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Nyoni T, Evers EC, Pérez M, Jeffe DB, Fritz SA, Colditz GA, Burnham JP. Perceived barriers and facilitators to the adoption of telemedicine infectious diseases consultations in southeastern Missouri hospitals. J Telemed Telecare 2024; 30:1462-1474. [PMID: 36659820 PMCID: PMC10354216 DOI: 10.1177/1357633x221149461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Telemedicine infectious diseases consultations (tele-ID consults) improves access to healthcare for underserved/resource-limited communities. However, factors promoting or hindering implementation of tele-ID consults in low-resource settings are understudied. This study sought to fill this gap by describing perceived barriers and facilitators tele-ID consults at three rural hospitals in southeastern Missouri. METHODS Twelve in-depth, semi-structured interviews were conducted with a purposively sampled group of information-rich hospital stakeholders from three rural, southeastern Missouri hospitals with partial or no on-site availability of ID physicians. Our literature-informed interview guide elicited participants' knowledge and experience with tele-ID consults, perceptions on ID consultation needs, and perceived barriers to and facilitators of tele-ID consults. Interview transcripts were coded using an iterative process of inductive analysis to identify core themes related to barriers and facilitators. RESULTS Perceived barriers to adopting and implementing tele-ID consults included logistical challenges, technology and devices, negative emotional responses, patient-related factors, concerns about reduced quality of care when using telemedicine, lack of acceptance or buy-in from physicians or staff, and legal concerns. Key facilitators included perceived need, perceived benefits to patients and physicians, flexibility and openness to change among staff members and patients, telemedicine champions, prior experiences, and enthusiasm. DISCUSSION Our findings demonstrate that rural hospitals need tele-ID consults and have the capacity to implement tele-ID consults, but operational and technical feasibility challenges remain. Adoption and implementation of tele-ID consults may reduce ID-physician shortage-related service gaps by permitting ID physician's greater geographic reach.
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Affiliation(s)
- Thabani Nyoni
- Brown School, Washington University in Saint Louis, St. Louis, Missouri, USA
| | - Emily C. Evers
- Brown School, Washington University in Saint Louis, St. Louis, Missouri, USA
| | - Maria Pérez
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Donna B. Jeffe
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephanie A. Fritz
- Department of Pediatrics, Washington University in St. Louis, Missouri, USA
| | - Graham A. Colditz
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jason P. Burnham
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
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2
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Farooq HZ, Whitton L, Mwendera C, Divall P, Spitters SJIM, Anderson J, Thornhill JP. Virtual care pathways for people living with HIV: A mixed-methods systematic review. HIV Med 2024. [PMID: 39289147 DOI: 10.1111/hiv.13701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 08/09/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND The COVID-19 pandemic prompted an unprecedented surge in virtual services, necessitating a rapid shift to digital healthcare approaches. This review focuses on evaluating the evidence of virtual care (VC) in delivering HIV care, considering the complex nature of HIV and the need for tailored-approaches, especially for marginalized populations. METHODS A mixed-methods systematic review was performed with searches on five databases, covering studies from January 1946 to May 2022. Inclusion criteria involved two-way virtual consultations between healthcare workers and people living with HIV (PLHIV), with detailed descriptions and outcomes. Qualitative and quantitative studies were included, and the risk of bias was assessed using the Newcastle-Ottawa score and Stenfors' framework. RESULTS Among 4143 identified records, 26 studies met the criteria, with various models of care described. The majority of studies were observational, and videoconferencing was the primary mode of virtual consultation employed. Quantitative analysis revealed PLHIV generally accept VC, with high attendance rates (87%). Mean acceptability and satisfaction rates were 80% and 85%, respectively, while 87% achieved HIV viral suppression. The setting and models of VC implementation varied, with some introduced in response to COVID-19 while others were as part of trials. CONCLUSIONS VC for PLHIV is deemed an acceptable and effective approach and is associated with good virological outcomes. Data on other health outcomes is lacking. The review underscores the importance of diverse models of care, patient choice and comprehensive training initiatives for both staff and patients. Establishing a 'gold standard' for VC models is crucial for ensuring appropriate and effective reviews of PLHIV in virtual settings.
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Affiliation(s)
- Hamzah Z Farooq
- SHARE Collaborative, Queen Mary University of London, London, UK
- Blizard Institute, Queen Mary University of London, London, UK
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
- Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, Manchester University Foundation Trust, Manchester, UK
- Department of Virology, UK Health Security Agency Manchester, Manchester, UK
| | - Louise Whitton
- SHARE Collaborative, Queen Mary University of London, London, UK
- Blizard Institute, Queen Mary University of London, London, UK
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
| | - Chikondi Mwendera
- SHARE Collaborative, Queen Mary University of London, London, UK
- Blizard Institute, Queen Mary University of London, London, UK
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
| | - Pip Divall
- University Hospitals of Leicester Library, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sophie J I M Spitters
- SHARE Collaborative, Queen Mary University of London, London, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Jane Anderson
- SHARE Collaborative, Queen Mary University of London, London, UK
- Blizard Institute, Queen Mary University of London, London, UK
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
| | - John P Thornhill
- SHARE Collaborative, Queen Mary University of London, London, UK
- Blizard Institute, Queen Mary University of London, London, UK
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
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Saeed H, Martini ND, Scahill S. Exploring telepharmacy: A bibliometric analysis of past research and future directions. Res Social Adm Pharm 2024; 20:805-819. [PMID: 38714397 DOI: 10.1016/j.sapharm.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/30/2024] [Accepted: 04/29/2024] [Indexed: 05/09/2024]
Abstract
This bibliometric review analyzes the evolution of telepharmacy research, significantly amplified by the COVID-19 pandemic. By employing bibliometric analysis, the study aims to provide a comprehensive overview of the current state and emerging trends in telepharmacy. This approach helps in identifying key areas of growth, predominant themes, and potential gaps in the literature. Utilizing data from 330 papers (1981-2023) sourced from Scopus and analyzed with Bibliometrix™, this study applies both performance analysis and science mapping methods to examine the telepharmacy literature. The findings reveal a consistent growth in telepharmacy research, with an 8.07 % average annual growth rate. Performance analysis highlights key authors, influential works, and leading journals and countries in the field. Document co-citation analysis identifies four developmental phases of telepharmacy: emergence, take-off, expansion, and future trajectory by uncovering the intellectual structure of the field. Co-words analysis elucidates evolving conceptual structures and significant subfields over time. These findings serve to inform practitioners and researchers about the evolving landscape of telepharmacy, guiding future research and practice in this increasingly important field.
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Affiliation(s)
- Hina Saeed
- School of Pharmacy, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Nataly Dominica Martini
- School of Pharmacy, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Shane Scahill
- School of Pharmacy, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
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4
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Cox AL, Tsang D, Spacek LA, Daskalakis C, Coppock D. The Impact of Telemedicine on Human Immunodeficiency Virus (HIV)-Related Clinical Outcomes During the COVID-19 Pandemic. AIDS Behav 2024; 28:2438-2443. [PMID: 38662279 PMCID: PMC11199220 DOI: 10.1007/s10461-024-04342-x] [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] [Accepted: 04/04/2024] [Indexed: 04/26/2024]
Abstract
The coronavirus disease of 2019 (COVID-19) pandemic exacerbated barriers to care for people living with human immunodeficiency virus (HIV) (PLWH). The quick uptake of telemedicine in the outpatient setting provided promise for care continuity. In this study, we compared appointment and laboratory no-show rates in an urban outpatient HIV clinic during three time periods: (1) Pre-COVID-19: 9/15/2019-3/14/2020 (predominately in-person), (2) "Early" COVID-19: 3/15/2020-9/14/2020 (predominately telemedicine), and (3) "Later" COVID-19: 9/15/2020-3/14/2021 (mixed in-person/telemedicine). Multivariable logistic regression models evaluated the two study hypotheses: (i) equivalence of Period 2 with Period 1 and of Period 3 with Period 1 and (ii) improved outcomes with telemedicine over in-person visits. No-show rates were 1% in Period 1, 4% in Period 2, and 18% in Period 3. Compared to the pre-pandemic period, individuals had a higher rate of appointment no-shows during Period 2 [OR (90% CI): 7.67 (2.68, 21.93)] and 3 [OR (90% CI): 30.91 (12.83 to 75.06). During the total study period, those with telemedicine appointments were less likely to no-show than those with in-person appointments [OR (95% CI): 0.36 (0.16-0.80), p = 0.012]. There was no statistical difference between telemedicine and in-person appointments for laboratory completion rates. Our study failed to prove that no-show rates before and during the pandemic were similar; in fact, no-show rates were higher during both the early and later pandemic. Overall, telemedicine was associated with lower no-show rates compared to in-person appointments. In future pandemics, telemedicine may be a valuable component to maintain care in PLWH.
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Affiliation(s)
- Avery Lin Cox
- Sidney Kimmel Medical College, Department of Medicine, Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, PA, United States of America.
| | - Daniel Tsang
- Sidney Kimmel Medical College, Department of Medicine, Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Lisa A Spacek
- Sidney Kimmel Medical College, Department of Medicine, Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Constantine Daskalakis
- Sidney Kimmel Medical College, Department of Medicine, Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Dagan Coppock
- Sidney Kimmel Medical College, Department of Medicine, Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, PA, United States of America
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5
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Saragih ID, Tonapa SI, Osingada CP, Porta CM, Lee BO. Effects of telehealth-assisted interventions among people living with HIV/AIDS: A systematic review and meta-analysis of randomized controlled studies. J Telemed Telecare 2024; 30:438-450. [PMID: 34967240 DOI: 10.1177/1357633x211070726] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Taking antiretroviral therapy (ART) is a daily necessity for people living with HIV but these individuals experience multiple barriers and challenges to medication adherence. Interventions to support medication adherence have yielded effects in the expected direction, but the extent to which telehealth or virtually delivered interventions to promote adherence are effective among people living with HIV/AIDS remains unknown. We aimed to address this knowledge gap and inform future research and practice that promotes the well-being of people living with HIV/AIDs through telehealth interventions addressing medication use. METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted using the following databases: Academic Search Complete, Cochrane library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PubMed, OVID (UpToDate), and the Web of Science. Relevant full-text articles published through September 2021 were retrieved. The revised Cochrane risk of bias tool for randomized trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth-assisted interventions for people living with HIV/AIDS. Stata 16.0 was used for statistical analysis. RESULTS A total of 12 studies (N = 3557 participants) that used telehealth-assisted interventions for people living with HIV/AIDS were included. Telehealth interventions were found to increase the adherence to treatment (standardized mean difference [SMD]: 0.21; 95% confidence interval (CI): 0.03 to 0.40), to reduce depressive symptoms (SMD: -2,74; 95% CI: -3.39 to -2.09), and to improve perceived quality of life (SMD: 0.74; 95% CI: 0.37 to 1.10). DISCUSSION The meta-effects of telehealth-assisted interventions include significantly enhanced adherence to treatment, improved quality of life, and reduced depressive symptoms among people living with HIV/AIDS. These findings suggesting that delivering health management interventions remotely through telehealth-assisted modalities was both feasible and effective in yielding health benefits for people living with HIV/AIDS. Integrating telehealth-assisted interventions as a modality in HIV/AIDS care might support continuity of care and sustained well-being. Future research should evaluate telehealth intervention outcomes and examine mediating, moderating, or other tailorable variables affecting intervention effectiveness.
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Affiliation(s)
| | - Santo Imanuel Tonapa
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Nursing, Sam Ratulangi University, Manado, Indonesia
| | | | - Carolyn M Porta
- School of Nursing, University of Minnesota, Minneapolis, USA
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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Ratcliffe J, Paer J, Quigee D, Carnevale C, Richards P, Lasota E, Dandan N, Scherer M, Gordon P, Cohall A, Sobieszczyk M, Zucker J. Examining Patient Preferences for Express, Telemedicine, and Standard Visits in a Sexual Health Clinic in New York City. Sex Transm Dis 2024; 51:28-32. [PMID: 37921848 PMCID: PMC10842572 DOI: 10.1097/olq.0000000000001895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
ABSTRACT This study, completed at an sexually transmitted infection (STI) clinic in 2019 to 2020, evaluated patient preferences for telemedicine, express, and standard visits. Active PrEP users preferred telemedicine and express visits, patients with prior STIs preferred express visits, and cisgender women preferred standard visits. Configuring STI clinic visit types requires shared decision making and individualization.
