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Prosperi Desenzi Ciaralo P, Guerreiro Cardoso PF, Minamoto H, Bibas BJ, Ribeiro de Carvalho CR, Pego-Fernandes PM. Implementation and Results of a Dedicated Telemedicine Program ( TeleTrachea) for Patients with Tracheal Diseases. Telemed J E Health 2024; 30:1317-1324. [PMID: 38109228 DOI: 10.1089/tmj.2023.0524] [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: 12/20/2023] Open
Abstract
Background: Central airway diseases requiring frequent outpatient visits to a specialized medical center due to tracheal devices. Many of these patients have mobility and cognition restrictions or require specialized transport due to the need for supplemental oxygen. This study describes the implementation and results of a telemedicine program dedicated to patients with central airway diseases based in a Brazilian public health system. Methods: A retrospective study of telemedicine consultation for patients with central airway diseases referred to a public academic hospital between August 1, 2020 and August 1, 2022. The consultations occurred in a telemedicine department using the hospital's proprietary platform. Data retrieved consisted of demographics, disease characteristics, and the treatment modalities of the patients. The analysis included the savings in kilometers not traveled, the carbon footprint based on reducing CO2 emissions, and the cost savings in transportation. Results: A total of 1,153 telemedicine visits conducted in 516 patients (median age of 31.5 years). Two hundred ninety patients (56.2%) had a tracheal device (129 silicone T-Tube, 128 tracheostomy, and 33 endoprosthesis) and 159 patients (30.8%) had difficulties in transportation to the specialized medical center. Patients were served from 147 Brazilian cities from 22 states. The savings in kilometers traveled was 1,224,108.54 km, corresponding to a 250.14 ton reduction in CO2 emissions. The costs savings in transportation for the municipalities was BRL$ 1,272,283.78. Conclusions: Telemedicine consultations for patients with central airway diseases are feasible and safe. Cost savings and the possibility of disseminating specialized care make telemedicine a fundamental tool in current medical practice.
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Affiliation(s)
- Pedro Prosperi Desenzi Ciaralo
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Paulo Francisco Guerreiro Cardoso
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Helio Minamoto
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Benoit Jacques Bibas
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Carlos Roberto Ribeiro de Carvalho
- Divisions of Pulmonology, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Paulo Manuel Pego-Fernandes
- Divisions of Thoracic Surgery, Instituto do Coracao do Hospital das Clinicas, HCFMUSP da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
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Heffernan A, Lalande A, Chadha R, MacNeill A, Chadha NK. Carbon savings potential of virtual care in obstructive sleep apnea and otitis media with effusion. Laryngoscope Investig Otolaryngol 2024; 9:e1221. [PMID: 38623079 PMCID: PMC11017970 DOI: 10.1002/lio2.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/07/2024] [Accepted: 01/16/2024] [Indexed: 04/17/2024] Open
Abstract
Objective To determine the carbon savings potential of incorporating virtual care into surgical care pathways for pediatric patients with obstructive sleep apnea or otitis media with effusion. Methods Pediatric patients with obstructive sleep apnea or otitis media with effusion were not enrolled, instead, a modeling cohort study design was used. This study utilized the British Columbia healthcare system and geography to model emissions. Care pathways were developed for pediatric patients with obstructive sleep apnea or otitis media with effusion requiring care at a tertiary pediatric center. Home addresses were located at the geographical center of the two most populated municipalities within each of the 10 most populated regional districts in 2020. Virtual visits replaced up to three clinically equivalent in-person visits. Emissions (kgCO2e) for transport and virtual visits were estimated. Population-weighted means and descriptive statistics were calculated. Results Utilizing 1, 2, or 3 virtual visits in the obstructive sleep apnea care pathway yielded potential emissions savings of 19.9%, 39.9%, and 59.8% respectively. Integrating 1, 2, or 3 virtual visits into the otitis media with effusion care pathway produced potential emissions savings of 16.6%, 33.2%, and 49.7%, respectively. Integrating 3 virtual visits can save up to 2156.8 kgCO2e per patient. Conclusions Appropriately conducting up to 50% of clinical encounters virtually for children with obstructive sleep apnea or otitis media with effusion reduced theoretical carbon emissions. For a single child, emission savings could reach over 2150 kgCO2e. Level of Evidence Level 5.
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Affiliation(s)
- Austin Heffernan
- Division of Otolaryngology‐Head and Neck Surgery, (Department of Surgery)University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Annie Lalande
- Institute for Resources, Environment and SustainabilityUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of SurgeryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Rashmi Chadha
- Department of Family PracticeUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Vancouver General HospitalVancouverBritish ColumbiaCanada
| | - Andrea MacNeill
- Department of SurgeryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Vancouver General HospitalVancouverBritish ColumbiaCanada
| | - Neil K. Chadha
- Division of Otolaryngology‐Head and Neck Surgery, (Department of Surgery)University of British ColumbiaVancouverBritish ColumbiaCanada
- Division of Pediatric Otolaryngology‐Head and Neck SurgeryBC Children's HospitalVancouverBritish ColumbiaCanada
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Rosi-Schumacher M, Patel S, Phan C, Goyal N. Understanding Financial Toxicity in Patients with Head and Neck Cancer: A Systematic Review. Clin Med Insights Oncol 2023; 17:11795549221147730. [PMID: 36710886 PMCID: PMC9880590 DOI: 10.1177/11795549221147730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/06/2022] [Indexed: 01/24/2023] Open
Abstract
Background Cancer treatment often results in financial burdens for patients including healthcare costs as well as treatment-induced disability leading to "financial toxicity" (FT) and decreased quality of life. The purpose of this review is to describe FT related to head and neck cancer (HNC) treatment, including quantifications of direct and indirect costs and descriptions of measurement tools. Methods PubMed, Embase, Cochrane Library, and Web of Science databases were searched to identify articles published before April 2022. Full-text published studies were included if they assessed direct or indirect costs of HNC treatment; studies were excluded if they did not focus on HNC or financial burden. The risk of bias was assessed, and the results of the studies were synthesized. Results Database searches yielded 530 unique studies, and 33 studies met the criteria for inclusion. Medical expenses for patients with HNC were higher than for patients with other cancers or controls in several studies. Major surgical procedures, neck dissection, free-flap reconstruction, and intensive care unit admission increased hospital costs. Trimodal therapy with surgery plus chemoradiation represented the most expensive treatment, and chemoradiation increased complication-related health care costs. In several studies, >50% of patients treated for HNC were disabled and did not return to work. One of the greatest contributors to the indirect cost of HNC treatment is the loss of lifetime wages. Patients with HNC are at risk for depression, anxiety, and social isolation, which are linked to a decreased quality of life and treatment non-adherence. The only tools used to assess FT in patients with HNC are the Comprehensive Score for financial Toxicity (COST) and the Financial Index of Toxicity (FIT). Conclusion Financial toxicity is highly prevalent among patients with HNC. Further research is needed to validate the assessment tools for quantifying FT in HNC patients.
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Affiliation(s)
- Mattie Rosi-Schumacher
- Department of Otolaryngology—Head and
Neck Surgery, Jacobs School of Medicine and Biomedical Sciences, The State
University of New York at Buffalo, Buffalo, NY, USA
| | - Shivam Patel
- Pennsylvania State University College
of Medicine, Hershey, PA, USA
| | - Chandat Phan
- Pennsylvania State University College
of Medicine, Hershey, PA, USA
| | - Neerav Goyal
- Pennsylvania State University College
of Medicine, Hershey, PA, USA,Department of Otolaryngology—Head and
Neck Surgery, Penn State Milton S Hershey Medical Center, Pennsylvania State
University, Hershey, PA, USA,Neerav Goyal, Department of
Otolaryngology—Head and Neck Surgery, Penn State Milton S Hershey Medical
Center, Pennsylvania State University, Hershey, PA 17033, USA.
