalence and management of many pediatric infectious diseases, including acute otitis media (AOM). Coronaviruses are a group of RNA viruses that cause respiratory tract infections in humans. Before the COVID-19 pandemic, coronavirus serotypes OC43, 229E, HKU1, and NL63 were infrequently detected in middle ear fluid (MEF) specimens and nasopharyngeal aspirates in children with AOM during the 1990s and 2000s and were associated with a mild course of the disease. At times when CoV was detected in OM cases, the overall viral load was relatively low. The new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative pathogen responsible for the eruption of the COVID-19 global pandemic. Following the pandemic declaration in many countries and by the World Health Organization in March 2020, preventive proactive measures were imposed to limit COVID-19. These included social distancing; lockdowns; closure of workplaces; kindergartens and schools; increased hygiene; use of antiseptics and alcohol-based gels; frequent temperature measurements and wearing masks. These measures were not the only ones taken, as hospitals and clinics tried to minimize treating non-urgent medical referrals such as OM, and elective surgical procedures were canceled, such as ventilating tube insertion (VTI). These changes and regulations altered the way OM is practiced during the COVID-19 pandemic. Advents in technology allowed a vast use of telemedicine technologies for OM, however, the accuracy of AOM diagnosis in those encounters was in doubt, and antibiotic prescription rates were still reported to be high. There was an overall decrease in AOM episodes and admissions rates and with high spontaneous resolution rates of MEF in children, and a reduction in VTI surgeries. Despite an initial fear regarding viral shedding during myringotomy, the procedure was shown to be safe. Special draping techniques for otologic surgery were suggested. Other aspects of OM practice included the presentation of adult patients with AOM who tested positive for SARS-2-CoV and its detection in MEF samples in living patients and in the mucosa of the middle ear and mastoid in post-mortem specimens.
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Affiliation(s)
- Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, Ashdod, Israel
| | - Jacob Pitaro
- Department of Otolaryngology-Head and Neck Surgery, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Udayan K Shah
- Pediatric Otolaryngology, Delaware Valley, and Enterprise Chief of Credentialing, Nemours Children's Health System, Wilmington, DE, United States.,Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paola Marchisio
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Ayan T Kumar
- Department of Otolaryngology-Head & Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Patrick C Barth
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States.,Pediatric Otolaryngology, Delaware Valley Nemours Children's Health System, Wilmington, DE, United States
| | - Sharon Ovnat Tamir
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, Ashdod, Israel
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Mbunge E, Muchemwa B, Batani J. Are we there yet? Unbundling the potential adoption and integration of telemedicine to improve virtual healthcare services in African health systems. SENSORS INTERNATIONAL 2022; 3:100152. [PMID: 34901894 PMCID: PMC8648577 DOI: 10.1016/j.sintl.2021.100152] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 01/14/2023] Open
Abstract
Since the outbreak of COVID-19, the attention has now shifted towards universal vaccination to gracefully lift strict COVID-19 restrictions previously imposed to contain the spread of the disease. Sub-Saharan Africa is experiencing an exponential increase of infections and deaths coupled with vaccines shortages, personal protective equipment, weak health systems and COVID-19 emerging variants. Some developed countries integrated telemedicine to reduce the impacts of the shortage of healthcare professionals and potentially reduce the risk of exposure, ensuring easy delivery of quality health services while limiting regular physical contact and direct hospitalization. However, the adoption of telemedicine and telehealth is still nascent in many sub-Saharan Africa countries. Therefore, this study reflects on progress made towards the use of telemedicine, virtual health care services, challenges encountered, and proffers ways to address them. We conducted a systematic literature review to synthesise literature on telemedicine in sub-Saharan Africa. The study revealed that telemedicine provides unprecedented benefits such as improving efficiency, effective utilization of healthcare resources, forward triaging, prevention of medical personnel infection, aiding medical students' clinical observation and participation, and assurance of social support for patients. However, the absence of policy on virtual care and political will, cost of sustenance of virtual health care services, inadequate funding, technological and infrastructural barriers, patient and healthcare personnel bias on virtual care and cultural barriers are identified as limiting factors to the adoption of virtual health care in many African health systems. To alleviate some of these barriers, we recommend the development of robust policies and frameworks for virtual health care, the inclusion of virtual care in the medical school curriculum, supporting virtual care research and development, increasing health funding, removing monopolisation of telecommunication services, developing of virtual health solutions that address eccentricities of African health systems.