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Affiliation(s)
| | | | | | | | - Paul Richards
- Division of Infectious Diseases, Department of Medicine
| | - Elijah Lasota
- Division of Infectious Diseases, Department of Medicine
| | | | | | - Peter Gordon
- Division of Infectious Diseases, Department of Medicine
| | | | | | - Jason Zucker
- Division of Infectious Diseases, Department of Internal Medicine and Pediatrics, Columbia University Medical Center, New York, NY
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Gil-Candel M, Solana-Altabella A, Vicente-Escrig E, Puplá-Bartoll A, Bodega Azuara J, Pérez-Huertas P, Ferrando Piqueres R. Developing a telepharmacy programme with home medication dispensing and informed delivery in a tertiary hospital: description of the model and analysis of the results. Eur J Hosp Pharm 2023; 30:107-112. [PMID: 35444000 PMCID: PMC9986923 DOI: 10.1136/ejhpharm-2021-003194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/28/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aimed to describe the actions taken to implement a telepharmacy programme with home medication dispensing and informed delivery in an outpatient pharmaceutical care unit of a tertiary hospital, where approximately 5000 patients are treated per year. It also aimed to substantiate the applicability and benefits of the programme through analysing the findings and measuring patient satisfaction. METHODS We identified the operational, logistical, technological and legal needs, as well as the need for training, information and coordination with the care team and patient associations. A standard operating procedure was developed which described the home dispensing model and the profile of patients eligible for telepharmacy. Care activity was evaluated, between the months of July 2020 and January 2021; and a survey was conducted to measure patient satisfaction based on the Enopex project, a cross-sectional observational study of patients who used telepharmacy services during the COVID-19 lockdown period in Spain. RESULTS A total of 2536 medication deliveries were made over 144 working days, with a mean of 18 (standard deviation (SD): 6) deliveries per day, and a total of 2854 dispensings (1.1 drugs per delivery). In total, 197 different types of pharmaceutical formulations were delivered, corresponding to 123 active ingredients. The distance and time avoided during the study period totalled 1 05 624 km and 1 09 452 min (76 days), whereby the median distance and time saved per patient were 66 (interquartile range (IQR):122 km and 90 (IQR:90) minutes, which represents an approximate carbon footprint reduction of 25 kg of CO2 per patient and 16.5 tonnes in total. The satisfaction survey conducted, completed by 134 patients, revealed high satisfaction with the pharmacy service of 9.88 points out of 10. CONCLUSIONS The SARS-CoV-2 pandemic (COVID-19) has provided the pharmacy service with an opportunity to develop and implement a telepharmacy programme that benefits patients, which has enabled better organisation of the unit and greater accessibility for patients attending in person. It is a replicable method that is applicable in other pharmacy services with similar characteristics and requirements.
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Affiliation(s)
- Mayte Gil-Candel
- Pharmacy, Hospital General Universitari de Castelló, Castellón de la Plana, Comunidad Valenciana, Spain
| | - Antonio Solana-Altabella
- Pharmacy, Hospital General Universitari de Castelló, Castellón de la Plana, Comunidad Valenciana, Spain
| | - Esther Vicente-Escrig
- Pharmacy, Hospital General Universitari de Castelló, Castellón de la Plana, Comunidad Valenciana, Spain
| | - Aarón Puplá-Bartoll
- Pharmacy, Hospital General Universitari de Castelló, Castellón de la Plana, Comunidad Valenciana, Spain
| | - Julia Bodega Azuara
- Pharmacy, Hospital General Universitari de Castelló, Castellón de la Plana, Comunidad Valenciana, Spain
| | | | - Raul Ferrando Piqueres
- Pharmacy, Hospital General Universitari de Castelló, Castellón de la Plana, Comunidad Valenciana, Spain
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Quirós-González V, Rubio R, Pulido F, Rial-Crestelo D, Martín-Jurado C, Hernández-Ros MÁ, López-Jiménez EA, Ferrari JM, Caro-Teller JM, Pinar Ó, Pedrera-Jiménez M, García-Barrio N, Serrano P, Bernal JL. Healthcare outcomes in patients with HIV infection at a tertiary hospital during the COVID-19 pandemic. Enferm Infecc Microbiol Clin 2023; 41:149-154. [PMID: 34456409 PMCID: PMC8380489 DOI: 10.1016/j.eimc.2021.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/25/2021] [Indexed: 11/02/2022]
Abstract
Background The COVID-19 pandemic has affected the care of patients with other diseases. Difficulty in access to healthcare during these months has been especially relevant for persons with HIV infection (PWH). This study therefore sought to ascertain the clinical outcomes and effectiveness of the measures implemented among PWH in a region with one of the highest incidence rates in Europe. Methods Retrospective, observational, pre-post intervention study to compare the outcomes of PWH attended at a high-complexity healthcare hospital from March to October 2020 and during the same months across the period 2016-2019. The intervention consisted of home drug deliveries and preferential use of non face-to-face consultations. The effectiveness of the measures implemented was determined by reference to the number of emergency visits, hospitalisations, mortality rate, and percentage of PWH with viral load >50 copies, before and after the two pandemic waves. Results A total of 2760 PWH were attended from January 2016 to October 2020. During the pandemic, there was a monthly mean of 106.87 telephone consultations and 2075 home deliveries of medical drugs dispensed to ambulatory patients. No statistically significant differences were found between the rate of admission of patients with COVID-HIV co-infection and that of the remaining patients (1172.76 admissions/100,000 population vs. 1424.29, p = 0.401) or in mortality (11.54% vs. 12.96%, p = 0.939). The percentage of PWH with viral load >50 copies was similar before and after the pandemic (1.20% pre-pandemic vs. 0.51% in 2020, p = 0.078). Conclusion Our results show that the strategies implemented during the first 8 months of the pandemic prevented any deterioration in the control and follow-up parameters routinely used on PWH. Furthermore, they contribute to the debate about how telemedicine and telepharmacy can fit into future healthcare models.
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Affiliation(s)
| | - Rafael Rubio
- Unidad de Infección VIH, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Federico Pulido
- Unidad de Infección VIH, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - David Rial-Crestelo
- Unidad de Infección VIH, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carlos Martín-Jurado
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - María Ángeles Hernández-Ros
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Óscar Pinar
- Servicio de Farmacia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Pablo Serrano
- Dirección de Planificación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José Luis Bernal
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
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Quirós-González V, Rubio R, Pulido F, Rial-Crestelo D, Martín-Jurado C, Hernández-Ros MÁ, López-Jiménez EA, Ferrari JM, Caro-Teller JM, Pinar Ó, Pedrera-Jiménez M, García-Barrio N, Serrano P, Bernal JL. Healthcare outcomes in patients with HIV infection at a tertiary hospital during the COVID-19 pandemic. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:149-154. [PMID: 36870732 PMCID: PMC9977934 DOI: 10.1016/j.eimce.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/25/2021] [Indexed: 03/05/2023]
Abstract
BACKGROUND The COVID-19 pandemic has affected the care of patients with other diseases. Difficulty in access to healthcare during these months has been especially relevant for persons with HIV infection (PWH). This study therefore sought to ascertain the clinical outcomes and effectiveness of the measures implemented among PWH in a region with one of the highest incidence rates in Europe. METHODS Retrospective, observational, pre-post intervention study to compare the outcomes of PWH attended at a high-complexity healthcare hospital from March to October 2020 and during the same months across the period 2016-2019. The intervention consisted of home drug deliveries and preferential use of non face-to-face consultations. The effectiveness of the measures implemented was determined by reference to the number of emergency visits, hospitalisations, mortality rate, and percentage of PWH with viral load >50copies, before and after the two pandemic waves. RESULTS A total of 2760 PWH were attended from January 2016 to October 2020. During the pandemic, there was a monthly mean of 106.87 telephone consultations and 2075 home deliveries of medical drugs dispensed to ambulatory patients. No statistically significant differences were found between the rate of admission of patients with COVID-HIV co-infection and that of the remaining patients (1172.76 admissions/100,000 population vs. 1424.29, p=0.401) or in mortality (11.54% vs. 12.96%, p=0.939). The percentage of PWH with viral load >50copies was similar before and after the pandemic (1.20% pre-pandemic vs. 0.51% in 2020, p=0.078). CONCLUSION Our results show that the strategies implemented during the first 8 months of the pandemic prevented any deterioration in the control and follow-up parameters routinely used on PWH. Furthermore, they contribute to the debate about how telemedicine and telepharmacy can fit into future healthcare models.
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Affiliation(s)
| | - Rafael Rubio
- Unidad de Infección VIH, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Federico Pulido
- Unidad de Infección VIH, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - David Rial-Crestelo
- Unidad de Infección VIH, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carlos Martín-Jurado
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - María Ángeles Hernández-Ros
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Óscar Pinar
- Servicio de Farmacia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Pablo Serrano
- Dirección de Planificación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José Luis Bernal
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
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Shokri F, Bahrainian S, Tajik F, Rezvani E, Shariati A, nourigheimasi S, Shahrebabaki ES, Ebrahimi M, Shamoon F, Heidary M. The potential role of telemedicine in the infectious disease pandemic with an emphasis on COVID-19: A narrative review. Health Sci Rep 2023; 6:e1024. [PMID: 36620507 PMCID: PMC9811063 DOI: 10.1002/hsr2.1024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 01/05/2023] Open
Abstract
Background and Aims Due of its low cost, rapid speed, data record, and vast communication coverage, information and communication technology might be useful for health-related fields in times of crisis. By providing medical or hygienic services to a patient who lives elsewhere using communication methods like email, fax, cellphones, applications, and wireless gadgets, telemedicine can aid in the better management of diseases. Reviewing the potential role of telemedicine in the pandemic of infectious diseases with a focus on the Coronavirus disease 2019 (COVID-19) epidemic was the main goal of this study. Methods "Google Scholar," "PubMed," "Science Direct," and "Scopus" databases were searched to collect the papers that identify the advantages and disadvantages of telemedicine in the disease pandemic. Searched keywords include: telepharmacy, telemedicine, remote communication, pandemic(s), epidemic, distant care, distant communication, phone consulation, video conference communication and patient education. Results Information and communication technology are crucial, especially when dealing with pandemics of infectious diseases like COVID-19. Less "in-person" patient visits to hospitals as a result of telemedicine eventually means less labor for the medical staff, less viral exposure for patients, and ultimately less disease spread. By establishing a bidirectional reciprocal relationship between patients and healthcare providers although they are in separate geographical areas, it can improve patient health status. Conclusion Governments are currently facing a significant budgetary burden because to the COVID-19 pandemic. Since patients are not sent to medical facilities in person, which could be a source of infection, telemedicine reduces disease spread while saving money.
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Affiliation(s)
- Fazlollah Shokri
- Department of Medical GeneticsFaculty of Medicine, Shahid Beheshti University of Medical SciencesTehranIran
| | - Sara Bahrainian
- Department of Food and Drug ControlSchool of Pharmacy, Ahvaz Jundishapur University of Medical SciencesAhvazIran
| | - Fatemeh Tajik
- Faculty of Medicine, Iran University of Medical SciencesTehranIran
| | - Elaheh Rezvani
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical SciencesIslamic Azad UniversityTehranIran
| | - Aref Shariati
- Molecular and medicine research center, Khomein University of Medical SciencesKhomeinIran
| | | | - Elahe Saberi Shahrebabaki
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung DiseasesShahid Beheshti University of Medical SciencesTehranIran
| | - Maryam Ebrahimi
- Faculty of Pharmacy, Tehran University of Medical SciencesTehranIran
| | - Farhan Shamoon
- Student Research Committee, Sabzevar University of Medical SciencesSabzevarIran
| | - Mohsen Heidary
- Cellular and Molecular Research Center, Sabzevar University of Medical SciencesSabzevarIran
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Osingada CP, McMorris B, Piehler TF, Tracy MF, Porta CM. Acceptability, Feasibility, and Efficacy of Telehealth Interventions for HIV Testing and Treatment in Adult Populations. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Charles Peter Osingada
- Adult and Gerontological Health Cooperative, School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Barbara McMorris
- Population Health and Systems Cooperative, School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Timothy F. Piehler
- Department of Family Social Science, College of Education and Human Development, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mary Fran Tracy
- Adult and Gerontological Health Cooperative, School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Carolyn M. Porta
- Population Health and Systems Cooperative, School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
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12
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Beck EJ, Mandalia S, Yfantopoulos P, Leon A, Merino MJ, Garcia F, Wittevogel M, Apers L, Benkovic I, Zekan S, Begovac J, Cunha AS, Teofilo E, Rodrigues G, Borges MDF, Fatz D, Vera J, Whetham J. Efficiency of the EmERGE Pathway of Care in Five European HIV Centres. PHARMACOECONOMICS 2022; 40:1235-1246. [PMID: 36227463 DOI: 10.1007/s40273-022-01193-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE We aimed to calculate the efficiency of the EmERGE Pathway of Care in five European HIV clinics, developed and implemented for medically stable people living with HIV. METHODS Participants were followed up for 1 year before and after implementation of EmERGE, between April 2016 and October 2019. Micro-costing studies were performed in the outpatient services of the clinics. Unit costs for outpatient services were calculated in national currencies and converted to US$ 2018 OECD purchasing parity prices to enable between clinic comparisons in terms of outcomes and costs. Unit costs were linked to the mean use of services for medically stable people living with HIV, before and after implementation of EmERGE. Primary outcome measures were CD4 count and viral load; secondary outcomes were patient activation (PAM13) and quality of life (PROQOL-HIV). Out-of-pocket expenditure data were collected. RESULTS There were 2251 participants: 87-93% were male, mean age at entry was 41-47 years. Medically stable people living with HIV had outpatient visits in four sites which decreased by 9-31% and costs by 5-33%; visits and costs increased by 8% in one site, which had to revert back to face-to-face visits. Antiretroviral drugs comprised 83-91% of annual costs: the Portuguese site had the highest antiretroviral drug costs in US$ purchasing parity prices. Primary and secondary outcome measures of participants did not change during the study. CONCLUSIONS EmERGE is acceptable and provided cost savings in different socio-economic settings. Antiretroviral drug costs remain the main cost drivers in medically stable people living with HIV. While antiretroviral drug prices in local currencies did not differ that much between countries, conversion to US$ purchasing parity prices revealed antiretroviral drugs were more expensive in the least wealthy countries. This needs to be taken into consideration when countries negotiate drug prices with pharmaceutical vendors. Greater efficiencies can be anticipated by extending the use of the EmERGE Pathway to people with complex HIV infection or other chronic diseases. Extending such use should be systematically monitored, implementation should be evaluated and funding should be provided to monitor and evaluate future changes in service provision.