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4
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Patel KB, Gonzalez BD, Turner K, Alishahi Tabriz A, Rollison DE, Robinson E, Naso C, Wang X, Spiess PE. Estimated Carbon Emissions Savings With Shifts From In-Person Visits to Telemedicine for Patients With Cancer. JAMA Netw Open 2023; 6:e2253788. [PMID: 36719682 PMCID: PMC9890284 DOI: 10.1001/jamanetworkopen.2022.53788] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
IMPORTANCE While the health care community advocates broadly for climate change policy, medical professionals can look within care practices to assess their contribution to carbon dioxide (CO2) emissions, and provide solutions wherever possible. Telemedicine can help in mitigating climate change by providing care from a distance. OBJECTIVE To assess the carbon savings achieved from telemedicine visits. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of telemedicine visits was conducted at a single-institution National Cancer Institute (NCI)-designated comprehensive cancer center. Eligible patients were aged 18 years and above, completed telemedicine visits from April 1, 2020, to June 20, 2021, and had a Florida mailing address documented in their electronic medical record. Groups were divided between those within driving time of 60 minutes (1-way) to the cancer center vs those living beyond 60 minutes of drive time. Data were analyzed between April 2020 and June 2021. MAIN OUTCOMES AND MEASURES Carbon emission savings from telemedicine, measured in total and average per-visit savings. RESULTS A total 49 329 telemedicine visits with 23 228 patients were conducted from April 1, 2020, to June 30, 2021. A total 21 489 visits were for patients with driving time of 60 minutes or less (median [IQR] age, 62.0 [52.0-71.0] years; 12 334 [57.4%] female; 1685 [7.8%] Black, 1500 [7.0%] Hispanic, 16 010 [74.5%] non-Hispanic White), while 27 840 visits were for patients with driving time greater than 60 minutes (median [IQR] age, 67.0 [57.0-74.0] years; 14 372 [51.6%] female; 1056 [3.8%] Black, 1364 [5.0%] Hispanic, 22 457 [80.7%] non-Hispanic White). For patients living within a driving time of 60 minutes from the cancer center, 424 471 kg CO2 emissions were saved (mean [SD] emissions savings, 19.8 [9.4] kg CO2 per visit) due to telemedicine-equivalent to 91.5 passenger vehicles driven for 1 year. For patients whose driving distance was greater than 60 minutes, 2 744 248 kg CO2 emissions were saved (mean emissions savings, 98.6 [54.8] kg CO2 per visit)-equivalent to 591 passenger vehicles driven for 1 year. CONCLUSIONS AND RELEVANCE Using a large data set, this cross-sectional analysis highlighted the carbon emissions savings due to telemedicine in oncology. This has important implications in reducing health care-related carbon footprint.
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Affiliation(s)
- Krupal B. Patel
- Department of Head and Neck and Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa
| | - Brian D. Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Dana E. Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Edmondo Robinson
- Department of Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, Florida
- Center for Digital Health, Moffitt Cancer Center, Tampa, Florida
| | - Cristina Naso
- Virtual Health Program, Moffitt Cancer Center, Tampa, Florida
| | - Xuefeng Wang
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Philippe E. Spiess
- Virtual Health Program, Moffitt Cancer Center, Tampa, Florida
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida
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Pickard Strange M, Booth A, Akiki M, Wieringa S, Shaw SE. The role of virtual consulting in developing environmentally sustainable healthcare: a systematic literature review (Preprint). J Med Internet Res 2022; 25:e44823. [PMID: 37133914 DOI: 10.2196/44823] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Health systems globally need to rapidly set and achieve targets for reaching net zero carbon emissions. Virtual consulting (including video- and telephone-based consulting) is regarded as one means by which this might be achieved, largely through reduced patient travel. Little is currently known about the ways in which forms of virtual consulting might contribute to the net zero agenda or how countries may develop and implement programs at scale that can support increased environmental sustainability. OBJECTIVE In this paper, we asked, What is the impact of virtual consulting on environmental sustainability in health care? and What can we learn from current evaluations that can inform future reductions in carbon emissions? METHODS We conducted a systematic review of published literature according to PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. We searched the MEDLINE, PubMed, and Scopus databases using key terms relating to "carbon footprint," "environmental impact," "telemedicine," and "remote consulting," using citation tracking to identify additional articles. The articles were screened, and full texts that met the inclusion criteria were obtained. Data on the approach to carbon footprinting reported reductions in emissions, and the opportunities and challenges associated with the environmental sustainability of virtual consultations were extracted into a spreadsheet, analyzed thematically, and theorized using the Planning and Evaluating Remote Consultation Services framework to consider the various interacting influences, including environmental sustainability, that shape the adoption of virtual consulting services. RESULTS A total of 1672 papers were identified. After removing duplicates and screening for eligibility, 23 papers that focused on a range of virtual consulting equipment and platforms across different clinical conditions and services were included. The focus on the environmental sustainability potential of virtual consulting was unanimously reported through carbon savings achieved by a reduction in travel related to face-to-face appointments. The shortlisted papers used a range of methods and assumptions to determine carbon savings, reporting these using different units and across varied sample sizes. This limited the potential for comparison. Despite methodological inconsistencies, all papers concluded that virtual consulting significantly reduced carbon emissions. However, there was limited consideration of wider factors (eg, patient suitability, clinical indication, and organizational infrastructure) influencing the adoption, use, and spread of virtual consultations and the carbon footprint of the entire clinical pathway in which the virtual consultation was provided (eg, risk of missed diagnoses from virtual consultations that result in the need for subsequent in-person consultations or admissions). CONCLUSIONS There is overwhelming evidence that virtual consulting can reduce health care carbon emissions, largely through reducing travel related to in-person appointments. However, the current evidence fails to look at system factors associated with implementing virtual health care delivery and wider research into carbon emissions across the entire clinical pathway.
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Affiliation(s)
- Martha Pickard Strange
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Amy Booth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Melissa Akiki
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- University of Oslo, Oslo, Norway
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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6
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Lange O, Plath J, Dziggel TF, Karpa DF, Keil M, Becker T, Rogowski WH. A Transparency Checklist for Carbon Footprint Calculations Applied within a Systematic Review of Virtual Care Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127474. [PMID: 35742724 PMCID: PMC9223517 DOI: 10.3390/ijerph19127474] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 02/06/2023]
Abstract
Increasing concerns about climate change imply that decisions on the digitization of healthcare should consider evidence about its carbon footprint (CF). This study aims to develop a transparency catalogue for reporting CF calculations, to compare results, and to assess the transparency (reporting quality) of the current evidence of virtual care (VC) intervention. We developed a checklist of transparency criteria based on the consolidation of three established standards/norms for CF calculation. We conducted a systematic review of primary studies written in English or German on the CF of VC interventions to check applicability. Based on our checklist, we extracted methodological information. We compared the results and calculated a transparency score. The checklist comprises 22 items in the aim, scope, data and analysis categories. Twenty-three studies out of 1466 records were included, mostly addressing telemedicine. The mean transparency score was 38% (minimum 14%, maximum 68%). On average, 148 kg carbon dioxide equivalents per patient were saved. Digitization may have co-benefits, improving care and reducing the healthcare CF. However, the evidence for this is weak, and CF reports are heterogeneous. Our transparency checklist may serve as a reference for developing a standard to assess the CF of virtual and other healthcare and public health services.