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Affiliation(s)
- Elliot Mbunge
- Department of Computer Science, Faculty of Science and Engineering, University of Eswatini, Private Bag 4, Kwaluseni, Eswatini,Corresponding author
| | - Benhildah Muchemwa
- Department of Computer Science, Faculty of Science and Engineering, University of Eswatini, Private Bag 4, Kwaluseni, Eswatini
| | - John Batani
- Faculty of Engineering and Technology, Botho University, Maseru, Lesotho
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Thirunavukkarasu A, Alotaibi NH, Al-Hazmi AH, Alenzi MJ, Alshaalan ZM, Alruwaili MG, Alruwaili TAM, Alanazi H, Alosaimi TH. Patients' Perceptions and Satisfaction with the Outpatient Telemedicine Clinics during COVID-19 Era in Saudi Arabia: A Cross-Sectional Study. Healthcare (Basel) 2021; 9:healthcare9121739. [PMID: 34946465 PMCID: PMC8701957 DOI: 10.3390/healthcare9121739] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/20/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022] Open
Abstract
Successful implementation of virtual healthcare depends immensely on patients’ perceptions and satisfaction. This cross-sectional study assessed patients’ perceptions of, and factors associated with, poor and average satisfaction with the outpatient telemedicine clinics in the Kingdom of Saudi Arabia (KSA). This questionnaire-based survey was conducted among 720 patients who attended outpatient telemedicine clinics from different regions of the KSA. Of the sample studied, 54.7% of the participants had high satisfaction and the most common disadvantage perceived by patients was technical issues (53.1%), followed by fewer personal interactions (30.4%). Around 75% of the participants desired to use telemedicine services even after the COVID-19 pandemic. Logistic regression analysis revealed that age group more than 40 years (OR = 1.59; 95% CI = 1.04–2.44, p = 0.031), education less than university level (OR = 1.68; 95% CI = 1.07–2.15, p = 0.025), and first-time participants (OR = 3.28; 95% CI = 2.32–4.65, p < 0.001) were significantly associated with poor and average satisfaction ratings. The concerned authorities must make targeted action plans to circumvent the disadvantages perceived by patients accessing telemedicine. Furthermore, a multicenter, exploratory study that compares the virtual clinic with other telemedicine services in the KSA is warranted.
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Affiliation(s)
- Ashokkumar Thirunavukkarasu
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia;
- Correspondence: ; Tel.: +966-599-739-619
| | | | - Ahmad Homoud Al-Hazmi
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia;
| | - Mohammed Jayed Alenzi
- Department of Surgery, Division of Urology, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia;
| | - Ziad Mansour Alshaalan
- Department of Internal Medicine, Division of Dermatology, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia;
| | | | | | - Hassan Alanazi
- Department of Obstetrics and Gynecology, King Khalid University Hospital, Riyadh 12372, Saudi Arabia;
| | - Turki Hanas Alosaimi
- Department of Hospital Management Services, Huraymala General Hospital, Riyadh 11911, Saudi Arabia;
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31
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McKee M. A platform for the international exchange of ideas: the Israel Journal of Health Policy Research celebrates its first decade. Isr J Health Policy Res 2021; 10:66. [PMID: 34906251 PMCID: PMC8670878 DOI: 10.1186/s13584-021-00502-9] [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: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 12/03/2022] Open
Abstract
For ten years the Israel Journal of Health Policy Research has provided a platform for exchange of knowledge and insights on health policy. It is a unique attempt by scholars and practitioners in one small country to share their knowledge with the world and, in turn to learn from experience elsewhere. Never has this role been as important as during the COVID pandemic, a message that is very clear when we look at failings elsewhere.
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Affiliation(s)
- Martin McKee
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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32
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Benis A, Banker M, Pinkasovich D, Kirin M, Yoshai BE, Benchoam-Ravid R, Ashkenazi S, Seidmann A. Reasons for Utilizing Telemedicine during and after the COVID-19 Pandemic: An Internet-Based International Study. J Clin Med 2021; 10:jcm10235519. [PMID: 34884221 PMCID: PMC8658517 DOI: 10.3390/jcm10235519] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic challenges healthcare services. Concomitantly, this pandemic had a stimulating effect on technological expansions related to telehealth and telemedicine. We sought to elucidate the principal patients' reasons for using telemedicine during the COVID-19 pandemic and the propensity to use it thereafter. Our primary objective was to identify the reasons of the survey participants' disparate attitudes toward the use of telemedicine. We performed an online, multilingual 30-question survey for 14 days during March-April 2021, focusing on the perception and usage of telemedicine and their intent to use it after the pandemic. We analyzed the data to identify the attributes influencing the intent to use telemedicine and built decision trees to highlight the most important related variables. We examined 473 answers: 272 from Israel, 87 from Uruguay, and 114 worldwide. Most participants were women (64.6%), married (63.8%) with 1-2 children (52.9%), and living in urban areas (84.6%). Only a third of the participants intended to continue using telemedicine after the COVID-19 pandemic. Our main findings are that an expected substitution effect, technical proficiency, reduced queueing times, and peer experience are the four major factors in the overall adoption of telemedicine. Specifically, (1) for most participants, the major factor influencing their telemedicine usage is the implicit expectation that such a visit will be a full substitute for an in-person appointment; (2) another factor affecting telemedicine usage by patients is their overall technical proficiency and comfort level in the use of common web-based tools, such as social media, while seeking relevant medical information; (3) time saving as telemedicine can allow for asynchronous communications, thereby reducing physical travel and queuing times at the clinic; and finally (4) some participants have also indicated that telemedicine seems more attractive to them after watching family and friends (peer experience) use it successfully.