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Affiliation(s)
- Eduard J Beck
- NPMS-HHC CIC, 21 Bedford Square, London, WC1B 3HH, UK.
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | - Agathe Leon
- Infectious Diseases Department, Hospital Clínic-IDIBAPS (HC-IDIBAPS), University of HC-IDIBAPS, Barcelona, Spain
| | - Marie J Merino
- Infectious Diseases Department, Hospital Clínic-IDIBAPS (HC-IDIBAPS), University of HC-IDIBAPS, Barcelona, Spain
| | - Felipe Garcia
- Infectious Diseases Department, Hospital Clínic-IDIBAPS (HC-IDIBAPS), University of HC-IDIBAPS, Barcelona, Spain
| | | | - Ludwig Apers
- Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - Ivana Benkovic
- University Hospital for Infectious Diseases (UHID), Zagreb, Croatia
| | - Sime Zekan
- University Hospital for Infectious Diseases (UHID), Zagreb, Croatia
| | - Josip Begovac
- University Hospital for Infectious Diseases (UHID), Zagreb, Croatia
| | - Ana S Cunha
- Hospital Capuchos, Centro Hospitalar De Lisboa Central, EPE (HC-CHLC), Lisbon, Portugal
| | - Eugenio Teofilo
- Hospital Capuchos, Centro Hospitalar De Lisboa Central, EPE (HC-CHLC), Lisbon, Portugal
| | - Goncalo Rodrigues
- Hospital Capuchos, Centro Hospitalar De Lisboa Central, EPE (HC-CHLC), Lisbon, Portugal
| | - Margarida D F Borges
- Hospital Capuchos, Centro Hospitalar De Lisboa Central, EPE (HC-CHLC), Lisbon, Portugal
| | - Duncan Fatz
- Brighton and Sussex University Hospitals NHS Trust (BSUHT), Brighton, UK
| | - Jamie Vera
- Brighton and Sussex University Hospitals NHS Trust (BSUHT), Brighton, UK
| | - Jennifer Whetham
- Brighton and Sussex University Hospitals NHS Trust (BSUHT), Brighton, UK
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13
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Amhare AF, Zhao M, Seeley J, Zhang WH, Goyomsa GG, Geleta TA, Zhao R, Zhang L. Impact of COVID-19 on HIV services and anticipated benefits of vaccination in restoring HIV services in Ethiopia: A qualitative assessment. Front Public Health 2022; 10:1033351. [PMID: 36408047 PMCID: PMC9671075 DOI: 10.3389/fpubh.2022.1033351] [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: 08/31/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
Background HIV services were inevitably disrupted and affected due to COVID-19. There are many challenges in implementing appropriate HIV services, particularly in the provision of health care and the link between people living with HIV/AIDS and retention in care. The study investigated the impact of COVID-19 on HIV services and the anticipated benefit of the COVID-19 vaccination on HIV service restoration in North Shewa, Oromia, Ethiopia. Methods A qualitative descriptive study approach was used to explore how healthcare delivery evolved during the outbreak of COVID-19 in Ethiopia. Sixteen antiretroviral therapy (ART) clinics were selected from 13 districts and one administrative town in Ethiopia. From them, 32 ART providers were purposively selected based on their experience in ART provision. Data were collected from June to July 2021 using in-depth interviews. A thematic analysis approach was used to analyze the data, based on themes and subthemes emerging from the data. ATLAS.ti software was used for coding. Results Healthcare for people living with HIV was interrupted due to the COVID-19 pandemic. Medical appointments, HIV testing and counseling services, opportunistic infection treatment, medicine supply, and routine viral load and CD4 T-cell count tests were interrupted. Due to a shortage of healthcare staff, outreach testing services and home index testing were discontinued and HIV testing was limited only to hospitals and health centers. This has substantially affected accessibility to HIV testing and reduced the quality of HIV service delivery. Telehealth and less frequent visits to health facilities were used as alternative ways of delivering HIV services. The COVID-19 vaccination campaign is expected to restore healthcare services. Vaccination may also increase the confidence of healthcare providers by changing their attitudes toward COVID-19. Conclusions The COVID-19 pandemic has substantially impacted HIV services and reduced the quality of HIV care in Ethiopia. Health facilities could not provide routine HIV services as they prioritize the fight against COVID-19, leading to an increase in service discontinuation and poor adherence.
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Affiliation(s)
- Abebe Feyissa Amhare
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China,College of Health Science, Salale University, Fiche, Ethiopia
| | - Min Zhao
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China,Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wei Hong Zhang
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium,School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Rui Zhao
- School of Humanities and Management, Institute of Life Culture, Guangdong Medical University, Dongguan, China,Rui Zhao
| | - Lei Zhang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,*Correspondence: Lei Zhang
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14
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Gupta N, Bariola JR, Mellors JW, Abdel-Massih RC. In-Person vs Tele-Infectious Disease (Tele-ID) Care: Is One Better? Open Forum Infect Dis 2022; 9:ofac410. [PMID: 36046699 PMCID: PMC9423376 DOI: 10.1093/ofid/ofac410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022] Open
Abstract
We compared outcomes at 3 community hospitals before and after switching from in-person to a Tele-ID group from an academic medical center. Compared to in-person, Tele-ID received significantly more consultations with similar outcomes for length of hospital stay, transfers, readmission, and mortality. Tele-ID is a suitable alternative for community settings.
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Affiliation(s)
- Nupur Gupta
- Division of Infectious Diseases, Department of Medicine, UPMC , Pittsburgh, PA , USA
| | - J Ryan Bariola
- Division of Infectious Diseases, Department of Medicine, UPMC , Pittsburgh, PA , USA
| | - John W Mellors
- Division of Infectious Diseases, Department of Medicine, UPMC , Pittsburgh, PA , USA
| | - Rima C Abdel-Massih
- Division of Infectious Diseases, Department of Medicine, UPMC , Pittsburgh, PA , USA
- Infectious Disease Connect, Inc , Pittsburgh, PA , USA
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Cascalheira CJ, Morrison C, D’Angelo AB, Villanueva OG, Grov C. The Impact of the COVID-19 Pandemic on HIV-Positive Men Who Have Sex With Men: (Dis)connection to Social, Sexual, and Health Networks. PSYCHOLOGY & SEXUALITY 2022; 14:306-320. [PMID: 36743519 PMCID: PMC9897219 DOI: 10.1080/19419899.2022.2112745] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/08/2022] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic has disproportionately affected HIV-positive cisgender men who have sex with men (MSM). Between May and June in 2020, we conducted one-on-one semi-structured qualitative interviews with 20 HIV-positive MSM aiming to describe their (dis)connection to social, sexual, and health networks during the COVID-19 pandemic. All participants relied on social support networks to manage pandemic-based distress, using computer-mediated communication as well as physical proximity. To connect to sexual networks, this sample described adaptations to their partner selection strategies, such as enumerating harm reduction approaches. To connect to health networks, participants depended on reassuring providers, resourceful case managers, telehealth, and streamlined access to their antiretroviral therapy (ART) medications. Nonetheless, stay-at-home recommendations reduced community connection, sexual activity, and healthcare access for many participants, and perceptions of these losses were shaped by psychosocial burdens (e.g., loneliness), structural burdens (e.g., environmental barriers, financial difficulties), and health-protective factors (e.g., hopeful outlook, adherence to a regular routine). The COVID-19 pandemic appears to have exacerbated health-related issues for HIV-positive MSM. Given the ongoing COVID-19 mutations, community-based organizations, clinicians, and researchers might use these findings to modify HIV prevention and intervention efforts.
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Affiliation(s)
| | - Corey Morrison
- City University of New York (CUNY) Institute for Implementation Science in Population Health
| | - Alexa B. D’Angelo
- City University of New York (CUNY) Institute for Implementation Science in Population Health
- CUNY Graduate School of Public Health and Health Policy
| | | | - Christian Grov
- City University of New York (CUNY) Institute for Implementation Science in Population Health
- CUNY Graduate School of Public Health and Health Policy
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16
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Burgess R, Feliciano JT, Lizbinski L, Ransome Y. Trends and Characteristics of #HIVPrevention Tweets Posted Between 2014 and 2019: Retrospective Infodemiology Study. JMIR Public Health Surveill 2022; 8:e35937. [PMID: 35969453 PMCID: PMC9412898 DOI: 10.2196/35937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/24/2022] [Accepted: 07/11/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Twitter is becoming an increasingly important avenue for people to seek information about HIV prevention. Tweets about HIV prevention may reflect or influence current norms about the acceptability of different HIV prevention methods. Therefore, it may be useful to empirically investigate trends in the level of attention paid to different HIV prevention topics on Twitter over time. OBJECTIVE The primary objective of this study was to investigate temporal trends in the frequency of tweets about different HIV prevention topics on Twitter between 2014 and 2019. METHODS We used the Twitter application programming interface to obtain English-language tweets employing #HIVPrevention between January 1, 2014, and December 31, 2019 (n=69,197, globally). Using iterative qualitative content analysis on samples of tweets, we developed a keyword list to categorize the tweets into 10 prevention topics (eg, condom use, preexposure prophylaxis [PrEP]) and compared the frequency of tweets mentioning each topic over time. We assessed the overall change in the proportions of #HIVPrevention tweets mentioning each prevention topic in 2019 as compared with 2014 using chi-square and Fisher exact tests. We also conducted descriptive analyses to identify the accounts posting the most original tweets, the accounts retweeted most frequently, the most frequently used word pairings, and the spatial distribution of tweets in the United States compared with the number of state-level HIV cases. RESULTS PrEP (13,895 tweets; 20.08% of all included tweets) and HIV testing (7688, 11.11%) were the most frequently mentioned topics, whereas condom use (2941, 4.25%) and postexposure prophylaxis (PEP; 823, 1.19%) were mentioned relatively less frequently. The proportions of tweets mentioning PrEP (327/2251, 14.53%, in 2014, 5067/12,971, 39.1%, in 2019; P≤.001), HIV testing (208/2251, 9.24%, in 2014, 2193/12,971, 16.91% in 2019; P≤.001), and PEP (25/2251, 1.11%, in 2014, 342/12,971, 2.64%, in 2019; P≤.001) were higher in 2019 compared with 2014, whereas the proportions of tweets mentioning abstinence, condom use, circumcision, harm reduction, and gender inequity were lower in 2019 compared with 2014. The top retweeted accounts were mostly UN-affiliated entities; celebrities and HIV advocates were also represented. Geotagged #HIVPrevention tweets in the United States between 2014 and 2019 (n=514) were positively correlated with the number of state-level HIV cases in 2019 (r=0.81, P≤.01). CONCLUSIONS Twitter may be a useful source for identifying HIV prevention trends. During our evaluation period (2014-2019), the most frequently mentioned prevention topics were PrEP and HIV testing in tweets using #HIVPrevention. Strategic responses to these tweets that provide information about where to get tested or how to obtain PrEP may be potential approaches to reduce HIV incidence.