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Affiliation(s)
- Oliver Lange
- Department of Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, 28359 Bremen, Germany; (M.K.); (W.H.R.)
- Leibniz ScienceCampus Digital Public Health Bremen, 28359 Bremen, Germany
- Correspondence:
| | - Julian Plath
- Professional Public Decision Making, Faculty of Cultural Studies, University of Bremen, 28359 Bremen, Germany; (J.P.); (T.F.D.); (T.B.)
| | - Timo F. Dziggel
- Professional Public Decision Making, Faculty of Cultural Studies, University of Bremen, 28359 Bremen, Germany; (J.P.); (T.F.D.); (T.B.)
| | - David F. Karpa
- Faculty of Business Studies and Economics, University of Bremen, 28359 Bremen, Germany;
| | - Mattis Keil
- Department of Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, 28359 Bremen, Germany; (M.K.); (W.H.R.)
| | - Tom Becker
- Professional Public Decision Making, Faculty of Cultural Studies, University of Bremen, 28359 Bremen, Germany; (J.P.); (T.F.D.); (T.B.)
| | - Wolf H. Rogowski
- Department of Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, 28359 Bremen, Germany; (M.K.); (W.H.R.)
- Leibniz ScienceCampus Digital Public Health Bremen, 28359 Bremen, Germany
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Qin RX, Velin L, Yates EF, El Omrani O, McLeod E, Tudravu J, Samad L, Woodward A, McClain CD. Building sustainable and resilient surgical systems: A narrative review of opportunities to integrate climate change into national surgical planning in the Western Pacific region. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 22:100407. [PMID: 35243461 PMCID: PMC8881731 DOI: 10.1016/j.lanwpc.2022.100407] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Five billion people lack access to surgical care worldwide; climate change is the biggest threat to human health in the 21st century. This review studies how climate change could be integrated into national surgical planning in the Western Pacific region. We searched databases (PubMed, Web of Science, and Global Health) for articles on climate change and surgical care. Findings were categorised using the modified World Health Organisation Health System Building Blocks Framework. 220 out of 2577 records were included. Infrastructure: Operating theatres are highly resource-intensive. Their carbon footprint could be reduced by maximising equipment longevity, improving energy efficiency, and renewable energy use. Service delivery Tele-medicine, outreaches, and avoiding desflurane could reduce emissions. Robust surgical systems are required to adapt to the increasing burden of surgically treated diseases, such as injuries from natural disasters. Finance: Climate change adaptation funds could be mobilised for surgical system strengthening. Information systems: Sustainability should be a key performance indicator for surgical systems. Workforce: Surgical providers could change clinical, institutional, and societal practices. Governance: Planning in surgical care and climate change should be aligned. Climate change mitigation is essential in the regional surgical care scale-up; surgical system strengthening is also necessary for adaptation to climate change.
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Donald N, Irukulla S. Greenhouse Gas Emission Savings in Relation to Telemedicine and Associated Patient Benefits: A Systematic Review. Telemed J E Health 2022; 28:1555-1563. [PMID: 35446668 DOI: 10.1089/tmj.2022.0047] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction: Telemedicine is a rapidly expanding service in the digitization of health care systems. Recently emphasis has been placed on the decarbonization of health care systems with National and World Health Organization initiatives aimed at carbon neutrality toward the mid-21st century. This study investigates greenhouse gas emissions related to telemedicine, its potential role in achieving carbon neutrality and its role in determining policy. We further investigate patient benefits related to telemedicine. Methods: A systematic review was conducted of the PubMed, Medline, EMBASE, EMCARE, CINAHL, and HMIC databases. Eligibility of studies was determined by predefined criteria. Results: A total of 31 studies were identified totaling over 57,000 patients. Carbon savings ranged from 0.69 kg CO2e (carbon dioxide equivalent) to 893 kg CO2e per encounter. Distances saved also ranged from 6.1 to 3,386 km. Further analysis of 18 included studies was conducted for cost savings that ranged from €1.73 in fuel costs to over U.S. $900 in travel related expenses. Similarly, 15 included studies were analyzed for time savings, which ranged from 38 min to 24 h. Conclusions: There are substantial carbon savings to be made with telemedicine systems. Furthermore, there are substantial benefits to patients in terms of both time savings and cost savings. Rural and isolated communities or patients needing tertiary or quaternary care may be a particular cohort that might benefit disproportionally from telemedicine and is an area where the largest per capita emission savings can potentially be made.
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Affiliation(s)
- Neil Donald
- West Herts Teaching Hospitals NHS Trust, Watford, United Kingdom
| | - Shashi Irukulla
- Ashford and St. Peter's Hospitals NHS Foundation Trust, Chertsey, United Kingdom
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Yang A, Kim D, Hwang PH, Lechner M. Telemedicine and Telementoring in Rhinology, Otology, and Laryngology: A Scoping Review. OTO Open 2022; 6:2473974X211072791. [PMID: 35274073 PMCID: PMC8902203 DOI: 10.1177/2473974x211072791] [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: 10/22/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Telemedicine and telementoring have had a significant boost across
all medical and surgical specialties over the last decade and
especially during the COVID-19 pandemic. The aim of this scoping
review is to synthesize the current use of telemedicine and
telementoring in otorhinolaryngology and head and neck
surgery. Data Sources PubMed and Cochrane Library. Review Methods A scoping review search was conducted, which identified 469
articles. Following full-text screening by 2 researchers, 173
articles were eligible for inclusion and further categorized via
relevant subdomains. Conclusions Virtual encounters and telementoring are the 2 main applications of
telemedicine in otolaryngology. These applications can be
classified into 7 subdomains. Different ear, nose, and throat
subspecialties utilized certain telemedicine applications more
than others; for example, almost all articles on patient
engagement tools are rhinology based. Overall, telemedicine is
feasible, showing similar concordance when compared with
traditional methods; it is also cost-effective, with high
patient and provider satisfaction. Implications for Practice Telemedicine in otorhinolaryngology has been widely employed during
the COVID-19 pandemic and has a huge potential, especially with
regard to its distributing quality care to rural areas. However,
it is important to note that with current exponential use, it is
equally crucial to ensure security and privacy and integrate
HIPAA-compliant systems (Health Insurance Portability and
Accountability Act) in the big data era. It is expected that
many more applications developed during the pandemic are here to
stay and will be refined in years to come.
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Affiliation(s)
- Angela Yang
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Dayoung Kim
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Peter H. Hwang
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Matt Lechner
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
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Metcalfe C, Dogan M, Glazzard N, Ross E, George A. Introduction of a novel telescopic pathway to streamline 2-week-wait suspected head and neck cancer referrals and improve efficiency: A prospective service evaluation. Laryngoscope Investig Otolaryngol 2022; 7:117-124. [PMID: 35155789 PMCID: PMC8823166 DOI: 10.1002/lio2.721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES This study summarizes the introduction of a novel telescopic pathway, which streamlines 2-week-wait suspected head and neck cancer referrals to our unit, describes the logistics of the pathway, and analyzes referral numbers and outcomes. We also discuss wider issues surrounding remote assessment in head and neck cancer. METHODS Data were collected prospectively between January and May 2021, capturing all 2-week-wait referrals to our unit following the introduction of a telescopic pathway which utilized a nurse-led clinic for nasendoscopic examination of selected patients and consultant-led remote assessment using store and forward technology. Information on referral numbers, waiting times and outcomes was recorded. RESULTS Three hundred and forty (185 high risk, 155 low risk) patients entered the telescopic pathway with the remaining 74 patients seen on the conventional standard of care pathway. Cancer conversion rates were 17%, <1%, and 5.4% for the high-risk telescopic, low-risk telescopic and standard of care pathways respectively. No patients discharged from the telescopic pathway were re-referred within 3 months. Review capacity for endoscopic examination was higher per consultant on the telescopic pathway versus the standard of care (p = .01). CONCLUSION A combination of risk stratification and asynchronous telescopic assessment shows promise for the management of suspected head and neck cancer referrals. Potential benefits include consultant-led care for all patients and enhanced documentation. Digital communication with patients may also assist with adherence to the new NHS 28-day diagnostic standard for cancer referrals. Ongoing data collection is required to assess how the pathway functions over a longer period. LEVEL OF EVIDENCE 2c.