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Affiliation(s)
- Arriel Benis
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon 5810201, Israel; (M.B.); (D.P.); (M.K.); (B.-e.Y.)
- Faculty of Digital Technologies in Medicine, Holon Institute of Technology, Holon 5810201, Israel
- Correspondence:
| | - Maxim Banker
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon 5810201, Israel; (M.B.); (D.P.); (M.K.); (B.-e.Y.)
| | - David Pinkasovich
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon 5810201, Israel; (M.B.); (D.P.); (M.K.); (B.-e.Y.)
| | - Mark Kirin
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon 5810201, Israel; (M.B.); (D.P.); (M.K.); (B.-e.Y.)
| | - Bat-el Yoshai
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon 5810201, Israel; (M.B.); (D.P.); (M.K.); (B.-e.Y.)
| | | | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel 4070000, Israel;
| | - Abraham Seidmann
- Department of Information Systems, Questrom Business School, Boston University, Boston, MA 02215, USA;
- Health Analytics and Digital Health, Digital Business Institute, Boston University, Boston, MA 02215, USA
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Neves AL, Li E, Serafini A, Jimenez G, Lingner H, Koskela TH, Hoffman RD, Collins C, Petek D, Claveria A, Tsopra R, Irving G, Gusso G, O'Neill BG, Hoedebecke K, Espitia SM, Ungan M, Nessler K, Lazic V, Laranjo L, Memarian E, Fernandez MJ, Ghafur S, Fontana G, Majeed A, Car J, Darzi A. Evaluating the Impact of COVID-19 on the Adoption of Virtual Care in General Practice in 20 Countries (inSIGHT): Protocol and Rationale Study. JMIR Res Protoc 2021; 10:e30099. [PMID: 34292867 PMCID: PMC8396553 DOI: 10.2196/30099] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/29/2021] [Accepted: 07/19/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND In recent decades, virtual care has emerged as a promising option to support primary care delivery. However, despite the potential, adoption rates remained low. With the outbreak of COVID-19, it has suddenly been pushed to the forefront of care delivery. As we progress into the second year of the COVID-19 pandemic, there is a need and opportunity to review the impact remote care had in primary care settings and reassess its potential future role. OBJECTIVE This study aims to explore the perspectives of general practitioners (GPs) and family doctors on the (1) use of virtual care during the COVID-19 pandemic, (2) perceived impact on quality and safety of care, and (3) essential factors for high-quality and sustainable use of virtual care in the future. METHODS This study used an online cross-sectional questionnaire completed by GPs distributed across 20 countries. The survey was hosted in Qualtrics and distributed using email, social media, and the researchers' personal contact networks. GPs were eligible for the survey if they were working mainly in primary care during the period of the COVID-19 pandemic. Descriptive statistical analysis will be performed for quantitative variables, and relationships between the use of virtual care and perceptions on impact on quality and safety of care and participants' characteristics may be explored. Qualitative data (free-text responses) will be analyzed using framework analysis. RESULTS Data collection took place from June 2020 to September 2020. As of this manuscript's submission, a total of 1605 GP respondents participated in the questionnaire. Further data analysis is currently ongoing. CONCLUSIONS The study will provide a comprehensive overview of the availability of virtual care technologies, perceived impact on quality and safety of care, and essential factors for high-quality future use. In addition, a description of the underlying factors that influence this adoption and perceptions, in both individual GP and family doctor characteristics and the context in which they work, will be provided. While the COVID-19 pandemic may prove the first great stress test of the capabilities, capacity, and robustness of digital systems currently in use, remote care will likely remain an increasingly common approach in the future. There is an imperative to identify the main lessons from this unexpected transformation and use them to inform policy decisions and health service design. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/30099.