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Affiliation(s)
- Raquel Burgess
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Josemari T Feliciano
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Leonardo Lizbinski
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
- The Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
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17
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Beck EJ, Mandalia S, Yfantopoulos P, Jones CI, Bremner S, Whetham J, Etcheverry F, Moreno L, Gonzalez E, Merino MJ, Leon A, Garcia F. Efficiency of the EmERGE Pathway to provide continuity of care for Spanish people living with medically stable HIV. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:388-395. [PMID: 35906033 DOI: 10.1016/j.eimce.2020.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/23/2020] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Calculate the efficiency of the EmERGE Pathway of Care for medically stable people living with HIV at the Hospital Clínic-IDIBAPS, Barcelona, Spain. METHODS 546 study participants were followed between 1st July 2016 and 30th October 2019 across three HIV outpatient clinics, but the virtual clinic was closed during the second year. Unit costs were calculated, linked to mean use outpatient services per patient year, one-year before and after the implementation of EmERGE. Costs were combined with primary and secondary outcomes. RESULTS Annual costs across HIV-outpatient services increased by 8%: €1073 (95%CI €999-€1157) to €1158 (95%CI €1084-€1238). Annual cost of ARVs was €7,557; total annual costs increased by 1% from €8430 (95%CI €8356-8514) to €8515 (95%CI €8441-8595). Annual cost for 433 participants managed in face-to-face (F2F) clinics decreased by 5% from €958 (95%CI 905-1018) to €904 (95%CI 863-945); participants transferred from virtual to F2F outpatient clinics (V2F) increased their annual cost by a factor of 2.2, from €115 (95%CI 94-139) to €251 (95%CI 219-290). No substantive changes were observed in primary and secondary outcomes. CONCLUSION EmERGE Pathway is an efficient and acceptable intervention. Increases in costs were caused by internal structural changes. The cost reduction observed in F2F clinics were off-set by the transfer of participants from the virtual to the F2F clinics due to the closure of the virtual clinic during the second year of the Study. Greater efficiencies are likely to be achieved by extending the use of the Pathway to other PLHIV.
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Affiliation(s)
- E J Beck
- NPMS-HHC CIC, London, UK; Department of Health Services Research and Policy, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | - C I Jones
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | - S Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | - J Whetham
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - F Etcheverry
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - L Moreno
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - E Gonzalez
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - M J Merino
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - A Leon
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - F Garcia
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
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18
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Javanbakht M, Rosen A, Ragsdale A, Richter EI, Shoptaw S, Gorbach PM. Interruptions in Mental Health Care, Cannabis Use, Depression, and Anxiety during the COVID-19 Pandemic: Findings from a Cohort of HIV-Positive and HIV-Negative MSM in Los Angeles, California. J Urban Health 2022; 99:305-315. [PMID: 35235134 PMCID: PMC8890012 DOI: 10.1007/s11524-022-00607-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Abstract
The objective was to examine the impact of the COVID-19 pandemic on mental health care, cannabis use, and behaviors that increase the risk of STIs among men living with or at high risk for HIV. Data were from mSTUDY - a cohort of men who have sex with men in Los Angeles, California. Participants who were 18 to 45 years and a half were HIV-positive. mSTUDY started in 2014, and at baseline and semiannual visits, information was collected on substance use, mental health, and sexual behaviors. We analyzed data from 737 study visits from March 2020 through August 2021. Compared to visits prior to the COVID-19 pandemic, there were significant increases in depressive symptomatology (CES-D ≥ 16) and anxiety (GAD-7 ≥ 10). These increases were highest immediately following the start of the pandemic and reverted to pre-pandemic levels within 17 months. Interruptions in mental health care were associated with higher substance use (especially cannabis) for managing anxiety/depression related to the pandemic (50% vs. 31%; p-value < .01). Cannabis use for managing pandemic-related anxiety/depression was higher among those reporting changes in sexual activity (53% vs. 36%; p-value = 0.01) and was independently associated with having more than one sex partner in the prior 2 weeks (adjusted OR = 1.5; 95% CI 1.0-2.4). Our findings indicate increases in substance use, in particular cannabis, linked directly to experiences resulting from the COVID-19 pandemic and the associated interruptions in mental health care. Strategies that deliver services without direct client contact are essential for populations at high risk for negative sexual and mental health outcomes.
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Affiliation(s)
- Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, CHS 46-082, Box 951772, Los Angeles, CA, 90095-1772, USA.
| | - Allison Rosen
- Department of Epidemiology, UCLA Fielding School of Public Health, CHS 46-082, Box 951772, Los Angeles, CA, 90095-1772, USA
| | - Amy Ragsdale
- Department of Epidemiology, UCLA Fielding School of Public Health, CHS 46-082, Box 951772, Los Angeles, CA, 90095-1772, USA
| | - E India Richter
- Department of Epidemiology, UCLA Fielding School of Public Health, CHS 46-082, Box 951772, Los Angeles, CA, 90095-1772, USA
| | - Steven Shoptaw
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Epidemiology, UCLA Fielding School of Public Health, CHS 46-082, Box 951772, Los Angeles, CA, 90095-1772, USA
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19
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El-Nahal WG, Shen NM, Keruly JC, Jones JL, Fojo AT, Lau B, Manabe YC, Moore RD, Gebo KA, Lesko CR, Chander G. Telemedicine and visit completion among people with HIV during the coronavirus disease 2019 pandemic compared with prepandemic. AIDS 2022; 36:355-362. [PMID: 34711737 PMCID: PMC8795480 DOI: 10.1097/qad.0000000000003119] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Telemedicine became the primary mode of delivering care during the COVID-19 pandemic. We describe the impact of telemedicine on access to care for people with HIV (PWH) by comparing the proportion of PWH engaged in care prior to and during the COVID-19 pandemic. DESIGN AND METHODS We conducted an observational analysis of patients enrolled in the Johns Hopkins HIV Clinical Cohort, a single-center cohort of patients at an urban HIV subspecialty clinic affiliated with an academic center. Due to the COVID-19 pandemic, the clinic transitioned from in-person to mostly telemedicine visits. We compared patients receiving care in two time periods. The prepandemic period included 2010 people with at least one visit scheduled between 1 September 2019 and 15 March 2020. The pandemic period included 1929 people with at least one visit scheduled between 16 March 2020 and 30 September 2020. We determined the proportion of patients completing at least one of their scheduled visits during each period. RESULTS Visit completion increased significantly from 88% prepandemic to 91% during the pandemic (P = 0.008). Visit completion improved significantly for patients age 20-39 (82 to 92%, P < 0.001), women (86 to 93%, P < 0.001), Black patients (88 to 91%, P = 0.002) and patients with detectable viremia (77 to 85%, P = 0.06) during the pandemic. Only 29% of people who completed at least one telemedicine visit during the pandemic did so as a video (versus telephone) visit. CONCLUSION During the pandemic when care was widely delivered via telemedicine, visit completion improved among groups with lower prepandemic engagement but most were limited to telephone visits.
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Affiliation(s)
- Walid G El-Nahal
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Nicola M Shen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeanne C Keruly
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Joyce L Jones
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Anthony T Fojo
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yukari C Manabe
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Kelly A Gebo
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Lynnerup C, Nørreslet M, Graabæk T. Attitudes towards video communication for New Medicine Service at community pharmacies – A qualitative pilot study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100103. [PMID: 35478522 PMCID: PMC9030321 DOI: 10.1016/j.rcsop.2022.100103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background New Medicine Service (NMS) is a community pharmacy service that can increase adherence among patients with a newly diagnosed chronic disease. NMS must be carried out by a pharmacist, which is a barrier for some pharmacy units with no pharmacist physically present. Video communication might be a way to overcome this barrier. Objective This study aims to explore both patients' and community pharmacy staff's attitudes of video-based NMS in a community pharmacy setting. Methods Semi-structured, telephone interviews were conducted with patients who have participated in video-based NMS. Focus groups with pharmacists who have carried out the video-based NMS and with staff that referred patients to the video-based NMS were conducted at community pharmacies. Thematic inductive analysis was used to analyse the interviews and focus groups. Results In total, 10 patient interviews were conducted, along with one focus group with four pharmacists and one focus group with 10 referring staff. Three main themes emerged during the analysis: (i) Talking to a screen, (ii) content of the NMS, and (iii) tackling the technique. Patients reported that their questions for the pharmacists were the same as if the NMS had been face-to-face. Pharmacists felt that they appeared more professional on video and that non-medical related conversation was reduced compared with ordinary face-to-face NMS. The referring staff either preferred referring to a video-based NMS over an ordinary face-to-face NMS or had no preferences. Conclusions Both patients and pharmacy staff had a positive attitude towards the video-based NMS, the content of the NMS and the performance of the IT-system. The consulting time was reduced for video-based NMS compared to face-to-face NMS, but that did not affect the medical related content of the NMS, which indicates that video-based NMS is possible without compromising the health related content.
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21
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Evers EC, Fritz SA, Colditz GA, Burnham JP. Perceptions of telemedicine and costs incurred by a visit to a general infectious diseases clinic: A survey. Open Forum Infect Dis 2022; 9:ofab661. [PMID: 35187192 PMCID: PMC8852313 DOI: 10.1093/ofid/ofab661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/28/2021] [Indexed: 11/21/2022] Open
Abstract
Background The costs of attending in-person general infectious diseases clinics and preferences for visit type (telemedicine vs in-person) are not well known. We aimed to measure the time-related, monetary, social, and societal costs associated with travel to an in-person clinic visit and to assess patients’ preferences, questions, and concerns regarding telemedicine. Methods Patients (≥18 years, living ≥25 miles from clinic at time of clinic visit) were recruited for this survey study from the general infectious diseases (ID) clinic at Washington University from June 2019 to February 2020. We calculated time and money potentially saved by telemedicine, as well as carbon dioxide emissions, with the assistance of Google Maps (low/high estimates). We also determined patient preferences regarding telemedicine for ID care. Results Seventy-five patients completed the study. The round-trip mean travel distance was 227.2 ± 142.6 miles, mean travel time was 3.6 ± 2.0 hours to 4.5 ± 2.3 hours (low and high estimates from Google Maps), travel costs were $131.34 ± $82.27, and mean carbon dioxide emissions were 91.79 ± 57.60 kg. Fifty-eight patients (77.3%) said they would be willing to have a telemedicine visit in the future, and 30 (40.5%) said they would rather have had their visit the day the survey was completed as a telemedicine visit. Conclusions Telemedicine has the potential to significantly reduce patient costs, both monetary and time-related, and offers substantial environmental benefits, while being an acceptable method of care delivery to most patients at a general ID clinic.
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Affiliation(s)
- Emily C Evers
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Stephanie A Fritz
- Department of Pediatrics, Washington University in St. Louis, Missouri, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jason P Burnham
- Division of Infectious Diseases Washington University School of Medicine, St. Louis, Missouri, USA
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22
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Hammour KA, Abdeljalil M, Manaseer Q, Al-Manaseer B. Jordanian experience: The internet pharmacy drug delivery platform during the COVID-19. HEALTH POLICY AND TECHNOLOGY 2022; 11:100596. [PMID: 35024326 PMCID: PMC8739364 DOI: 10.1016/j.hlpt.2022.100596] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The present study aimed to see how well the newly designed internet hospital drug delivery platform model worked in the pharmacy department during the COVID-19 pandemic to make it easier for patients to get their prescribed drugs during the home quarantine. Methods: The internet hospital drug delivery platform was designed and activated by the pharmacy department in collaboration with the information technology department. The pharmacy department, in partnership with the information technology department, built and launched the internet hospital drug delivery platform (IHDD) immediately after the Jordanian government declared a full lockdown. Results: During the quarantine, a total of 5994 prescriptions, including 28494 medications, were delivered to 4853 patients. The majority of the patients (n = 1835; 37.8%) were aged 60 to 74.Nearly three quarters (4722; 78.8%) of the patients were from Amman, the capital of Jordan, and the top five online prescription departments were cardiology (n = 1737, 31.6%), endocrinology (n = 624, 11.4%), nephrology (n = 557, 10.1%), respiratory (n = 462, 8.4%), and neurology (n = 412, 7.5%). Conclusion: The IHDD platform was found to be efficient and convenient because it handled the challenge of precisely delivering medications to patients on time. To meet the pandemic's challenge, the pharmacy department has extended its inventive powers. In addition to safeguarding the environment, health technology was used to provide a coordinated, systematic program for the administration of medications. The pharmacy department, in partnership with the information technology department, built and deployed the internet hospital drug distribution infrastructure shortly after Jordan's government proclaimed a full lockdown. During the quarantine, a total of 5994 prescriptions, including 28494 medications, were delivered to 4853 patients. The majority of the patients (n = 1835; 37.8%) were between the ages of 60 and 74.Nearly three quarters (4722; 78.8%) of the patients were from Amman, the capital of Jordan, and the top five online prescription departments were cardiology (n = 1737, 31.6%), endocrinology (n = 624, 11.4%), nephrology (n = 557, 10.1%), respiratory (n = 462, 8.4%), and urology (n = 412, 7.5%). The pharmacy department has expanded its capabilities creatively to face the challenge posed by the pandemic. Health technology was utilized to ensure a coordinated, systematic program for the delivery of medications, in addition to preserving the safety of the dedicated staff.