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Affiliation(s)
- Christopher Metcalfe
- Department of Otolaryngology, Royal Stoke University HospitalUniversity Hospitals North MidlandsStoke‐on‐TrentUnited Kingdom
| | - Mehmet Dogan
- Department of Otolaryngology, Royal Stoke University HospitalUniversity Hospitals North MidlandsStoke‐on‐TrentUnited Kingdom
| | - Nina Glazzard
- Department of Otolaryngology, Royal Stoke University HospitalUniversity Hospitals North MidlandsStoke‐on‐TrentUnited Kingdom
| | - Elizabeth Ross
- Department of Otolaryngology, Royal Stoke University HospitalUniversity Hospitals North MidlandsStoke‐on‐TrentUnited Kingdom
| | - Ajith George
- Department of Otolaryngology, Royal Stoke University HospitalUniversity Hospitals North MidlandsStoke‐on‐TrentUnited Kingdom
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11
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Ravindrane R, Patel J. The environmental impacts of telemedicine in place of face-to-face patient care: a systematic review. Future Healthc J 2021; 9:28-33. [DOI: 10.7861/fhj.2021-0148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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12
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Gupta T, Gkiousias V, Bhutta MF. A systematic review of outcomes of remote consultation in ENT. Clin Otolaryngol 2021; 46:699-719. [PMID: 33754458 DOI: 10.1111/coa.13768] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/11/2021] [Accepted: 03/14/2021] [Indexed: 12/18/2022]
Abstract
AIMS Remote or tele-consultation has become an emerging modality of consultation in many specialities, including ENT. Advantages include increasing accessibility, potential to reduce costs and, during the COVID-19 pandemic, reduced risk of infection transmission. Here, we systematically collate and synthesise the evidence base on outcomes from remote consultation in adult and paediatric ENT services. METHODS We performed a review in accordance with PRISMA guidelines. We searched Medline and Embase for relevant articles. Outcomes include specific patient pathway efficiency measures (including number of healthcare visits, lead time, touch time and handoff), patient/clinician satisfaction, cost analysis and safety implications. RESULTS From 6325 articles screened, 53 met inclusion criteria. Publications included studies on remote consultation for initial, preoperative and follow-up assessment (including postoperative). In most instances, remote consultation reduced costs and time from referral to assessment and was associated with high patient satisfaction. However, a face-to-face follow-up appointment was required in 13%-72% of initial consultations, suggesting that remote consultation is only appropriate in selected cases. CONCLUSION Remote consultation is appropriate and preferable for ENT consultation in specific conditions and circumstances. Future research should look to better define those conditions and circumstances, and report using recognised quality standards and outcome measures.
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Affiliation(s)
- Tanya Gupta
- Ear, Nose and Throat Department, Royal Sussex County Hospital, Brighton, UK
| | | | - Mahmood F Bhutta
- Ear, Nose and Throat Department, Royal Sussex County Hospital, Brighton, UK.,Brighton & Sussex Medical School, Falmer, Brighton, UK
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13
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Purohit A, Smith J, Hibble A. Does telemedicine reduce the carbon footprint of healthcare? A systematic review. Future Healthc J 2021; 8:e85-e91. [PMID: 33791483 DOI: 10.7861/fhj.2020-0080] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In the rapidly progressing field of telemedicine, there is a multitude of evidence assessing the effectiveness and financial costs of telemedicine projects; however, there is very little assessing the environmental impact despite the increasing threat of the climate emergency. This report provides a systematic review of the evidence on the carbon footprint of telemedicine. The identified papers unanimously report that telemedicine does reduce the carbon footprint of healthcare, primarily by reduction in transport-associated emissions. The carbon footprint savings range between 0.70-372 kg CO2e per consultation. However, these values are highly context specific. The carbon emissions produced from the use of the telemedicine systems themselves were found to be very low in comparison to emissions saved from travel reductions. This could have wide implications in reducing the carbon footprint of healthcare services globally. In order for telemedicine services to be successfully implemented, further research is necessary to determine context-specific considerations and potential rebound effects.
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14
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Cabrera CI, Ning AY, Cai Y, D'Anza B. Systematic Review of Telehealth Cost Minimization for Patients and Health Systems in Otolaryngology. Laryngoscope 2020; 131:1741-1748. [PMID: 33355932 DOI: 10.1002/lary.29321] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/30/2020] [Accepted: 11/20/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE/HYPOTHESIS The COVID-19 pandemic has resulted in telehealth becoming commonplace in many health care fields. Telehealth benefits include improving access, decreasing costs, and elevating patient's experience. A review of cost minimization (CM) analyses was performed in order to explore scientific studies associated with integrating tele-otolaryngology in clinical practice. Our primary objective was to evaluate published literature for cost related to the implementation of telemedicine across otolaryngology, and to determine CM when compared to in-person visits. STUDY DESIGN Systematic Literature Review. METHODS We performed a systematic review using PubMed, EMBASE, and Cochrane in May 2020, to identify studies with a cost analysis of tele-otolaryngology care. Inclusion criteria focused on articles citing CM data from telehealth services. Literature quality was assessed using the MINORS scoring system. RESULTS From 380 original articles screened only nine evaluated cost in otolaryngology. CM in the US ranged from $68 to $900 per visit. Cost was evaluated in general otolaryngology, sleep medicine, otology, and head and neck cancer surgery, the latter had the most benefit. The most common types of telehealth visits were routine follow-up and screening. Data were insufficient for meta-analysis. CONCLUSIONS Telemedicine has been trialed across various otolaryngology subspecialties; its incorporation is projected to have a meaningful impact on access to specialty care. This research suggests that the delivery of virtual care reduces cost with the potential of increasing net revenue across multiple otolaryngology subspecialties. Further studies are needed to better discern the entirety of cost savings and the best settings for integration. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1741-1748, 2021.
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Affiliation(s)
- Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Anne Y Ning
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Yida Cai
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Brian D'Anza
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
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15
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Abstract
BACKGROUND Telemedicine is an emerging field with numerous applications within medicine. Previous review articles describe its use within plastic surgery and otolaryngology but none, to the authors' knowledge, within dermatologic surgery. OBJECTIVE To provide a review of the applications of telemedicine within dermatologic surgery. MATERIALS AND METHODS A PubMed search of articles published on teledermatology was conducted in July 2018. Articles were selected based on their relevance to dermatologic surgery and reviewed for their discussion of the applications of telemedicine in surgical and cosmetic dermatology. RESULTS The initial search resulted in 156 articles. Eleven ultimately met inclusion criteria: 2 in referral and consultation, 5 in telepathology, 2 in intraoperative uses, and 2 in postprocedural care. CONCLUSION For preoperative consultation, teledermatology enables the surgeon to plan ahead and increases access to care by reducing the number of clinic visits. Telepathology has the potential to allow intraoperative consultation with a dermatopathologist to achieve accurate tumor clearance without delay. Smartglasses represent a promising technology for greater care coordination and a teaching tool. Postprocedural monitoring via text messaging provides convenient access to expert advice and early detection of postoperative complications. With increasing technologic advancements, telemedicine holds great potential to augment the dermatologic surgeon's daily practice.