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Affiliation(s)
- Ana Luísa Neves
- Institute of Global Health Innovation, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Edmond Li
- Institute of Global Health Innovation, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Geronimo Jimenez
- Center for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Heidrun Lingner
- Center for Public Health and Healthcare, German Center for Lung Research (DZL) / BREATH Hannover, Hannover Medical School, Hannover, Germany
| | - Tuomas H Koskela
- Department of General Practice, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, Tampere, Finland
| | - Robert D Hoffman
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ana Claveria
- Primary Care Research Unit, Vigo Health Area, Vigo, Spain
- Galicia South Health Research Institute, Vigo, Spain
| | - Rosy Tsopra
- Information Sciences to Support Personalized Medicine, Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Paris, France
- Department of Medical Informatics, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Greg Irving
- Health Research Institute, Edge Hill University, Ormskirk, United Kingdom
| | - Gustavo Gusso
- Department of Internal Medicine, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Braden Gregory O'Neill
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Kyle Hoedebecke
- Department of Utilization Management, Oscar Health, Dallas, TX, United States
| | | | - Mehmet Ungan
- Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Ensieh Memarian
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- Internal Medicine and Epidemiology Research Group, Skane University Hospital, Malmö, Sweden
| | - Maria Jose Fernandez
- Galicia South Health Research Institute, Vigo, Spain
- Leiro Health Center, Leiro, Spain
| | - Saira Ghafur
- Institute of Global Health Innovation, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gianluca Fontana
- Institute of Global Health Innovation, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Josip Car
- Center for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Institute of Global Health Innovation, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
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Baroncelli GI, Bertelloni S, Cosci O Di Coscio M, Tyutyusheva N, D'Elios S, Peroni D. Management of patients with X-linked hypophosphatemic rickets during Covid-19 pandemic lockdown. J Pediatr Endocrinol Metab 2021; 34:905-910. [PMID: 33887813 DOI: 10.1515/jpem-2021-0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/02/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify a safe pathway for management and treatment of patients with X-linked hypophosphatemic rickets (XLH) during Covid-19 pandemic lockdown. METHODS Twenty-six patients with XLH (age 3.1-25.7 years) were enrolled in Pediatric Endocrine Unit; nine of them were receiving human monoclonal anti-fibroblast growth factor 23 antibody (burosumab) and 17 (pediatric patients, age 9.5-17.9 years, n=7; young-adult patients, age 20.1-25.7 years, n=10) received conventional treatment with inorganic oral phosphate salts and active vitamin D metabolites. A Covid-19 free pathway was addressed for XLH patients receiving burosumab treatment in hospital. XLH patients receiving conventional treatment were followed by phone calls, e-mails, or telemedicine. RESULTS All XLH patients receiving burosumab continued the scheduled follow-up and treatment; none of them was infected by Covid-19. Seven XLH patients out of 17 (41%) receiving conventional treatment showed some complication related to the disease itself or its treatment: periapical abscess with gingival fistula was diagnosed in five patients (three children and two young-adults) and treated with antibiotics with complete resolution; one child showed abdominal pain due to the administration of high doses of inorganic oral phosphate salts solved by reducing the dosage, and one child had severe legs pain during deambulation after orthopedic surgery solved with common analgesics. CONCLUSIONS Covid-19 free pathway was safe and effective to manage XLH patients receiving burosumab. E-health technologies were useful methods to follow XLH patients receiving conventional treatment during Covid-19 pandemic lockdown.
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Affiliation(s)
- Giampiero I Baroncelli
- Division of Pediatrics, Department of Obstetrics, Gynecology and Pediatrics, University-Hospital, Pisa, Italy
| | - Silvano Bertelloni
- Division of Pediatrics, Department of Obstetrics, Gynecology and Pediatrics, University-Hospital, Pisa, Italy
| | - Mirna Cosci O Di Coscio
- Division of Pediatrics, Department of Obstetrics, Gynecology and Pediatrics, University-Hospital, Pisa, Italy
| | - Nina Tyutyusheva
- Division of Pediatrics, Department of Obstetrics, Gynecology and Pediatrics, University-Hospital, Pisa, Italy
| | - Sofia D'Elios
- Division of Pediatrics, Department of Obstetrics, Gynecology and Pediatrics, University-Hospital, Pisa, Italy
| | - Diego Peroni
- Division of Pediatrics, Department of Obstetrics, Gynecology and Pediatrics, University-Hospital, Pisa, Italy
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Freed B, Hillman S, Shantikumar S, Bick D, Dale J, Gauly J. The impact of disasters on contraception in OECD member countries: a scoping review. EUR J CONTRACEP REPR 2021; 26:429-438. [PMID: 34126834 DOI: 10.1080/13625187.2021.1934440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Review evidence is lacking about how contraception is affected by severe social disruption, such as that caused by the COVID-19 pandemic. The purpose of this scoping review was to explore the impact of natural and man-made disasters on contraception in OECD member countries. METHODS Manual searches and systematic searches in six electronic databases were conducted with no language restrictions. All articles were screened by at least two researchers. The data were analysed thematically. RESULTS 108 articles were included. Most focussed on the Zika virus outbreak (n = 50) and the COVID-19 pandemic (n = 28). Four key themes were identified: importance of contraception during disasters, impact of disasters on contraceptive behaviour, barriers to contraception during disasters and ways of improving use of contraception during disasters. Despite efforts to increase access to contraception including by transforming ways of delivery, barriers to use meant that unmet need persisted. CONCLUSIONS To prevent adverse health outcomes and reduce health costs as a result of failure to have access to contraception during disasters, there is a need to intensify efforts to remove barriers to use. This should include increasing access and information on methods of contraception and their side effects (e.g., menstrual suppression) and making contraception freely available.