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Affiliation(s)
- Khawla Abu Hammour
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman 11942 Jordan
| | - Mariam Abdeljalil
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman 11942 Jordan
| | - Qusai Manaseer
- Faculty of Medicine/The University of Jordan, Amman 11942 Jordan
| | - Bayan Al-Manaseer
- Jordan University Hospital, The University of Jordan, Amman 11942 Jordan
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23
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Ender PT, Markson RH, Suri A, Ruppert K, Padron N, Stoltzfus JC, Berges V, Reed R. Rapid Implementation of a Telemedicine Program in a Ryan White-Funded HIV Clinic During a Global Pandemic. J Acquir Immune Defic Syndr 2022; 89:e2-e4. [PMID: 34878440 DOI: 10.1097/qai.0000000000002815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Peter T Ender
- Section of Infectious Diseases, Department of Medicine, St. Luke's University Health Network, Bethlehem, PA
- Department of Community Health and Preventive Medicine, St. Luke's University Health Network, Bethlehem, PA
- Temple/St. Luke's School of Medicine, Bethlehem, PA
| | - Rebecca H Markson
- Department of Family Medicine, St. Luke's University Health Network, Easton, PA
| | - Ambuj Suri
- Temple/St. Luke's School of Medicine, Bethlehem, PA
| | - Katey Ruppert
- Department of Community Health and Preventive Medicine, St. Luke's University Health Network, Bethlehem, PA
| | - Nichole Padron
- Department of Community Health and Preventive Medicine, St. Luke's University Health Network, Bethlehem, PA
| | - Jill C Stoltzfus
- Temple/St. Luke's School of Medicine, Bethlehem, PA
- Graduate Medical Education, Data Management and Outcomes Assessment, St. Luke's University Health Network, Bethlehem, PA
| | - Victoria Berges
- Department of Community Health and Preventive Medicine, St. Luke's University Health Network, Bethlehem, PA
| | - Rajika Reed
- Department of Community Health and Preventive Medicine, St. Luke's University Health Network, Bethlehem, PA
- Temple/St. Luke's School of Medicine, Bethlehem, PA
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24
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Ender PT, Markson RH, Suri A, Ruppert K, Padron N, Stoltzfus JC, Berges V, Reed R. Rapid Implementation of a Telemedicine Program in a Ryan White–Funded HIV Clinic During a Global Pandemic. J Acquir Immune Defic Syndr 2022. [DOI: http://doi.org.10.1097/qai.0000000000002815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Lizano-Díez I, Amaral-Rohter S, Pérez-Carbonell L, Aceituno S. Impact of Home Care Services on Patient and Economic Outcomes: A Targeted Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2021. [DOI: 10.1177/10848223211038305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patient Support Programs (PSPs) reinforce patients’ care provided by health care professionals with the aim to improve adherence and patient empowerment. PSPs may include interventions such as home-based care, individualized medication counseling, support, training, and home delivery of medicines and/or devices. This study described these services and its impact on patient-reported outcomes and health care savings. We conducted an integrative literature review which was limited to publications from the last 10 years (2009-2019) and focused on diseases that require special support and/or parenteral administration. From 7040 total citations, we identified 64 home-based care services performed worldwide. Among the home-based care services, most were provided by nurses (n = 47/64; 73.4%) and addressed to cancer patients (n = 22/64; 34.4%); 23 out of 64 services (35.9%) incorporated telepharmacy. In general, home-based services and PSPs showed a positive impact on patients’ adherence to medication, patient satisfaction, and health-related quality of life. In addition, 14 (21.9%) services reported economic results, most of which showed that home therapy led to substantial cost savings.
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26
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Badowski ME, Bente JA, Davis EM, Isaacs D, Lewis L, Martello JL, Pitlick M, Almodóvar AS, Stadler S, Sutton Burke E, Belk M, Tovey A, Kane‐Gill SL. Telehealth and technological applications in
patient‐centered
care: Implications for pharmacy learners and clinical pharmacists. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - Diana Isaacs
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Lindi Lewis
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | | | | | | | - Madeline Belk
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Amber Tovey
- American College of Clinical Pharmacy Lenexa Kansas USA
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27
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Lawal FJ, Omotayo MO, Lee TJ, Srinivasa Rao ASR, Vazquez JA. HIV Treatment Outcomes in Rural Georgia Using Telemedicine. Open Forum Infect Dis 2021; 8:ofab234. [PMID: 34104669 PMCID: PMC8180244 DOI: 10.1093/ofid/ofab234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/04/2021] [Indexed: 11/29/2022] Open
Abstract
Background The increasing shortage of specialized health care services contributes to the ongoing HIV epidemic. Telemedicine (TM) is a potential tool to improve HIV care, but little is known about its effectiveness when compared with traditional (face-to-face [F2F]) care in rural populations. The objective of this study was to compare the effectiveness of HIV care delivered through TM with the F2F model. Methods We conducted a retrospective chart review of a subset of patients with HIV who attended a TM clinic in Dublin, Georgia, and an F2F clinic in Augusta, Georgia, between May 2017 and April 2018. All TM patients were matched to F2F patients based on gender, age, and race. HIV viral load (VL) and CD4 count gain were compared using t test and Mann-Whitney U statistics. Results Three hundred eighty-five patients were included in the analyses (F2F = 200; TM = 185). The mean CD4 in the TM group was higher (643.9 cells/mm3) than that of the F2F group (596.3 cells/mm3; P < .001). There was no statistically significant difference in VL reduction, control, or mean VL (F2F = 416.8 cp/mL; TM = 713.4 cp/mL; P = .30). Thirty-eight of eighty-five patients with detectable VL achieved viral suppression during the study period (F2F = 24/54; TM = 14/31), with a mean change of 3.34 × 104 and –1 to 0.24 × 104, respectively (P = 1.00). Conclusions TM was associated with outcome measures comparable to F2F. Increased access to specialty HIV care through TM can facilitate HIV control in communities with limited health care access in the rural United States. Rigorous prospective evaluation of TM for HIV care effectiveness is warranted.
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Affiliation(s)
- Folake J Lawal
- Division of Infectious Diseases, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Moshood O Omotayo
- Centre for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Tae Jin Lee
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Arni S R Srinivasa Rao
- Laboratory for Theory and Mathematical Modeling, Division of Infectious Diseases, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Jose A Vazquez
- Division of Infectious Diseases, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Lee PS, Koo S, Panter S. The value of physical examination in the era of telemedicine. J R Coll Physicians Edinb 2021; 51:85-90. [PMID: 33877145 DOI: 10.4997/jrcpe.2021.122] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Telemedicine use has expanded rapidly to cope with increasing demand on services by delivering remote clinical review and monitoring of long-term conditions. Triaging individual patients to determine their suitability for telephone, video or face-to-face consultations is necessary. This is crucial in the context of COVID-19 to ensure doctor-patient safety. Telemedicine was shown to be safe and feasible in managing certain chronic diseases and providing patient education. When reviewing newly referred or long-term patients, different specialty clinics have different requirements for physical examination. Clinicians prefer face-to-face consultations at the initial visit to establish a doctor-patient relationship; telephone or video consultations are reasonable options for long-term patients where physical examination may not be needed. Video consultations, often aided by sophisticated devices and apps or medical assistants, are useful to facilitate remote physical examination. Most patients prefer telemedicine as it saves time and travel cost and provides better access to appointments.
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Affiliation(s)
| | - Sara Koo
- South Tyneside and Sunderland NHS Foundation Trust
| | - Simon Panter
- South Tyneside and Sunderland NHS Foundation Trust
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29
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Gárate FJ, Chausa P, Whetham J, Jones CI, García F, Cáceres C, Sánchez-González P, Wallitt E, Gómez EJ. EmERGE mHealth Platform: Implementation and Technical Evaluation of a Digital Supported Pathway of Care for Medically Stable HIV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063156. [PMID: 33803821 PMCID: PMC8003226 DOI: 10.3390/ijerph18063156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 12/21/2022]
Abstract
In this article, we described a new mobile-Health (mHealth) supported clinical pathway of care for people living with medically stable HIV in terms of platform acceptability, usability and technical feasibility. The EmERGE mHealth platform was codesigned with clinicians and the community, developed using Scrum agile methodology, integrated with hospital information systems and validated in a large prospective cohort study of 2251 participants. The evaluation of this new paradigm of care was conducted using a tailored Health Technology Assessment: the Model for Assessment of Telemedicine Applications. Usability and acceptability were assessed through the System Usability Score and a Patient Reported Experience Measure. The EmERGE platform was successfully deployed across diverse care settings in five European countries and used by 2251 patients and more than 20 clinicians for up to 30 months. Results from the formal evaluation demonstrated that the EmERGE platform is feasible and acceptable, with a high level of usability (median System Usability Score (SUS) 85.0%) and very positive patient-reported experiences (94.2% would recommend to a friend). The EmERGE platform is a secure and General Data Protection Regulation (GDPR)-compliant system with a complete set of functionalities that could be easily adapted to other clinical conditions, clinical sites and health systems thanks to its modular technical architecture.
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Affiliation(s)
- Francisco J. Gárate
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.C.); (P.S.-G.); (E.J.G.)
- Correspondence: (F.J.G.); (P.C.)
| | - Paloma Chausa
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.C.); (P.S.-G.); (E.J.G.)
- Correspondence: (F.J.G.); (P.C.)
| | - Jennifer Whetham
- Department of Sexual Health and HIV Medicine, Brighton and Sussex University Hospitals NHS Trust, BN2 5BE Brighton, UK;
| | | | - Felipe García
- Infectious Diseases Department, Fundacio Privada Clinic per a la Recerca Biomedica—IDIBAPS, University of Barcelona, 08036 Barcelona, Spain;
| | - César Cáceres
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.C.); (P.S.-G.); (E.J.G.)
- Computer Science Department, Universidad Rey Juan Carlos, 28933 Madrid, Spain
| | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.C.); (P.S.-G.); (E.J.G.)
- Centro de Investigación Biomédica en Red, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
| | | | - Enrique J. Gómez
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.C.); (P.S.-G.); (E.J.G.)
- Centro de Investigación Biomédica en Red, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
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Beck EJ, Mandalia S, Yfantopoulos P, Jones CI, Bremner S, Whetham J, Etcheverry F, Moreno L, Gonzalez E, Merino MJ, Leon A, Garcia F. Efficiency of the EmERGE Pathway to provide continuity of care for Spanish people living with medically stable HIV. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(20)30422-5. [PMID: 33549335 DOI: 10.1016/j.eimc.2020.11.018] [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: 08/21/2020] [Revised: 11/13/2020] [Accepted: 11/23/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Calculate the efficiency of the EmERGE Pathway of Care for medically stable people living with HIV at the Hospital Clínic-IDIBAPS, Barcelona, Spain. METHODS 546 study participants were followed between 1st July 2016 and 30th October 2019 across three HIV outpatient clinics, but the virtual clinic was closed during the second year. Unit costs were calculated, linked to mean use outpatient services per patient year, one-year before and after the implementation of EmERGE. Costs were combined with primary and secondary outcomes. RESULTS Annual costs across HIV-outpatient services increased by 8%: €1073 (95%CI €999-€1157) to €1158 (95%CI €1084-€1238). Annual cost of ARVs was €7,557; total annual costs increased by 1% from €8430 (95%CI €8356-8514) to €8515 (95%CI €8441-8595). Annual cost for 433 participants managed in face-to-face (F2F) clinics decreased by 5% from €958 (95%CI 905-1018) to €904 (95%CI 863-945); participants transferred from virtual to F2F outpatient clinics (V2F) increased their annual cost by a factor of 2.2, from €115 (95%CI 94-139) to €251 (95%CI 219-290). No substantive changes were observed in primary and secondary outcomes. CONCLUSION EmERGE Pathway is an efficient and acceptable intervention. Increases in costs were caused by internal structural changes. The cost reduction observed in F2F clinics were off-set by the transfer of participants from the virtual to the F2F clinics due to the closure of the virtual clinic during the second year of the Study. Greater efficiencies are likely to be achieved by extending the use of the Pathway to other PLHIV.