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16
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Singh AK, Kasle DA, Jiang R, Sukys J, Savoca EL, Z Lerner M, Kohli N. A Review of Telemedicine Applications in Otorhinolaryngology: Considerations During the Coronavirus Disease of 2019 Pandemic. Laryngoscope 2020; 131:744-759. [PMID: 32942340 PMCID: PMC7537247 DOI: 10.1002/lary.29131] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE/HYPOTHESIS Review the published literature of telemedicine's use within otorhinolaryngology (ORL), highlight its successful implementation, and document areas with need of future research. STUDY DESIGN State of the Art Review. METHODS Three independent, comprehensive searches for articles published on the subject of telemedicine in ORL were conducted of literature available from January 2000 to April 2020. Search terms were designed to identify studies which examined telemedicine use within ORL. Consensus among authors was used to include all relevant articles. RESULTS While several, small reports document clinical outcomes, patient satisfaction, and the cost of telemedicine, much of the literature on telemedicine in ORL is comprised of preliminary, proof-of-concept reports. Further research will be necessary to establish its strengths and limitations. CONCLUSIONS Particularly during the coronavirus disease of 2019 pandemic, telemedicine can, and should, be used within ORL practice. This review can assist in guiding providers in implementing telemedicine that has been demonstrated to be successful, and direct future research. Laryngoscope, 131:744-759, 2021.
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Affiliation(s)
- Amrita K Singh
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - David A Kasle
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Roy Jiang
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Jordan Sukys
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Emily L Savoca
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Michael Z Lerner
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Nikita Kohli
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
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17
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Oral & Maxillofacial surgery is ready for patient-centred eHealth interventions - the outcomes of a scoping review. Int J Oral Maxillofac Surg 2018; 48:830-840. [PMID: 30466811 DOI: 10.1016/j.ijom.2018.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/15/2018] [Accepted: 10/02/2018] [Indexed: 10/27/2022]
Abstract
Within the field of oral and maxillofacial (OMF) surgery, eHealth is expected to be a tool to improve quality of care. The aim of this study is to map the research of patient-centred eHealth interventions within OMF surgery by means of a scoping review. After a systematic literature search, relevant studies on patient-centred eHealth interventions for OMF-surgery patients were selected. The interventions were mapped based on their key components, target population and outcome measures. To gain insight in the research phase of evaluation, the framework of the Medical Research Council (MRC) was used. Forty-one papers were included, comprising 34 unique interventions. Nineteen interventions were designed for head and neck cancer patients, 11 interventions concernd video-teleconsultation. According to the MRC framework, 26 papers fitted into the feasibility and piloting phase of research, 8 into the evaluation phase, 7 were in the development phase. No implementation studies were found. This scoping review can be a starting point for those who are interested in applying and evaluating eHealth in their practice. Since many feasibility and pilot studies were found on similar interventions, a more extensive collaboration with and connecting to each other is recommended to catalyze the implementation of eHealth in daily practice. Profound involvement of patients in developing and evaluating eHealth interventions is essential to achieve true patient-centred OMF surgery.
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18
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Pateman KA, Cockburn NL, Batstone MD, Ford PJ. Quality of life of head and neck cancer patients in urban and regional areas: An Australian perspective. Aust J Rural Health 2018; 26:157-164. [PMID: 29913059 DOI: 10.1111/ajr.12340] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Head and neck cancer treatment affects quality of life. There are differences in quality of life outcomes and perceived supportive care needs between cancer patients living in metropolitan and regional-remote areas. This study investigated quality of life over the first 6 months following head and neck cancer diagnosis and observed differences in quality of life by geographical location. DESIGN Prospective observational study. SETTING Tertiary hospital in Brisbane, Australia. PARTICIPANTS Newly diagnosed patients who were referred for the diagnosis, and/or treatment of head and neck cancer. MAIN OUTCOME MEASURE(S) Quality of life was measured by the University of Washington Quality of Life Survey, version 4 (UW-QoL). Participants completed the UW-QoL questionnaire prior to starting treatment, 1 month and 6 months post treatment. Metropolitan and regional or remote status was classified according to the Australian Standard Geographic Classification-Remoteness Area system. RESULTS Ninety-five participants were included at baseline; 49 and 41 participants completed the 1-month and 6-month follow-ups, respectively. Scores in most UW-QoL domains decreased between baseline and 1 month post treatment and increased towards pre-treatment scores at the 6-month follow-up (except for anxiety and saliva). Pain at baseline was significantly worse in the regional-remote participants compared with metropolitan participants. No other statistically significant differences in UW-QoL score by geographical location were observed. CONCLUSION The findings generally did not support significant differences in quality of life outcome between metropolitan and regional-remote head and neck cancer patients. The difference in pain experience between metropolitan and regional-remote groups requires further investigation.
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Affiliation(s)
- Kelsey A Pateman
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Nicole L Cockburn
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Martin D Batstone
- Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Pauline J Ford
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
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19
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Whetten J, Montoya J, Yonas H. ACCESS to Better Health and Clear Skies: Telemedicine and Greenhouse Gas Reduction. Telemed J E Health 2018; 25:960-965. [PMID: 30359184 DOI: 10.1089/tmj.2018.0172] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: This study estimates the reduction in greenhouse gas (GHG) emissions resulting from 2,020 neuro-emergent telemedicine consultations. We then estimate potential GHG reduction if the program was expanded nationwide. Materials and Methods: Travel distances in miles were calculated for each avoided patient transfer using hospital location data and ArcGIS® tools. Potential GHG reductions from program expansion were calculated based on state and national stroke Diagnosis-Related Groups (DRGs). Along with average flight distance from a rural hospital to closest level one trauma center. Results: Participation in the Access to Critical Cerebral Emergent Support Services (ACCESS) from May 2015 to July 2017 resulted in 2,020 consultations. Of these consultations, there was a 70% (1,414) reduction in patient transfers. Emission reduction totaled 618,772 kg of carbon dioxide equivalents (CO2e) (618.77 metric tons) or 0.306 metric tons of CO2e per patient. Expanding the program across New Mexico and similar U.S. areas resulted in potential reductions of 4,307 (IQR 3,386-5,274) and 213,279 (IQR 169,320-263,570) metric tons of CO2e. Conclusion: Transport accounts for 26% of global CO2 emissions and is one of the few industrial sectors where emissions are still growing. What makes this study more impactful is that aviation's emissions are not part of the Kyoto Protocol and little is being done in this sector. GHG reduction was not the main intention of the ACCESS program, but it has shown to be a significant by-product.