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Affiliation(s)
- Benjamin Freed
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Sarah Hillman
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Debra Bick
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Julia Gauly
- Warwick Medical School, University of Warwick, Coventry, UK
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Brown CL, Montez K, Amati JB, Simeonsson K, Townsend JD, Orr CJ, Palakshappa D. Impact of COVID-19 on Pediatric Primary Care Visits at Four Academic Institutions in the Carolinas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115734. [PMID: 34071783 PMCID: PMC8199093 DOI: 10.3390/ijerph18115734] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 12/01/2022]
Abstract
We aimed to determine how COVID-19 affected the number and type of pediatric primary care visits in April 2020, compared to April 2019, and which characteristics were associated with obtaining care in 2020. We performed a retrospective chart review of patients receiving care in April 2019 and April 2020 from four large, academic institutions across two states. The subjects were included if they were aged 0–18 years and were seen in a pediatric clinic in April 2019 or April 2020. We extracted the number of visits, visit type, and visit diagnosis; and the patient characteristics, including age, race/ethnicity, and insurance status. Logistic regression analysis identified characteristics associated with obtaining care in April 2020. We included 120,230 visits. Participants were 50% white and half had Medicaid. In 2020 there were significantly fewer visits for both well and acute visits with 42,670 visits in 2020 compared to 77,560 in 2019; 6616 were telehealth visits in 2020. Visits for chronic conditions were significantly decreased in 2020. Attending a visit in 2020 was more likely if the participant was black or Hispanic, younger, attending an acute visit, or had private insurance. During the COVID-19 pandemic, pediatric primary care decreased substantially for both well visits and follow-up of chronic conditions.
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Affiliation(s)
- Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
- Correspondence: ; Tel.: +1-(336)-716-4987
| | - Kimberly Montez
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
| | - Jane Blakely Amati
- Department of Pediatrics, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA;
| | - Kristina Simeonsson
- Department of Pediatrics, East Carolina University, Greenville, NC 27834, USA; (K.S.); (J.D.T.)
| | - John D. Townsend
- Department of Pediatrics, East Carolina University, Greenville, NC 27834, USA; (K.S.); (J.D.T.)
| | - Colin J. Orr
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA;
| | - Deepak Palakshappa
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
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Erlichman M, Zalut T, Schwartz S, Weiser G. The ongoing indirect effect of the COVID-19 pandemic on a pediatric emergency department. PLoS One 2021; 16:e0251003. [PMID: 33956832 PMCID: PMC8117792 DOI: 10.1371/journal.pone.0251003] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/16/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction The SARS-CoV-2 coronavirus pandemic may cause significant morbidity and
mortality in adults, yet severe cases are rare among children. The indirect
impact of the pandemic on health care delivery in general and pediatric
emergency department (PED) visits in particular has been widely
reported. Aims To assess the impact of the pandemic and the social restrictions imposed in
its wake on PED visits and hospitalization rates in our Israeli medical
center. We also sought to track these data in relation to the variation in
pandemic severity and social restrictions over time. A comparison of this
data with that of the adult emergency department was also performed. Methods Data for this study were drawn from the Shaare Zedek Medical Center (SZMC),
Jerusalem, Israel computerized databank. The daily number of PED and adult
ER visits as well as hospitalizations resulting from these visits during the
months January-July during the years 2018, 2019, 2020 were recorded. We
compared the risk ratio for hospitalization in 2019 and 2020, as well as the
incidence rate ratio. Results During March and April there was a decrease in PED visits from 4,588 visits
in 2019 to 2,527 visits in 2020 (ratio = .551, 95%CI [.52,.58]. Despite the
drop in PED visits, the rate of hospitalizations rose with respect to 2019
(Risk Ratio = 1.31, p < .001, 95%CI [1.17,1.47]). Similar but more
moderate trends were seen in the adult ED. From May-July 2020, after the
lockdown was lifted, PED visits remained 30% below the same time period from
2018 and 2019, while the hospitalization rate returned to its pre-pandemic
level. Conclusions A significant drop in PED visits is seen to extend well beyond the peak of
the pandemic and the lockdown period. This highlights the potential risk of
children with serious emergencies becoming casualties of the pandemic by
their not being brought to medical attention. Efforts should be made to
raise public awareness among parents and other caretakers of children
regarding this matter.