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Affiliation(s)
- E J Beck
- NPMS-HHC CIC, London, UK; Department of Health Services Research and Policy, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | - C I Jones
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | - S Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | - J Whetham
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - F Etcheverry
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - L Moreno
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - E Gonzalez
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - M J Merino
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - A Leon
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - F Garcia
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
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Monkowski D, Rhodes LV, Templer S, Kromer S, Hartner J, Pianucci K, Kincaid H. A Retrospective Cohort Study to Assess the Impact of an Inpatient Infectious Disease Telemedicine Consultation Service on Hospital and Patient Outcomes. Clin Infect Dis 2021; 70:763-770. [PMID: 31002338 DOI: 10.1093/cid/ciz293] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/04/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Here, we review our experience of providing inpatient infectious disease (ID) consultations using real-time interactive telemedicine assessments. We sought to obtain a baseline and document trends regarding the use of telemedicine ID (teleID) consults as an adjunct to the standard of care through the time period in which teleID consultations were introduced. METHODS Data were pulled via manual, retrospective chart reviews of the electronic medical record. Primary outcomes included lengths of stay (LOS), antibiotic usage, and relapse incidences. RESULTS There were a total of 244 patients at 1 remote hospital site who were provided with ID consultations, either in person, via teleID, or both. Before the availability of teleID (pre-teleID), there were 73 patients transferred for ID consults, while 171 patients were seen via teleID once available. While all 73 patients in the pre-teleID group were transferred from the remote hospital to the hub hospital, only 14 (8.2%) of all remote hospital patients assessed by teleID were transferred. Patient LOS across both facilities decreased when patients were seen via teleID, compared to pre-teleID (P = .0001). The median number of days that patients received antibiotics decreased in the teleID group (median 15, interquartile range [IQR] 9-25), compared to the pre-teleID group (median 19, IQR 11-28), but this decrease was not statistically significant (P = .0770). There was no statistically significant difference in relapse rates, although data were lacking because of patients being lost to follow-up. CONCLUSIONS ID telemedicine practice directed at inpatients appears to be a promising route of care.
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Affiliation(s)
- Daniel Monkowski
- Lehigh Valley Physician Group Infectious Diseases, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Luther V Rhodes
- Lehigh Valley Physician Group Infectious Diseases, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Suzanne Templer
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Sharon Kromer
- Center for Connected Care and Innovation, Allentown, Pennsylvania
| | - Jessica Hartner
- 7C Medical Surgical Unit, Lehigh Valley Health Network, Allentown, Pennsylvania
| | | | - Hope Kincaid
- Network Office of Research and Innovation, Lehigh Valley Health Network, Allentown, Pennsylvania
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Video-based teleconsultations in pharmaceutical care - A systematic review. Res Social Adm Pharm 2020; 17:1523-1531. [PMID: 33341405 DOI: 10.1016/j.sapharm.2020.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND In recent years, telemedicine has gained increasing importance in the delivery of pharmaceutical care. The use of video technologies for remote communication between different parties offers the potential to meet the future challenges which arise from the increase in elderly and chronically ill patients. However, the influence of these technologies on patient-related outcomes in pharmaceutical care is not yet sufficiently known. METHOD In December 2018 a systematic literature search was conducted in the databases Medline, Cochrane Library and PubPharm. Randomized controlled trials were considered, which investigate real-time video conferencing between pharmacists on the one hand and patients or other healthcare providers on the other hand. The influence on patient related outcomes compared to standard care was assessed. The bias potential was evaluated using the Cochrane Risk-of-Bias instrument. A total of 4 randomized controlled trials could be included. RESULTS The studies describe partly complex intervention settings with adults and adolescents suffering from asthma, chronic renal failure, HIV infection, hyperlipidemia, hypertension and/or diabetes. None of the studies considers the interprofessional communication of pharmacists with other service providers. No influence on clinical or psychological endpoints was found. In some cases, an increase in adherence and correct medication use is evident. Healthcare utilization is not influenced. In all studies there is an increased risk of systematic bias. DISCUSSION Teleconsultations with pharmacists can rather be used to ensure the general provision of pharmaceutical care than to improve patient-related outcomes. Further studies are necessary to fully depict the influence of telemedical interventions in pharmaceutical care.
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Peláez Bejarano A, Villar Santos P, Robustillo-Cortés MDLA, Sánchez Gómez E, Santos Rubio MD. Implementation of a novel home delivery service during pandemic. Eur J Hosp Pharm 2020; 28:e120-e123. [PMID: 33115800 PMCID: PMC8640397 DOI: 10.1136/ejhpharm-2020-002500] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/30/2020] [Accepted: 10/13/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction During the COVID-19 pandemic, measures have been put in place to adapt to patients’ needs during home quarantine, such as “telehealthcare”. With this service, hospital pharmacists develop a distinct role via the implementation of pharmacovigilance services and pharmaceutical care plans for patients with comorbidities, and for special populations as immunosuppressed patients. Methods Cross-sectional study involving hospital and community pharmacists actively practising during the COVID-19 pandemic. Patients who could not come to the hospital pharmacy department were provided with a delivery service to the community pharmacy of their choice. Results A total of 1186 patients requested this service. Erythropoiesis-stimulating agents were the most in-demand medication, followed by rheumatoid arthritis and antiretroviral drugs. 125 patients responded to the telephone survey, most of whom stated that they would use the delivery service again, and expressed their desire to continue doing so. Discussion Without a doubt, telepharmacy and medication delivery services have provided multiple benefits during home quarantine. The delivery service enabled us to provide drugs to patients in their immediate environment through a service that was free for both the patient and the hospital pharmacy service. However, at present, the available evidence of the impact of telepharmacy models is sparse. Conclusions This medication delivery service has provided multiple benefits to patients during home quarantine. Although the users of this service seem to be satisfied with the current model, in the future, we should consider which patients would benefit most from this service and shape it to individual needs.
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Affiliation(s)
- Ana Peláez Bejarano
- Unidad de Gestión Clínica Farmacia, Hospital Juan Ramón Jiménez, Huelva 21005, Spain
| | - Pilar Villar Santos
- Unidad de Gestión Clínica Farmacia, Hospital Juan Ramón Jiménez, Huelva 21005, Spain
| | | | - Ernesto Sánchez Gómez
- Unidad de Gestión Clínica Farmacia, Hospital Juan Ramón Jiménez, Huelva 21005, Spain
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Ridgway JP, Schmitt J, Friedman E, Taylor M, Devlin S, McNulty M, Pitrak D. HIV Care Continuum and COVID-19 Outcomes Among People Living with HIV During the COVID-19 Pandemic, Chicago, IL. AIDS Behav 2020; 24:2770-2772. [PMID: 32382823 PMCID: PMC7203502 DOI: 10.1007/s10461-020-02905-2] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Ridgway JP, Schmitt J, Friedman E, Taylor M, Devlin S, McNulty M, Pitrak D. HIV Care Continuum and COVID-19 Outcomes Among People Living with HIV During the COVID-19 Pandemic, Chicago, IL. AIDS Behav 2020. [DOI: http://doi.org.10.1007/s10461-020-02905-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Dandachi D, Dang BN, Lucari B, Teti M, Giordano TP. Exploring the Attitude of Patients with HIV About Using Telehealth for HIV Care. AIDS Patient Care STDS 2020; 34:166-172. [PMID: 32324481 DOI: 10.1089/apc.2019.0261] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Telehealth could address many of the factors identified as barriers for retention in HIV care. In this study, we explore people with HIV (PWH)'s attitudes about using telemedicine for HIV care instead of face-to-face clinic visits. We administered a one-time survey to PWH presenting to an outpatient HIV center in Houston, Texas, from February to June 2018. The survey items were used to assess PWH's attitudes toward and concerns for telehealth and explanatory variables; 371 participants completed the survey; median age was 51, 36% and were female, and 63% was African American. Overall 57% of respondents were more likely to use telehealth for their HIV care if available, as compared with one-on-one in-person care, and 37% would use telehealth frequently or always as an alternative to clinic visits. Participants reported many benefits, including ability to fit better their schedule, decreasing travel time, and privacy but expressed concerns about the ability to effective communication and examination and the safety of personal information. Factors associated with likelihood of using telehealth include personal factors (US-born, men who have sex with men, higher educational attainment, higher HIV-related stigma perception), HIV-related factors (long-standing HIV), and structural factors (having difficulty attending clinic visits, not knowing about or not having the necessary technology). There was no association between participants with uncontrolled HIV, medication adherence, and likelihood of using telehealth. Telehealth programs for PWH can improve retention in care. Availability and confidence using various telehealth technologies need to be addressed to increase acceptability and usage of telehealth among PWH.
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Affiliation(s)
- Dima Dandachi
- Division of Infectious Diseases, Department of Medicine, University of Missouri, Columbia, Missouri, USA
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas, Health Science Center at Houston, Houston, Texas, USA
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Bich N. Dang
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Brandon Lucari
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Michelle Teti
- Department of Public Health, University of Missouri, Columbia, Missouri, USA
| | - Thomas P. Giordano
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
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Burnham JP, Fritz SA, Yaeger LH, Colditz GA. Telemedicine Infectious Diseases Consultations and Clinical Outcomes: A Systematic Review. Open Forum Infect Dis 2019; 6:ofz517. [PMID: 31879674 PMCID: PMC6925389 DOI: 10.1093/ofid/ofz517] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/04/2019] [Indexed: 12/20/2022] Open
Abstract
Background Telemedicine use is increasing in many specialties, but its impact on clinical outcomes in infectious diseases has not been systematically reviewed. We reviewed the current evidence for clinical effectiveness of telemedicine infectious diseases consultations, including outcomes of mortality, hospital readmission, antimicrobial use, cost, length of stay, adherence, and patient satisfaction. Methods We queried Ovid MEDLINE 1946-, Embase.com 1947-, Scopus 1823-, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov 1997- through August 5, 2019, for studies looking at clinical outcomes of infectious diseases in the setting of telemedicine use. We did not restrict by language or year of publication. Clinical outcomes searched included 30-day all-cause mortality, 30-day readmissions, patient compliance/adherence, patient satisfaction, cost or cost-effectiveness, length of hospital stay, antimicrobial use, and antimicrobial stewardship. Bias was assessed using standard methodologies. PROSPERO CRD42018105225. Results From a search pool of 1154 studies, only 18 involved telemedicine infectious diseases consultation and our selected clinical outcomes. The outcomes tracked were heterogeneous, precluding meta-analysis, and the majority of studies were of poor quality. Overall, clinical outcomes with telemedicine infectious diseases consultation seem comparable to in-person infectious diseases consultation. Conclusions Although in widespread use, the clinical effectiveness of telemedicine infectious diseases consultations has yet to be sufficiently studied. Further studies, or publication of previously collected and available data, are warranted to verify the cost-effectiveness of this widespread practice. Systematic review registration PROSPERO CRD42018105225.
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Affiliation(s)
- Jason P Burnham
- Division of Infectious Diseases Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephanie A Fritz
- Department of Pediatrics, Washington University in St. Louis, Missouri, USA
| | - Lauren H Yaeger
- Bernard Becker Medical Library, Washington University in St. Louis, Missouri, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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Jain KM, Bhat P, Maulsby C, Andersen A, Soto T, Tarrant A, Holtgrave DR, Nortrup E, Werner M, Dill L. Extending access to care across the rural US south: Preliminary results from the Alabama eHealth programme. J Telemed Telecare 2019; 25:301-309. [PMID: 29448879 PMCID: PMC6445775 DOI: 10.1177/1357633x18755227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Using a mixed-methods formative evaluation, the purpose of this study was to provide a broad overview of the Alabama eHealth programme set-up and initial patient outcomes. The Alabama eHealth programme uses telemedicine to provide medical care to people living with HIV in rural Alabama. It was led by a community-based organisation, Medical Advocacy and Outreach (MAO), and supported by AIDS United and the Corporation for National Community Service's Social Innovation Fund with matching support from non-federal donors. METHODS We conducted and transcribed in-depth interviews with Alabama eHealth staff and then performed directed content analysis. We also tracked patients' ( n = 240) appointment attendance, CD4 counts, and viral loads. FINDINGS Staff described the steps taken to establish the programme, associated challenges (e.g., costly, inadequate broadband in rural areas), and technology enabling this programme (electronic medical records, telemedicine equipment). Of all enrolled patients, 76% were retained in care, 88% had antiretroviral therapy and 75% had a suppressed viral load. Among patients without missing data, 96% were retained in care, 97% used antiretroviral therapy and 93% had suppressed viral loads. There were no statistically significant demographic differences between those with and without missing data. CONCLUSIONS Patients enrolled in a telemedicine programme evaluation successfully moved through the HIV continuum of care.