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Affiliation(s)
- Justin Whetten
- Department of Economics, University of New Mexico, Albuquerque, New Mexico
| | - Julianna Montoya
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico
| | - Howard Yonas
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico
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20
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Mayadevi M, Thankappan K, Limbachiya SV, Vidhyadharan S, Villegas B, Ouyoung M, Balasubramanian D, Menon JR, Sinha U, Iyer S. Interdisciplinary Telemedicine in the Management of Dysphagia in Head and Neck. Dysphagia 2018; 33:474-480. [PMID: 29404691 DOI: 10.1007/s00455-018-9876-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 01/23/2018] [Indexed: 11/29/2022]
Abstract
The study considered the feasibility and impact of interdisciplinary telemedicine discussions in the management of post-treatment dysphagia in patients with head and neck tumors. This is a retrospective analysis of patients with persistent dysphagia after treatment for head and neck pathology, at an institute in India. The cases were discussed in the telemedicine meeting conducted between host institute and a second unit in the United States. A monthly meeting was organized, using an internet-based video conference system. The ongoing swallowing problems and management were presented, and through discussions, a plan for further management was formulated and carried out. The Functional Oral Intake Scale (FOIS) was measured before and after the implementation of the plan. Twenty-six patients were discussed, out of which, 22 were head and neck malignancies. The recommendations concurred with that of the host unit in 18, differed for three and additive in five patients. The pre-treatment mean FOIS was 1.46 with a standard deviation of 0.989 and post-treatment mean improved to 3.92 with a standard deviation of 1.809 (p < 0.0001). The present study supports the success of an interdisciplinary telemedicine meeting to manage difficult cases of dysphagia in head and neck. The outcome in terms of the FOIS score improved significantly after implementing them. In addition to the direct patient benefits, the meeting helped to facilitate interdepartmental collaboration between two units treating similar sets of patients across the globe, in specialized clinical areas like dysphagia management.
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Affiliation(s)
- Mydhili Mayadevi
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, AIMS Ponekkara PO, Kochi, Kerala, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, AIMS Ponekkara PO, Kochi, Kerala, India.
| | - Shashikant Vishnubhai Limbachiya
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, AIMS Ponekkara PO, Kochi, Kerala, India
| | - Sivakumar Vidhyadharan
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, AIMS Ponekkara PO, Kochi, Kerala, India
| | - Brenda Villegas
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck Medicine of USC, University of Southern California, Los Angeles, USA
| | - Melody Ouyoung
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck Medicine of USC, University of Southern California, Los Angeles, USA
| | - Deepak Balasubramanian
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, AIMS Ponekkara PO, Kochi, Kerala, India
| | - Jayakumar R Menon
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, AIMS Ponekkara PO, Kochi, Kerala, India
| | - Uttam Sinha
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck Medicine of USC, University of Southern California, Los Angeles, USA
| | - Subramania Iyer
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, AIMS Ponekkara PO, Kochi, Kerala, India
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21
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Burns CL, Kularatna S, Ward EC, Hill AJ, Byrnes J, Kenny LM. Cost analysis of a speech pathology synchronous telepractice service for patients with head and neck cancer. Head Neck 2017; 39:2470-2480. [DOI: 10.1002/hed.24916] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/24/2017] [Accepted: 07/13/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Clare L. Burns
- Speech Pathology and Audiology Department; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- The University of Queensland; School of Health and Rehabilitation Sciences; Brisbane Queensland Australia
- Centre for Research Excellence in Telehealth; The University of Queensland; Brisbane Queensland Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation; Queensland University of Technology; Brisbane Queensland Australia
| | - Elizabeth C. Ward
- The University of Queensland; School of Health and Rehabilitation Sciences; Brisbane Queensland Australia
- Centre for Research Excellence in Telehealth; The University of Queensland; Brisbane Queensland Australia
- Centre for Functioning and Health Research, Metro South; Brisbane Queensland Australia
| | - Anne J. Hill
- The University of Queensland; School of Health and Rehabilitation Sciences; Brisbane Queensland Australia
- Centre for Research Excellence in Telehealth; The University of Queensland; Brisbane Queensland Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics; Menzies Health Institute Queensland, Griffith University; Brisbane Australia
| | - Lizbeth M. Kenny
- Central Integrated Regional Cancer Services; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
- Cancer Care Services; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
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22
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Bossi P, Alfieri S. The Benefit of a Multidisciplinary Approach to the Patient Treated with (Chemo) Radiation for Head and Neck Cancer. Curr Treat Options Oncol 2017; 17:53. [PMID: 27520784 DOI: 10.1007/s11864-016-0431-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OPINION STATEMENT In the past two decades, multidisciplinary care has emerged as new way to manage cancer given the need to gather together specific areas of expertise and to discuss the variety of treatment approaches available for each patient. Of all the cancer subtypes, head and neck cancer might be considered one of the most valid areas, from an oncological point of view, for a multidisciplinary approach to be applied. Head and Neck Cancer is a complex disease area due to its varied histology and subsites, its numerous feasible treatments, its multiple typical comorbidities, and its treatment-induced toxicities whose management requires the simultaneous involvement of several professionals as part of the same health care team. However, the benefits of a multidisciplinary team approach in this particular area have not yet been properly documented in terms of survival outcomes. Moreover, there are some concerns and the limitations of a multidisciplinary team approach for Head and Neck Cancer patients are still open to question: cost-efficiency, the implications from a medical law perspective, the level of expertise required and the timing of each intervention (fixed or as required; before, during or after oncological treatment), and the role of the leader with other interested specialists to optimize all multidisciplinary care mechanisms.
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Affiliation(s)
- Paolo Bossi
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milano, Italy.
| | - Salvatore Alfieri
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milano, Italy
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23
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Burns CL, Ward EC, Hill AJ, Kularatna S, Byrnes J, Kenny LM. Randomized controlled trial of a multisite speech pathology telepractice service providing swallowing and communication intervention to patients with head and neck cancer: Evaluation of service outcomes. Head Neck 2017; 39:932-939. [PMID: 28225567 DOI: 10.1002/hed.24706] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/04/2016] [Accepted: 12/09/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The purpose of this study was to present our evaluation of a new speech pathology telepractice service supporting the swallowing and communication management of patients with head and neck cancer. METHODS A multicenter randomized controlled trial was conducted within a large public cancer service. Referrals from speech pathologists at 3 regional sites (spoke sites) were managed by a specialist clinician from a cancer center (hub site) either via standard care (phone/email support/appointments at the hub site) or a newly established telepractice service (online consultation between the hub site and spoke site). RESULTS Eighty-two referrals (39 for standard care and 43 for telepractice care) were managed. Service efficiency favoring the telepractice model was reported with a significant reduction in the number (p = .004) and duration (p = .024) of contact events required to manage the referrals. Higher consumer and clinician satisfaction was also reported for the telepractice service. CONCLUSION A speech pathology telepractice service benefits both the patient and health provider through higher service efficiency and treatment satisfaction. © 2017 Wiley Periodicals, Inc. Head Neck 39: 932-939, 2017.
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Affiliation(s)
- Clare L Burns
- Speech Pathology and Audiology Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Centre for Research Excellence in Telehealth, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth C Ward
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Centre for Research Excellence in Telehealth, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Functioning and Health Research, Metro South, Brisbane, Queensland, Australia
| | - Anne J Hill
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Centre for Research Excellence in Telehealth, The University of Queensland, Brisbane, Queensland, Australia
| | - Sanjeewa Kularatna
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Lizbeth M Kenny
- Central Integrated Regional Cancer Services, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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24
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Malandraki GA, Kantarcigil C. Telehealth for Dysphagia Rehabilitation: The Present and the Future. ACTA ACUST UNITED AC 2017. [DOI: 10.1044/persp2.sig18.42] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Dysphagia affects about nine million adults and half a million children annually in the United States alone, and its prevalence is only projected to increase as the baby boomer generation grows older. For many individuals who live in rural or underserved areas, accessing a speech-language pathologist (SLP) with expertise in dysphagia can be challenging. Telehealth appears to be a viable solution to address the needs of individuals living in these areas, and for patients and clinicians with mobility/access limitations. This article provides an overview of the current research evidence in dysphagia telehealth and identifies research and clinical practice gaps as well as potential solutions. Our aim is to provide foundational knowledge for dysphagia clinicians who are interested in entering the telehealth arena.