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Affiliation(s)
- Matti Erlichman
- Shaare Zedek Medical Center and the Faculty of Medicine at the Hebrew
University in Jerusalem, Pediatric Emergency Department, Jerusalem,
Israel
| | - Todd Zalut
- Emergency Department, Shaare Zedek Medical Center, Jerusalem,
Israel
| | - Shepard Schwartz
- Shaare Zedek Medical Center and the Faculty of Medicine at the Hebrew
University in Jerusalem, Pediatric Emergency Department, Jerusalem,
Israel
| | - Giora Weiser
- Shaare Zedek Medical Center and the Faculty of Medicine at the Hebrew
University in Jerusalem, Pediatric Emergency Department, Jerusalem,
Israel
- * E-mail:
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Training the Next Industrial Engineers and Managers about Industry 4.0: A Case Study about Challenges and Opportunities in the COVID-19 Era. SENSORS 2021; 21:s21092905. [PMID: 33919164 PMCID: PMC8122260 DOI: 10.3390/s21092905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 12/22/2022]
Abstract
Training the next generation of industrial engineers and managers is a constant challenge for academia, given the fast changes of industrial technology. The current and predicted development trends in applied technologies affecting industry worldwide as formulated in the Industry 4.0 initiative have clearly emphasized the needs for constantly adapting curricula. The sensible socioeconomic changes generated by the COVID-19 pandemic have induced significant challenges to society in general and industry. Higher education, specifically when dealing with Industry 4.0, must take these new challenges rapidly into account. Modernization of the industrial engineering curriculum combined with its migration to a blended teaching landscape must be updated in real-time with real-world cases. The COVID-19 crisis provides, paradoxically, an opportunity for dealing with the challenges of training industrial engineers to confront a virtual dematerialized work model which has accelerated during and will remain for the foreseeable future after the pandemic. The paper describes the methodology used for adapting, enhancing, and evaluating the learning and teaching experience under the urgent and unexpected challenges to move from face-to-face university courses distant and online teaching. The methodology we describe is built on a process that started before the onset of the pandemic, hence in the paper we start by describing the pre-COVID-19 status in comparison to published initiatives followed by the real time modifications we introduced in the faculty to adapt to the post-COVID-19 teaching/learning era. The focus presented is on Industry 4.0. subjects at the leading edge of the technology changes affecting the industrial engineering and technology management field. The manuscript addresses the flow from system design subjects to implementation areas of the curriculum, including practical examples and the rapid decisions and changes made to encompass the effects of the COVID-19 pandemic on content and teaching methods including feedback received from participants.
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Laso-Alonso AE, Mata-Zubillaga D, González-García LG, Rodríguez-Manchón S, Corral-Hospital S, García-Aparicio C. [Impact of COVID-19s alarm states in the care of pediatric patients in Primary Care in a health area in northern Spain]. Semergen 2021; 47:448-456. [PMID: 33958273 PMCID: PMC8057767 DOI: 10.1016/j.semerg.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/09/2021] [Accepted: 03/20/2021] [Indexed: 12/24/2022]
Abstract
Objetivo La pandemia por SARS-CoV-2 ha supuesto un cambio global en el modelo asistencial, potenciando la asistencia telemática, especialmente a nivel de Atención Primaria (AP). El objetivo de nuestro estudio es describir el impacto que han tenido los dos estados de alarma decretados en España en la asistencia de la población infantil a nivel de AP. Material y métodos Estudio observacional retrospectivo. Se analizaron las consultas de AP correspondientes a pacientes pediátricos (<14 años) de un área sanitaria del norte de España y de un Centro de Salud perteneciente a esa área, durante el primer y segundo estados de alarma, y se compararon con sus períodos homólogos del 2019. Resultados Durante el primer estado de alarma en que se estableció confinamiento domiciliario y cierre de los colegios, se objetivó un gran descenso de las consultas pediátricas en los centros de salud (758 vs. 1.381 en 2019), a expensas principalmente de revisiones de salud y enfermedades infecciosas. Dicha disminución no se observó en el segundo estado de alarma (1.375 vs. 1.233 en 2019). En ambos aumentó de forma significativa el porcentaje de consultas telefónicas. Conclusiones La implantación de los estados de alarma ha supuesto un descenso de la demanda asistencial, sobre todo durante la primera ola, que podría deberse al temor de las familias a acudir al centro de salud y la disminución de la transmisibilidad de los virus debido al confinamiento domiciliario, asimismo ha supuesto un aumento de la atención telemática secundaria a la necesidad de reorganización de la asistencia sanitaria.