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Affiliation(s)
- Kriti M Jain
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Cathy Maulsby
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Tomas Soto
- Medical Advocacy and Outreach of Alabama, USA
| | | | - David R Holtgrave
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, USA
| | | | | | - Laurie Dill
- Medical Advocacy and Outreach of Alabama, USA
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HIV telehealth: framing the dialog and debate for reaching community consensus. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00310-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dandachi D, Lee C, Morgan RO, Tavakoli-Tabasi S, Giordano TP, Rodriguez-Barradas MC. Integration of telehealth services in the healthcare system: with emphasis on the experience of patients living with HIV. J Investig Med 2019; 67:815-820. [PMID: 30826803 DOI: 10.1136/jim-2018-000872] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2019] [Indexed: 01/18/2023]
Abstract
The US Health Resources and Services Administration defines telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health and health administration. Many studies have supported the use of telehealth to increase convenience to patients, improve patient satisfaction, diminish healthcare disparities, and reduce cost that will ultimately lead to improvement in clinical outcomes and quality of care. However, guaranteeing confidentiality, educating patients and providers, and obtaining insurance reimbursement are some of the challenges that face the implementation of telehealth program. The use of telehealth has been investigated in acute infections, such as endocarditis and chronic infections as in hepatitis C, and HIV. The purpose of this review is to focus on the use of telehealth services for people living with HIV (PLWH). For PLWH, telehealth could be particularly useful by connecting specialty providers to an underserved population and addressing many of the factors identified as barriers to HIV care. To date, the literature supports the use of telehealth for the management of chronic diseases including HIV. Most of the studies showed a high acceptability and positive experience with telehealth services among PLWH. However, fewer studies have evaluated telemedicine for chronic direct care of PLWH. Well-designed studies are needed to show that the implementation of telehealth could improve the HIV care continuum. In addition, future research should focus on identifying the group of patients that could benefit the most from such intervention.
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Affiliation(s)
- Dima Dandachi
- Internal Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA.,Internal Medicine, Section of Infectious Diseases, University of Missouri Health Care, Columbia, Missouri, USA.,University of Texas School of Public Health, Houston, Texas, USA
| | - Celine Lee
- University of Texas School of Public Health, Houston, Texas, USA
| | - Robert O Morgan
- University of Texas School of Public Health, Houston, Texas, USA
| | | | - Thomas P Giordano
- Internal Medicine, Section of Infectious Diseases, University of Missouri Health Care, Columbia, Missouri, USA
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Mizuno Y, Higa DH, Leighton CA, Mullins M, Crepaz N. Is co-location of services with HIV care associated with improved HIV care outcomes? A systematic review. AIDS Care 2019; 31:1323-1331. [PMID: 30773038 DOI: 10.1080/09540121.2019.1576847] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This systematic review identifies models of service co-location, a structural intervention strategy to remove barriers to HIV care and services, and examines their associations with HIV care outcomes. A cumulative database (e.g., MEDLINE, EMBASE) of HIV, AIDS, and STI literature was systematically searched and manual searches were conducted to identify relevant studies. Thirty-six studies were classified into six models of co-location: HIV care co-located with multiple ancillary services, tuberculosis (TB) care, non-HIV specific primary care, drug abuse treatment, prevention of mother to child transmission programs (PMTCT), and mental health care. More evidence of a positive association was seen for linkage to care and antiretroviral therapy (ART) uptake than for retention and viral suppression. Models of co-location that addressed HIV and non-HIV medical care issues (i.e., co-location with non-HIV specific primary care, PMTCT, and TB) had more positive associations, particularly for linkage to care and ART uptake, than other co-location models. While some findings are encouraging, more research with rigorous study designs is needed to strengthen the evaluation of, and evidence for, service co-location.
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Affiliation(s)
- Yuko Mizuno
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Darrel H Higa
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Carolyn A Leighton
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Mary Mullins
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Nicole Crepaz
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
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Portillo AB, García-Cervigón GP, Figueras MP, Jiménez GN, Galán GJ, Arribas MV, Núñez LM, Gómez RH, Segarral OM, Herraiz CG, Berriguete RG, García JEL. [Telemedicine, prison and illness associated with HIV]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2019; 32:539-544. [PMID: 31642638 PMCID: PMC6913080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Communicate the activity of telemedicine, from its opening, between a hospital consultation of infectious diseases and a penitentiary center. METHODS Descriptive study of the tele-consultation of infectious diseases of the Alcorcón Foundation University Hospital with the Navalcarnero penitentiary center from 2013 to 2017, which is carried out by videoconference. The reason and number of consultations, diagnosis of HIV, antiretroviral treatment (ART), immunovirological situation, diagnosis of hepatitis C virus (HCV= and intervention performed by the infectious expert were analyzed. RESULTS A total of 75 patients were evaluated in a total of 168 consultations (in the first year 11 consultations and in the fifth year 62). The index of successive / new consultations was 1.24 and 85% of the patients required less than 1 year of follow-up. 84% of patients did not move to the hospital. 99% of patients accepted this modality. 96% were HIV positive, 94% of them took ART and 85% had undetectable viral load with 532 CD4/mL of medium. 90% had positive serology for HCV. 72% of the consultations were for the assessment of HCV treatment, which was sofosbuvir/ledipasvir by 63%. 40% changed their ART (70% to avoid interactions). CONCLUSIONS Most of the evaluated patients have HIV infection. This type of consultation has a growing demand, is efficient (avoids transfers and is decisive) and has high acceptance. The most frequent reason for consultation was the treatment of HCV and more than a third of patients required ART change.
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Affiliation(s)
- Antonio Blanco Portillo
- Hospital Universitario Fundación Alcorcón. C/Budapest, 1 28922 Alcorcón, Madrid.,Correspondencia: Antonio Blanco Portillo Hospital Universitario Fundación Alcorcón. C/Budapest, 1 28922 Alcorcón, Madrid. Spain E-mail:
| | | | | | | | - Germán Jiménez Galán
- Centro Penitenciario Madrid IV. Carretera N-V, Km 27.7, 28600 Navalcarnero, Madrid
| | | | - Leonor Moreno Núñez
- Hospital Universitario Fundación Alcorcón. C/Budapest, 1 28922 Alcorcón, Madrid
| | - Rafael Hervás Gómez
- Hospital Universitario Fundación Alcorcón. C/Budapest, 1 28922 Alcorcón, Madrid
| | | | | | | | - Juan E Losa García
- Hospital Universitario Fundación Alcorcón. C/Budapest, 1 28922 Alcorcón, Madrid
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Margusino-Framiñán L, Cid-Silva P, Castro-Iglesias Á, Mena-de-Cea Á, Rodríguez-Osorio I, Pernas-Souto B, Vázquez-Rodríguez P, López-Calvo S, Martín-Herranz I. Teleconsultation for the Pharmaceutical Care of HIV Outpatients in Receipt of Home Antiretrovirals Delivery: Clinical, Economic, and Patient-Perceived Quality Analysis. Telemed J E Health 2018; 25:399-406. [PMID: 30036159 DOI: 10.1089/tmj.2018.0041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background/Introduction: Pharmacist teleconsultations, combined with home drug delivery or mail-order pharmacy (MOP), can help hospital outpatients with difficulties accessing treatment. The objectives of this study are to describe a teleconsultation protocol and to evaluate clinical, economic, and patient-perceived quality results. Materials and Methods: A cohort observational study was carried out for 3 years on HIV outpatients. Clinical variables were adherence, plasma HIV-RNA, and CD4+ levels. A pharmacoeconomic analysis was carried out through a cost-minimization study. Patient-perceived quality was assessed through a satisfaction survey. Simple random sampling was performed for 95% safety, accuracy ±1%, and losses ±20%. Results: The 38 participants (sample size) consisted of 82% male patients, aged 44.7 ± 8.4 years. There were 854 teleconsultations and 100% treatment adherence. All HIV outpatients kept virally suppressed (p = 1.00) and maintained a controlled immunological level (p = 0.87). The economic evaluation revealed 137 ± 23 € patient/year costs-saved and 18.5 ± 7.2 h/patient/year working time gained. Patient-perceived quality average score was >9.4 out of 10 in all items; the most valued factors were the saving of direct costs and reconciliation with work commitments (45%) and the least valued attributes were making the payment for the shipment and having to adjust to a telephone appointment (41%). Discussion/Conclusions: A teleconsultation protocol associated with home antiretrovirals delivery or MOP obtains a high degree of satisfaction from the HIV hospital outpatients receiving treatment, without repercussions on the therapeutic objectives and with the saving of important direct costs for the patient and indirect costs in relation to labor productivity.
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Affiliation(s)
- Luis Margusino-Framiñán
- 1 Pharmacy Service, A Coruña University Hospital, A Coruña, Spain.,2 Division of Clinical Virology, A Coruña Biomedical Research Institute (INIBIC), A Coruña University Hospital, SERGAS, A Coruña University (UDC), A Coruña, Spain
| | - Purificación Cid-Silva
- 1 Pharmacy Service, A Coruña University Hospital, A Coruña, Spain.,2 Division of Clinical Virology, A Coruña Biomedical Research Institute (INIBIC), A Coruña University Hospital, SERGAS, A Coruña University (UDC), A Coruña, Spain
| | - Ángeles Castro-Iglesias
- 2 Division of Clinical Virology, A Coruña Biomedical Research Institute (INIBIC), A Coruña University Hospital, SERGAS, A Coruña University (UDC), A Coruña, Spain.,3 Infectious Diseases Unit, Internal Medicine Service, A Coruña University Hospital, A Coruña, Spain
| | - Álvaro Mena-de-Cea
- 2 Division of Clinical Virology, A Coruña Biomedical Research Institute (INIBIC), A Coruña University Hospital, SERGAS, A Coruña University (UDC), A Coruña, Spain.,3 Infectious Diseases Unit, Internal Medicine Service, A Coruña University Hospital, A Coruña, Spain
| | - Iria Rodríguez-Osorio
- 2 Division of Clinical Virology, A Coruña Biomedical Research Institute (INIBIC), A Coruña University Hospital, SERGAS, A Coruña University (UDC), A Coruña, Spain.,3 Infectious Diseases Unit, Internal Medicine Service, A Coruña University Hospital, A Coruña, Spain
| | - Berta Pernas-Souto
- 2 Division of Clinical Virology, A Coruña Biomedical Research Institute (INIBIC), A Coruña University Hospital, SERGAS, A Coruña University (UDC), A Coruña, Spain.,3 Infectious Diseases Unit, Internal Medicine Service, A Coruña University Hospital, A Coruña, Spain
| | - Pilar Vázquez-Rodríguez
- 2 Division of Clinical Virology, A Coruña Biomedical Research Institute (INIBIC), A Coruña University Hospital, SERGAS, A Coruña University (UDC), A Coruña, Spain.,3 Infectious Diseases Unit, Internal Medicine Service, A Coruña University Hospital, A Coruña, Spain
| | - Soledad López-Calvo
- 2 Division of Clinical Virology, A Coruña Biomedical Research Institute (INIBIC), A Coruña University Hospital, SERGAS, A Coruña University (UDC), A Coruña, Spain.,3 Infectious Diseases Unit, Internal Medicine Service, A Coruña University Hospital, A Coruña, Spain
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Saberi P, Ming K, Dawson-Rose C. What does it mean to be youth-friendly? Results from qualitative interviews with health care providers and clinic staff serving youth and young adults living with HIV. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2018; 9:65-75. [PMID: 29731672 PMCID: PMC5927154 DOI: 10.2147/ahmt.s158759] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose Given the consistent associations between younger age and numerous suboptimal clinical outcomes, there is a critical need for more research in youth living with human immunodeficiency virus (YLWH) and tailoring of health care delivery to the unique and complex needs of this population. The objective of this study was to examine the facilitators of and barriers to engagement in care among YLHW at the system and provider/staff level, as well as the barriers to using technology-based forms of communication with YLWH to improve retention and engagement in care. Patients and methods We conducted in-depth qualitative interviews with health care providers and staff members at the clinics and organizations serving YLWH in the San Francisco Bay Area. Results We interviewed 17 health care providers and staff members with a mean of 8 years of experience in providing clinical care to YLWH. Interviewees noted various facilitators of and barriers to engagement in care among YLWH, including the environment of the clinic (e.g., clinic location and service setting), provision of youth-friendly services (e.g., flexible hours and use of technology), and youth-friendly providers/staff (e.g., nonjudgmental approach). With regard to barriers to using technology in organizations and clinics, interviewees discussed the challenges at the system level (e.g., availability of technology, clinic capacity, and Health Insurance Portability and Accountability Act compliance), provider/staff level (e.g., time constraints and familiarity with technology), and youth level (e.g., changing of cellular telephones and relationship with provider/staff). Conclusion Given the need for improved clinical outcomes among YLWH, our results can provide guidance for clinics and institutions providing care for this population to enhance the youth-friendliness of their services and examine their guidelines around the use of technology.