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Affiliation(s)
- Georgia A. Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University West Lafayette, IN
| | - Cagla Kantarcigil
- Department of Speech, Language, and Hearing Sciences, Purdue University West Lafayette, IN
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25
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Beswick DM, Vashi A, Song Y, Pham R, Holsinger FC, Rayl JD, Walker B, Chardos J, Yuan A, Benadam-Lenrow E, Davis D, Sung CK, Divi V, Sirjani DB. Consultation via telemedicine and access to operative care for patients with head and neck cancer in a Veterans Health Administration population. Head Neck 2016; 38:925-9. [PMID: 26899939 DOI: 10.1002/hed.24386] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/26/2015] [Accepted: 12/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate a telemedicine model that utilizes an audiovisual teleconference as a preoperative visit. METHODS Veterans Health Administration (VHA) patients with head and neck cancer at 2 remote locations were provided access to the Palo Alto Veterans Affairs (PAVA) Health Care System otolaryngology department via the telemedicine protocol: tissue diagnosis and imaging at the patient site; data review at PAVA; and a preoperative teleconference connecting the patient to PAVA. Operative care occurred at PAVA. Follow-up care was provided remotely via teleconference. RESULTS Fifteen patients were evaluated. Eleven underwent surgery, 4 with high-grade neoplasms (carcinoma). Average time from referral to operation was 28 days (range, 17-36 days) and 72 (range, 31-108 days), respectively, for high-grade and low-grade groups. The average patient was spared 28 hours traveling time and $900/patient was saved on travel-related costs. CONCLUSION A telemedicine model enables timely access to surgical care and permits considerable savings among select VHA patients with head and neck cancer. © 2016 Wiley Periodicals, Inc. Head Neck 38: 925-929, 2016.
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Affiliation(s)
- Daniel M Beswick
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Anita Vashi
- Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Yohan Song
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Rosemary Pham
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - F Chris Holsinger
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - James D Rayl
- Department of Otolaryngology - Head and Neck Surgery, New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico
| | - Beth Walker
- Ambulatory Care Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - John Chardos
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Annie Yuan
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Ella Benadam-Lenrow
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Dolores Davis
- Department of Surgery, Central California Veterans Affairs Health Care System, Fresno, California
| | - C Kwang Sung
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Vasu Divi
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Davud B Sirjani
- Department of Otolaryngology - Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Wissinger E, Griebsch I, Lungershausen J, Foster T, Pashos CL. The economic burden of head and neck cancer: a systematic literature review. PHARMACOECONOMICS 2014; 32:865-82. [PMID: 24842794 PMCID: PMC4153967 DOI: 10.1007/s40273-014-0169-3] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND This systematic literature review aimed to evaluate and summarize the existing evidence on resource use and costs associated with the diagnosis and treatment of head and neck cancer (HNC) in adult patients, to better understand the currently available data. The costs associated with HNC are complex, as the disease involves multiple sites, and treatment may require a multidisciplinary medical team and different treatment modalities. METHODS Databases (MEDLINE and Embase) were searched to identify studies published in English between October 2003 and October 2013 analyzing the economics of HNC in adult patients. Additional relevant publications were identified through manual searches of abstracts from recent conference proceedings. RESULTS Of 606 studies initially identified, 77 met the inclusion criteria and were evaluated in the assessment. Most included studies were conducted in the USA. The vast majority of studies assessed direct costs of HNC, such as those associated with diagnosis and screening, radiotherapy, chemotherapy, surgery, side effects of treatment, and follow-up care. The costs of treatment far exceeded those for other aspects of care. There was considerable heterogeneity in the reporting of economic outcomes in the included studies; truly comparable cost data were sparse in the literature. Based on these limited data, in the US costs associated with systemic therapy were greater than costs for surgery or radiotherapy. However, this trend was not seen in Europe, where surgery incurred a higher cost than radiotherapy with or without chemotherapy. CONCLUSIONS Most studies investigating the direct healthcare costs of HNC have utilized US databases of claims to public and private payers. Data from these studies suggested that costs generally are higher for HNC patients with recurrent and/or metastatic disease, for patients undergoing surgery, and for those patients insured by private payers. Further work is needed, particularly in Europe and other regions outside the USA; prospective studies assessing the cost associated with HNC would allow for more systematic comparison of costs, and would provide valuable economic information to payers, providers, and patients.
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Affiliation(s)
| | | | | | | | - Chris L. Pashos
- UBC: An Express Scripts Company, 430 Bedford Street, Suite 100, Lexington, MA 02420 USA
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Gollnick I, Frehiwot M, Krause EM, Schaller S, Limpert E, Strauß G, Lipp T, Scherz M, Injac Z. [Interdisciplinary teleconsultation: first practical experiences with 100 patients]. HNO 2014; 61:495-503. [PMID: 23619814 DOI: 10.1007/s00106-012-2668-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED PROBLEM DEFINITION: Increasing specialization can be observed in the various medical fields and as a consequence there is little professional exchange between ear nose and throat (ENT) specialists and general practitioners. At the same time there has been significant technological development in telemedicine over the last 5 years; however, this potential is not being sufficiently exploited. The objective of this project is to implement a practicable solution for teleconsulation between ENT specialists and general practitioners. MATERIALS AND METHODS The connection is based on a secure broadband internet connection, the corresponding server structure and a video endoscopic system. In the period from 01 January 2011 to 30 June 2012 (18 months) a total of 102 patients were included in the study in which 4 general practitioners and 5 ENT specialists participated. The protocol comprised the following parameters: indications and typical questions, number of patients presenting to the ENT specialist due to the available teleconsultation service (CBO), number of patients referred to the ENT specialist after teleconsultation (CIO), assessment of the quality of the additional expert opinion (LOQ GP), assessment of the accuracy of the specialist physician tele-diagnosis (TDS-FA) and assessment of the impact of the expert physician diagnosis on the general medical treatment (COS). RESULTS Teleconsultation was most frequently used for diagnostics on tonsils (37% of the presented cases), the external auditory canal (32%) and the inner nose (15%). Of the patients analyzed were 53.9% presented to the ENT specialist only because the teleconsultation service provided an effortless opportunity and after teleconsultation 40.1% of the patients were referred to the ENT specialist. General practitioners assessed the benefit from the specialist opinion with 64 points. Diagnostic certainty of the specialist opinion, i.e. the validity scale of the diagnosis made, was on average 2.0. In approximately 35.3% of the cases (36 out of 102 patients) participating general practitioners documented a considerable impact of teleconsultation on the diagnosis and/or therapy. CONCLUSIONS Teleconsultation between general practitioners and ENT specialists can provide an advantage in treatment quality and patient comfort. According to the experience gained there is a very low risk of diminishing the professional competency of ENT medicine and the involvement of the expert group in the early project stage allows a greater leeway in project implementation. This could also have an impact on future medical performance specifications. According to the ENT experts involved in the project further applications of teleconsultation are very conceivable.
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Affiliation(s)
- I Gollnick
- International Reference and Development Centre for Surgical Technology (IRDC) Leipzig, Käthe-Kollwitz-Str. 64, 04109, Leipzig, Deutschland.