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Affiliation(s)
- A E Laso-Alonso
- Hospital Vital Álvarez Buylla, Servicio de Pediatría, Servicio de Salud del Principado de Asturias, Asturias, España.
| | - D Mata-Zubillaga
- Hospital Vital Álvarez Buylla, Servicio de Pediatría, Servicio de Salud del Principado de Asturias, Asturias, España
| | - L G González-García
- Hospital Vital Álvarez Buylla, Servicio de Pediatría, Servicio de Salud del Principado de Asturias, Asturias, España
| | - S Rodríguez-Manchón
- Hospital Vital Álvarez Buylla, Servicio de Pediatría, Servicio de Salud del Principado de Asturias, Asturias, España
| | - S Corral-Hospital
- Hospital Vital Álvarez Buylla, Servicio de Pediatría, Servicio de Salud del Principado de Asturias, Asturias, España
| | - C García-Aparicio
- Hospital Vital Álvarez Buylla, Servicio de Pediatría, Servicio de Salud del Principado de Asturias, Asturias, España
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Jacob R, Weiser G, Padeh G, Kaplan O, Maimon M, Takagi D, Peled S, Gamsu S, Krupik D, Kuchinski Cohen N, Klein A, Gur-Soferman Md Mha H, Sharkansky L, Chistyakov Md I, Shavit I. Complications of serious acute conditions in children during the COVID-19 pandemic. Am J Emerg Med 2021; 49:421-423. [PMID: 33736922 PMCID: PMC7897455 DOI: 10.1016/j.ajem.2021.02.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ron Jacob
- Pediatric Emergency Department, Ha'Emek Medical Center, Afula, Israel
| | - Giora Weiser
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Gabi Padeh
- Emergency Department, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Or Kaplan
- Pediatric Emergency Department, Soroka Medical Center, Beer Sheba, Israel
| | - Michal Maimon
- Pediatric Emergency Department, Soroka Medical Center, Beer Sheba, Israel
| | - Dania Takagi
- Pediatric Emergency Department, Meir Medical Center, Kfar Saba, Israel
| | - Shuny Peled
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
| | - Shirly Gamsu
- Pediatric Emergency Department, Shamir Medical Center, Beer Yaakov, Israel
| | - Danna Krupik
- Pediatric Emergency Department, Ziv Medical Center, Safed, Israel
| | | | - Adi Klein
- Pediatric Emergency Department, Hillel Yaffe Medical Center, Hadera, Israel
| | | | - Livnat Sharkansky
- Pediatric Emergency Department, Bnai Zion Medical Center, Haifa, Israel
| | | | - Itai Shavit
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel.
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41
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Arafat MY, Zaman S, Hawlader MDH. Telemedicine improves mental health in COVID-19 pandemic. J Glob Health 2021; 11:03004. [PMID: 34326984 PMCID: PMC8294826 DOI: 10.7189/jogh.11.03004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Md Yeasin Arafat
- Department of Public Health, North South University (NSU), Dhaka, Bangladesh
| | - Sanjana Zaman
- Department of Public Health, North South University (NSU), Dhaka, Bangladesh.,Department of Public Health, Daffodil International University, Dhaka, Bangladesh
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An MH, You SC, Park RW, Lee S. Using an Extended Technology Acceptance Model to Understand the Factors Influencing Telehealth Utilization After Flattening the COVID-19 Curve in South Korea: Cross-sectional Survey Study. JMIR Med Inform 2021; 9:e25435. [PMID: 33395397 PMCID: PMC7801132 DOI: 10.2196/25435] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Although telehealth is considered a key component in combating the worldwide crisis caused by COVID-19, the factors that influence its acceptance by the general population after the flattening of the COVID-19 curve remain unclear. OBJECTIVE We aimed to identify factors affecting telehealth acceptance, including anxiety related to COVID-19, after the initial rapid spread of the disease in South Korea. METHODS We proposed an extended technology acceptance model (TAM) and performed a cross-sectional survey of individuals aged ≥30 years. In total, 471 usable responses were collected. Confirmatory factor analysis was used to examine the validity of measurements, and the partial least squares (PLS) method was used to investigate factors influencing telehealth acceptance and the impacts of COVID-19. RESULTS PLS analysis showed that increased accessibility, enhanced care, and ease of telehealth use had positive effects on its perceived usefulness (P=.002, P<.001, and P<.001, respectively). Furthermore, perceived usefulness, ease, and privacy/discomfort significantly impacted the acceptance of telehealth (P<.001, P<.001, and P<.001, respectively). However, anxiety toward COVID-19 was not associated with telehealth acceptance (P=.112), and this insignificant relationship was consistent in the cluster (n=216, 46%) of respondents with chronic diseases (P=.185). CONCLUSIONS Increased accessibility, enhanced care, usefulness, ease of use, and privacy/discomfort are decisive variables affecting telehealth acceptance in the Korean general population, whereas anxiety about COVID-19 is not. This study may lead to a tailored promotion of telehealth after the pandemic subsides.