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Affiliation(s)
- Parya Saberi
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kristin Ming
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
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Wood EM, Zani B, Esterhuizen TM, Young T. Nurse led home-based care for people with HIV/AIDS. BMC Health Serv Res 2018; 18:219. [PMID: 29587719 PMCID: PMC5870334 DOI: 10.1186/s12913-018-3002-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 03/14/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Home-based care is used in many countries to increase quality of life and limit hospital stay, particularly where public health services are overburdened. Home-based care objectives for HIV/AIDS can include medical care, delivery of antiretroviral treatment and psychosocial support. This review assesses the effects of home-based nursing on morbidity in people infected with HIV/AIDS. METHODS The trials studied are in HIV positive adults and children, regardless of sex or setting and all randomised controlled. Home-based care provided by qualified nurses was compared with hospital or health-facility based treatment. The following electronic databases were searched from January 1980 to March 2015: AIDSearch, CINAHL, Cochrane Register of Controlled Trials, EMBASE, MEDLINE and PsycINFO/LIT, with an updated search in November 2016. Two authors independently screened titles and abstracts from the electronic search based on the study design, interventions and types of participant. For all selected abstracts, full text articles were obtained. The final study selection was determined with use of an eligibility form. Data extraction was performed independently from assessment of risk of bias. The results were analysed by narrative synthesis, in order to be able to obtain relevant effect measures plus 95% confidence intervals. RESULTS Seven studies met the inclusion criteria. The trial size varied from 37 to 238 participants. Only one trial was conducted in children. Five studies were conducted in the USA and two in China. Four studies looked at home-based adherence support and the rest at providing home-based psychosocial support. Reported adherence to antiretroviral drugs improved with nurse-led home-based care but did not affect viral load. Psychiatric nurse support in those with existing mental health conditions improved mental health and depressive symptoms. Home-based psychological support impacted on HIV stigma, worry and physical functioning and in certain cases depressive symptoms. CONCLUSIONS Nurse-led home-based interventions could help adherence to antiretroviral therapy and improve mental health. Further larger scale studies are needed, looking in more detail at improving medical care for HIV, especially related to screening and management of opportunistic infections and co-morbidities.
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Affiliation(s)
- Elizabeth M. Wood
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Babalwa Zani
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Tonya M. Esterhuizen
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Taryn Young
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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46
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Gras G. Use of telemedicine in the management of infectious diseases. Med Mal Infect 2018; 48:231-237. [PMID: 29452936 DOI: 10.1016/j.medmal.2018.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 01/08/2018] [Indexed: 11/30/2022]
Abstract
Communication technologies have invaded our daily lives. Several studies have assessed these technologies in the management of infectious diseases (mainly HIV). Weekly short text messages and real-time compliance monitoring assessed in HIV patients are both associated with higher compliance in low-income countries. Virtual consultations to monitor stable chronic HIV patients or tuberculosis treatment in high-income countries appear to be acceptable and efficient. Although assessed in small studies, virtual monitoring seems to reinforce the doctor-patient relationship and the relation between primary care settings and hospitals in various infectious diseases (endocarditis, urinary tract infection, skin and soft tissue infection, HIV, tuberculosis, hepatitis C). A better prevention of infectious diseases (mainly sexually transmitted infections) seems to be observed with telemedicine tools. As fees for teleconsultation or telemonitoring have yet to be defined, the development and evaluation (cost effectiveness) of these tools are difficult. The regulatory framework will need to be improved to encourage such developments, all the while ensuring the confidentiality of data. The development of new tools will require the collaboration of physicians, users, and healthcare systems.
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Affiliation(s)
- G Gras
- Maladies infectieuses, CHU Bretonneau, 2, boulevard Tonnelé, 37044 Tours cedex, France.
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47
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Cooper CL, Hatashita H, Corsi DJ, Parmar P, Corrin R, Garber G. Direct-Acting Antiviral Therapy Outcomes in Canadian Chronic Hepatitis C Telemedicine Patients. Ann Hepatol 2017; 16:874-880. [PMID: 29055923 DOI: 10.5604/01.3001.0010.5277] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Many of the 300,000 HCV-infected Canadians live in under-served and remote areas without access to HCV healthcare specialists. Telemedicine (TM) and advances in HCV management can facilitate linkage of these marginalized patients to healthcare. MATERIALS AND METHODS A cohort database analysis was performed on patients followed at The Ottawa Hospital and Regional Viral Hepatitis Program between January 2012 and August 2016. We compared patient characteristics, fibrosis work-up and antiviral treatment outcomes in TM (n = 157) and non-TM (n = 1,130) patients (The Ottawa Hospital Viral Hepatitis Outpatient Clinic) residing in Eastern Ontario. RESULTS TM patients were more often infected with genotype 3 (25.9% vs. 16.4%), were more commonly Indigenous (7.0% vs. 2.2%) had a history of injection drug use (70.1% vs. 54.9%) and incarceration (46.5% vs 35.5%). Groups were comparable in age (48.9 years), gender (63.7% male) and cirrhotic stage (24.0%). 59.2% of TM patients underwent transient elastography during regional outreach blitzes compared to 61.8% of non-TM patients (p = 0.54). Overall, half as many TM patients initiated antiviral therapy as non-TM patients (27.4% vs. 53.8%, p < 0.001). The introduction of DAA regimens is bridging this gap (22.2% of TM patients vs. 34.3% of non-TM patients). SVR rates with interferon-free, DAA regimens were 94.7% and 94.8% in TM and non-TM groups (p = 0.99). CONCLUSION Our TM program engages and retains a population that faces many barriers to effective HCV treatment. TM patients initiated HCV therapy and achieved High SVR rates comparable to those obtained using traditional models of care.
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Affiliation(s)
- Curtis L Cooper
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada Division of Infectious Diseases, Department of Medicine Ottawa Hospital Research Institute
| | - Holly Hatashita
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel J Corsi
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Parmvir Parmar
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Raymond Corrin
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Gary Garber
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Niznik JD, He H, Kane-Gill SL. Impact of clinical pharmacist services delivered via telemedicine in the outpatient or ambulatory care setting: A systematic review. Res Social Adm Pharm 2017; 14:707-717. [PMID: 29100941 DOI: 10.1016/j.sapharm.2017.10.011] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 10/25/2017] [Accepted: 10/25/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Utilization of telemedicine allows pharmacists to extend the reach of clinical interventions, connecting them with patients and providers, but the overall impact of these services is under-studied. OBJECTIVE Identify the impact of clinical pharmacist telemedicine interventions on clinical outcomes, subsequently defined as clinical disease management, patient self-management, and adherence, in outpatient or ambulatory settings. METHODS A literature search was conducted from database inception through May 2016 in Medline, SCOPUS, and EMBASE. Broad terms "telemedicine", "telehealth", and "telephone" were used in combination with "pharmacist" or "pharmacy" and "telepharmacy". The search and extraction process followed PRISMA guidelines. Results were screened for pharmacist interventions and reviewed to identify studies in outpatient our ambulatory settings. Studies of non-clinical outcomes (i.e. dispensing or product preparation) and with no comparator were excluded. The final studies were categorized by types of outcomes reported: clinical disease management, patient self-management, and adherence. RESULTS Only 34 studies measured clinical outcomes against a comparator, consistent with the research question. The majority utilized scheduled models of care (n = 29). Telephone was the most common communication method (n = 25). The most utilized interventions were pharmacist-led telephonic clinics (n = 10). Most studies focused on chronic disease management in adults including hypertension, diabetes, anticoagulation, depression, hyperlipidemia, asthma, heart failure, HIV, PTSD, CKD, stroke, COPD and smoking cessation. Twenty-three studies had a positive impact with one reporting negative results. Higher positive impact rate was observed for scheduled (72.4%, 21/29) and continuous (100%, 2/2) models compared to responsive/reactive (25%, 1/4). CONCLUSIONS Clinical pharmacy telemedicine interventions in the outpatient or ambulatory setting, primarily via phone, have an overall positive impact on outcomes related to clinical disease management, patient self-management, and adherence in the management of chronic diseases. Commonalities among studies with positive impact included utilization of continuous or scheduled models via telephone, with frequent monitoring and interventions. Studies identified did not evaluate benefits of video capability over telephone or cost-effectiveness, both of which are useful directions for future study.
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Affiliation(s)
- Joshua D Niznik
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States; VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA, United States; Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States.
| | - Harvey He
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sandra L Kane-Gill
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States; Critical Care Medicine, Biomedical Informatics and Clinical Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, United States; UPMC, Pittsburgh, PA, United States
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McDougall JA, Ferucci ED, Glover J, Fraenkel L. Telerheumatology: A Systematic Review. Arthritis Care Res (Hoboken) 2017; 69:1546-1557. [PMID: 27863164 DOI: 10.1002/acr.23153] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 10/04/2016] [Accepted: 11/15/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To identify and summarize the published and gray literature on the use of telemedicine for the diagnosis and management of inflammatory and/or autoimmune rheumatic disease. METHODS We performed a registered systematic search (CRD42015025382) for studies using MEDLINE (1946 to July 2015), Embase (1974 to July 2015), Web of Science (1900 to July 2015), and Scopus (1946 to July 2015) databases. We included studies that demonstrated the use of telemedicine for diagnosis and/or management of inflammatory/autoimmune rheumatic disease. Following data extraction, we performed a descriptive analysis. RESULTS Our literature search identified 1,468 potentially eligible studies. Of these studies, 20 were ultimately included in this review. Studies varied significantly in publication type, quality of evidence, and the reporting of methods. Most demonstrated a high risk of bias. Rheumatoid arthritis was the most commonly studied rheumatic disease (42% of patients). Studies demonstrated conflicting results regarding the effectiveness of telemedicine (18 found it effective, 1 found it effective but possibly harmful, and 1 found it ineffective). A limited number of studies included some component of a cost analysis (n = 6; 16% of patients); all of these found telemedicine to be cost-effective. CONCLUSION Studies identified by this systematic review generally found telemedicine to be effective for the diagnosis and management of autoimmune/inflammatory rheumatic disease; however, there is limited evidence to support this conclusion. Further studies are needed to determine the best uses of telemedicine for the diagnosis and management of these conditions.
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Mammen JR, Elson MJ, Java JJ, Beck CA, Beran DB, Biglan KM, Boyd CM, Schmidt PN, Simone R, Willis AW, Dorsey ER. Patient and Physician Perceptions of Virtual Visits for Parkinson's Disease: A Qualitative Study. Telemed J E Health 2017; 24:255-267. [PMID: 28787250 DOI: 10.1089/tmj.2017.0119] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background and Introduction: Delivering care through telemedicine directly into the patient's home is increasingly feasible, valuable, and beneficial. However, qualitative data on how patients' and physicians' perceive these virtual house calls are lacking. We conducted a qualitative analysis of perceptions of these visits for Parkinson's disease to (1) determine how patients and physicians perceive virtual visits and (2) identify components contributing to positive and negative perceptions. MATERIALS AND METHODS Qualitative survey data were collected from patients and physicians during a 12-month randomized controlled trial of virtual house calls for Parkinson's disease. Data from 149 cases were analyzed using case-based qualitative content analysis and quantitative sentiment analysis techniques. RESULTS Positive and negative perceptions of virtual visits were driven by three themes: (1) personal benefits of the virtual visit, (2) perceived quality of care, and (3) perceived quality of interpersonal engagement. In general, participants who identified greater personal benefit, high quality of care, and good interpersonal engagement perceived visits positively. Technical problems with the software were commonly mentioned. The sentiment analysis for patients was strongly favorable (+2.5) and moderately favorable for physicians (+0.8). Physician scores were lowest (-0.3) for the ability to perform a detailed motor examination remotely. DISCUSSION Patients and providers generally view telemedicine favorably, but individual experiences are dependent on technical issues. CONCLUSIONS Satisfaction with and effectiveness of remote care will likely increase as common technical problems are resolved.
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Affiliation(s)
| | - Molly J Elson
- 2 The Center for Health and Technology, University of Rochester Medical Center , Rochester, New York
| | - James J Java
- 3 Department of Biostatistics and Computational Biology, University of Rochester , Rochester, New York
| | - Christopher A Beck
- 3 Department of Biostatistics and Computational Biology, University of Rochester , Rochester, New York
| | | | - Kevin M Biglan
- 5 Department of Neurology, University of Rochester Medical Center , Rochester, New York
| | - Cynthia M Boyd
- 6 Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | | | | | - Allison W Willis
- 8 Departments of Neurology and of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania
| | - E Ray Dorsey
- 2 The Center for Health and Technology, University of Rochester Medical Center , Rochester, New York.,5 Department of Neurology, University of Rochester Medical Center , Rochester, New York
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