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Oliveira TC, Barlow J, Gonçalves L, Bayer S. Teleconsultations reduce greenhouse gas emissions. J Health Serv Res Policy 2013; 18:209-14. [PMID: 23945677 DOI: 10.1177/1355819613492717] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Health services contribute significantly to greenhouse gas emissions. New models of delivering care closer to patients have the potential to reduce travelling and associated emissions. We aimed to compare the emissions of patients attending a teleconsultation - an outpatient appointment using video-conferencing equipment - with those of patients attending a face-to-face appointment. METHODS We estimated the total distances travelled and the direct and indirect greenhouse gas emissions for 20,824 teleconsultations performed between 2004 and 2011 in Alentejo, a Portuguese region. These were compared to the distances and emissions that would have resulted if teleconsultations were not available and patients had to attend face-to-face outpatient appointments. Estimates were calculated using survey data on mode of transport, and national aggregate data for car engine size and fuel. A sensitivity analysis using the lower and upper quartiles for survey distances was performed. RESULTS Teleconsultations led to reductions in distances and emissions of 95%. 2,313,819 km of travelling and 455 tonnes of greenhouse gas emissions were avoided (22 kg of carbon dioxide equivalent per patient). The incorporation of modes of transport and car engine size and fuel in the analysis led to emission estimates which were 12% smaller than those assuming all patients used an average car. CONCLUSIONS The availability of remote care services can significantly reduce road travel and associated emissions. At a time when many countries are committed to reducing their carbon footprint, it is desirable to explore how these reductions could be incorporated into technology assessments and economic evaluations.
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Krupinski EA, Patterson T, Norman CD, Roth Y, ElNasser Z, Abdeen Z, Noyek A, Sriharan A, Ignatieff A, Black S, Freedman M. Successful Models for Telehealth. Otolaryngol Clin North Am 2011; 44:1275-88, vii-viii. [DOI: 10.1016/j.otc.2011.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Head BA, Keeney C, Studts JL, Khayat M, Bumpous J, Pfeifer M. Feasibility and Acceptance of a Telehealth Intervention to Promote Symptom Management during Treatment for Head and Neck Cancer. ACTA ACUST UNITED AC 2011; 9:e1-e11. [PMID: 21499540 DOI: 10.1016/j.suponc.2010.12.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Patients undergoing treatment for head and neck cancers have a myriad of distressing symptoms and treatment side effects which significantly alter communication and lower quality of life. Telehealth technology has demonstrated promise in improving patient-provider communication by delivering supportive educational content and guidance to patients in their homes. A telehealth intervention using a simple telemessaging device was developed to provide daily education, guidance, and encouragement for patients undergoing initial treatment of head and neck cancer. The goal of this article is to report the feasibility and acceptance of the intervention using both quantitative and qualitative measures. No eligible patients declined participation based on technology issues. Participants completed the intervention over 86% of the expected days of use. Direct nursing contact was seldom needed during the study period. Satisfaction with the technology and the intervention was very high. In this study a telehealth intervention was shown to be feasible, well accepted, and regularly used by patients experiencing extreme symptom burden and declining quality of life as a result of aggressive treatment for head and neck cancer.
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Affiliation(s)
- Barbara A Head
- Univeristy of Louisville School of Medicine Louisville, Kentucky
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Audebert HJ, Meyer T, Klostermann F. Potentials of telemedicine for green health care. Front Neurol 2010; 1:10. [PMID: 21188251 PMCID: PMC3008912 DOI: 10.3389/fneur.2010.00010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 05/21/2010] [Indexed: 12/01/2022] Open
Abstract
Neurological facilities are traditionally centered in academic hospitals and often far away from the patients’ living area. Both, the transfer of patients to remote hospitals and inpatient treatment are associated with high energy consumption. Numbers of patients with neurological diseases are expected to increase along with the demographical changes and the environmental impact of neurological treatment should become a target for health policy, therefore. Positive effects have been demonstrated for the use of telemedicine by improving inpatient treatment in local community hospitals or avoiding hospital admissions via monitoring of complex diseases in outpatient settings. We discuss the potentials of telemedicine in the field of in- and outpatient neurological care as well as the need for more scientific evaluation on environmental impacts.
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Affiliation(s)
- Heinrich J Audebert
- Center for Stroke Research, Charité Universitätsmedizin Berlin Berlin, Germany
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Masino C, Rubinstein E, Lem L, Purdy B, Rossos PG. The Impact of Telemedicine on Greenhouse Gas Emissions at an Academic Health Science Center in Canada. Telemed J E Health 2010; 16:973-6. [DOI: 10.1089/tmj.2010.0057] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Caterina Masino
- Telehealth Program, Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
| | - Ed Rubinstein
- Department of Energy and Environment, University Health Network, Toronto, Ontario, Canada
| | - Leon Lem
- Telehealth Program, Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
| | - Brendan Purdy
- Telehealth Program, Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
| | - Peter G. Rossos
- Telehealth Program, Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2010; 18:134-45. [PMID: 20234215 DOI: 10.1097/moo.0b013e3283383ef9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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van der Pol M, McKenzie L. Costs and benefits of tele-endoscopy clinics in a remote location. J Telemed Telecare 2010; 16:89-94. [PMID: 20139140 DOI: 10.1258/jtt.2009.090609] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We assessed the cost and benefits of tele-endoscopy clinics in a remote location in Scotland. Before the introduction of a tele-endoscopy service, patients whose symptoms suggested possible cancer of the airways had to travel to the mainland (to Aberdeen) to receive an endoscopy. The costs of staff, capital, disposables and travel were estimated for the tele-endoscopy clinic and for the conventional, mainland clinic. The benefits of the two types of clinic were estimated from a sample of the general public using a survey method called the discrete choice experiment. The average cost per patient was lower for the tele-endoscopy clinic (pounds sterling 353) than for the mainland clinic (pounds sterling 381). This was true if more than 27 patients were seen per year. Assuming equal waiting times, individuals preferred the tele-endoscopy clinic to the mainland clinic. The net benefits were larger for tele-endoscopy clinics as long as the additional waiting time was not longer than four weeks. Tele-endoscopy clinics in Shetland are an efficient alternative to conventional practice. The results are sensitive to both economies of scale and scope. The model can readily be applied to mainland communities outside the main population centres in Scotland.
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Wootton R, Tait A, Croft A. Environmental aspects of health care in the Grampian NHS region and the place of telehealth. J Telemed Telecare 2010; 16:215-20. [PMID: 20511579 PMCID: PMC3104823 DOI: 10.1258/jtt.2010.004015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Detailed information about the composition of the carbon footprint of the NHS in the Grampian health region, and in Scotland generally, is not available at present. Based on the limited information available, our best guess is that travel emissions in Grampian are substantial, perhaps 49,000 tonnes CO(2) per year. This is equivalent to 233 million km of car travel per year. A well-established telemedicine network in the Grampian region, which saves over 2000 patient journeys a year from community hospitals, avoids about 260,000 km travel per year, or about 59 tonnes CO(2) per year. Therefore using telehealth as it has been used historically (primarily to facilitate hospital-to-hospital interactions) seems unlikely to have a major environmental impact--although of course there may be other good reasons for persevering with conventional telehealth. On the other hand, telehealth might be useful in reducing staff travel and to a lesser extent, visitor travel. It looks particularly promising for reducing outpatient travel, where substantial carbon savings might be made by reconfiguring the way that certain services are provided.
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