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Affiliation(s)
- Min Ho An
- So-Ahn Public Health Center, Jeon-ra-nam-do, Republic of Korea
| | - Seng Chan You
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Seongwon Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
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43
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Reingold SM, Hadjipanayis A, van Esso D, Del Torso S, Dornbusch HJ, de Guchtenaere A, Pancheva R, Mujkic A, Syridou G, Valiulis A, Mazur A, Rios J, Spreitzer MV, Mamenko M, D'Avino A, Kubatova G, Geitmann K, Wyder C, Altorjai P, Michailidou K, Grossman Z. COVID-19 Era Effect on Pandemic and Post-pandemic Pediatric Telemedicine Use: A Survey of the European Academy of Pediatrics Research in Ambulatory Settings Network. Front Pediatr 2021; 9:713930. [PMID: 34746051 PMCID: PMC8570300 DOI: 10.3389/fped.2021.713930] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/16/2021] [Indexed: 01/22/2023] Open
Abstract
Background: During the COVID-19 pandemic, telemedicine use has increased within community pediatrics. This trend runs counter to reluctance to adaptation of the new mode of healthcare that existed prior to the pandemic. Little is known about what we can expect after the pandemic: if physicians will opt for telemedicine modalities and if tele-pediatrics will continue to be a significant mode of community pediatric care. Objective: The goal of this study was to survey primary pediatric care providers as to their experiences and clinical decision making with telemedicine modalities prior to and during the COVID-19 pandemic, as well as their projected use after the pandemic ends. Material and methods: Using the EAPRASnet database we surveyed pediatricians throughout Europe, using a web-based questionnaire. The survey was performed during the COVID-19 pandemic (June-July 2020), assessed telemedicine use for several modalities, prior to and during the pandemic as well as predicted use after the pandemic will have resolved. Participants were also surveyed regarding clinical decision making in two hypothetical clinical scenarios managed by telemedicine. Results: A total of 710 physicians participated, 76% were pediatricians. The percentage of respondents who reported daily use for at least 50% of all encounters via telemedicine modalities increased during the pandemic: phone calls (4% prior to the pandemic to 52% during the pandemic), emails (2-9%), text messages (1-6%), social media (3-11%), cell-phone pictures/video (1-9%), and video conferencing (1-7%) (p < 0.005). The predicted post-pandemic use of these modalities partially declined to 19, 4, 3, 6, 9, and 4%, respectively (p < 0.005), yet demonstrating a prospectively sustained use of pictures/videos after the pandemic. Reported high likelihood of remotely treating suspected pneumonia and acute otitis media with antibiotics decreased from 8 to 16% during the pandemic to an assumed 2 and 4% after the pandemic, respectively (p < 0.005). Conclusions: This study demonstrates an increased utilization of telemedicine by pediatric providers during the COVID-19 pandemic, as well as a partially sustained effect that will promote telemedicine use as part of a hybrid care provision after the pandemic will have resolved.
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Affiliation(s)
| | | | | | | | | | - Ann de Guchtenaere
- Department of Paediatrics, University Hospital Ghent, Ghent, Belgium.,Department of Paediatrics, Regional Hospital AZ Damiaan, Ostend, Belgium
| | - Rouzha Pancheva
- Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna, Varna, Bulgaria
| | - Aida Mujkic
- Andrija Štampar School of Public Health, School of Medicine, Univeristy of Zagreb, Zagreb, Croatia
| | - Garyfallia Syridou
- Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Arunas Valiulis
- Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Artur Mazur
- Department of Pediatrics and Pediatric Endocrinology and Diabetes, Medical College, University of Rzeszow, Rzeszow, Poland
| | - Joana Rios
- Department of Pediatrics, Hospital Beatriz Ângelo, Loures, Portugal
| | | | - Marina Mamenko
- Department of Pediatrics, Shupyk National Medical Academy of Post-graduate Education, Kyiv, Ukraine
| | - Antonio D'Avino
- Pediatria di Famiglia, Federazione Italiana Medici Pediatri FIMP, Naples, Italy
| | | | | | | | | | - Kyriaki Michailidou
- Biostatistics Unit, Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Zachi Grossman
- Adelson School of Medicine, Ariel University, Ariel, Israel.,Maccabi Healthcare Services, Tel Aviv-Yafo, Israel
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