1
|
Bourré T, Costes M, Mouriaux F, Soethoudt M. [Ophthalmology telemedicine at Rennes University Medical Center: Evaluation of the secure platform OMNIDOC during its first year of use]. J Fr Ophtalmol 2024; 47:104263. [PMID: 39106558 DOI: 10.1016/j.jfo.2024.104263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/17/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION Ophthalmology as a specialty is a pioneer in the area of telemedicine. Remote consultation represents one of the 5 types of telemedicine services, with a growing volume of activity in university hospitals. In November 2020, the ophthalmology department of Rennes University Medical Center launched its remote consultation network with the secured platform OMNIDOC. The goal of this study was to assess its contribution during its first year of use. MATERIALS AND METHODS Beginning in November 2020, ophthalmology consults at Rennes University Medical Center were directed towards the dedicated OMNIDOC network. Three-hundred and forty-one requests for remote consultation were received and analyzed between November 2020 and October 2021. We sent a satisfaction survey to both the requesting and consultant physicians to assess whether or not the network was beneficial. RESULTS Three-hundred and twenty-seven remote consultations requested by 126 practitioners were included in the study. The median response time was 6hours. Every field of the specialty was involved, of which 22.3% were for pediatric patients under 6years of age. Among the requests, 89.7% were regional (Brittany) and came mostly from ophthalmologists (61.77%). Nearly one out of two patients did not require an in-person consultation at Rennes University Medical Center. DISCUSSION The implementation of a remote consultation network allowed access to a rapid, facilitated medical ophthalmology consultation. Such a platform delivers safety and traceability of the interactions. It enhances and optimizes the patients' care pathway and encourages relationships with community physicians.
Collapse
Affiliation(s)
- T Bourré
- Département d'ophtalmologie, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
| | - M Costes
- Département gériatrie, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - F Mouriaux
- Département d'ophtalmologie, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - M Soethoudt
- Département d'ophtalmologie, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| |
Collapse
|
2
|
Hewson T, Minchin M, Lee K, Liu S, Wong E, Edge C, Hard J, Forsyth K, Senior J, Shaw J. Interventions for the detection, monitoring, and management of chronic non-communicable diseases in the prison population: an international systematic review. BMC Public Health 2024; 24:292. [PMID: 38267909 PMCID: PMC10809496 DOI: 10.1186/s12889-024-17715-7] [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: 02/28/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND High rates of health inequalities and chronic non-communicable diseases exist amongst the prison population. This places people in and/or released from prison at heightened risk of multimorbidity, premature mortality, and reduced quality of life. Ensuring appropriate healthcare for people in prison to improve their health outcomes is an important aspect of social justice. This review examines the global literature on healthcare interventions to detect, monitor and manage chronic non-communicable diseases amongst the prison population and people recently released from prison. METHODS Systematic searches of EMBASE, MEDLINE, CINAHL, Web of Science, Scopus, and the Cochrane Library were conducted and supplemented by citation searching and review of the grey literature. The literature searches attempted to identify all articles describing any healthcare intervention for adults in prison, or released from prison in the past 1 year, to detect, monitor, or manage any chronic non-communicable illness. 19,061 articles were identified, of which 1058 articles were screened by abstract and 203 articles were reviewed by full text. RESULTS Sixty-five studies were included in the review, involving 18,311 participants from multiple countries. Most studies were quasi-experimental and/or low to moderate in quality. Numerous healthcare interventions were described in the literature including chronic disease screening, telemedicine, health education, integrated care systems, implementing specialist equipment and staff roles to manage chronic diseases in prisons, and providing enhanced primary care contact and/or support from community health workers for people recently released from prison. These interventions were associated with improvement in various measures of clinical and cost effectiveness, although comparison between different care models was not possible due to high levels of clinical heterogeneity. CONCLUSIONS It is currently unclear which interventions are most effective at monitoring and managing chronic non-communicable diseases in prison. More research is needed to determine the most effective interventions for improving chronic disease management in prisons and how these should be implemented to ensure optimal success. Future research should examine interventions for addressing multimorbidity within prisons, since most studies tested interventions for a singular non-communicable disease.
Collapse
Affiliation(s)
- Thomas Hewson
- Health and Justice Research Network, University of Manchester, Manchester, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
| | - Matilda Minchin
- Health and Justice Research Network, University of Manchester, Manchester, UK
| | - Kenn Lee
- Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Shiyao Liu
- School of Medical Sciences, University of Manchester, Manchester, UK
| | - Evelyn Wong
- School of Medical Sciences, University of Manchester, Manchester, UK
| | - Chantal Edge
- Department of Health and Social Care, UK Health Security Agency, London, UK
| | - Jake Hard
- Health & Justice Information Service, NHS England Health and Justice, London, UK
| | - Katrina Forsyth
- Health and Justice Research Network, University of Manchester, Manchester, UK
| | - Jane Senior
- Health and Justice Research Network, University of Manchester, Manchester, UK
| | - Jennifer Shaw
- Health and Justice Research Network, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Independent Advisory Panel for Deaths in Custody, London, UK
| |
Collapse
|
3
|
Hwang JK, Del Toro NP, Han G, Oh DH, Tejasvi T, Lipner SR. Review of Teledermatology: Lessons Learned from the COVID-19 Pandemic. Am J Clin Dermatol 2024; 25:5-14. [PMID: 38062339 DOI: 10.1007/s40257-023-00826-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 01/23/2024]
Abstract
Utilization of telemedicine for dermatology has greatly expanded since the start of the COVID-19 pandemic, with over 500 new teledermatology studies published since 2020. An updated review on teledermatology is necessary to incorporate new findings and perspectives, and educate dermatologists on effective utilization. We discuss teledermatology in terms of diagnostic accuracy and clinical outcomes, patient and physician satisfaction, considerations for special patient populations, published practice guidelines, cost effectiveness and efficiency, as well as administrative regulations and policies. Our findings emphasize the need for dermatologist education, prioritization of reliable reimbursement systems, and technological innovations to support the continued development of teledermatology in the post-pandemic era.
Collapse
Affiliation(s)
- Jonathan K Hwang
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10021, USA
| | - Natalia Pelet Del Toro
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 1991 Marcus Ave, New Hyde Park, NY, 11042, USA
| | - George Han
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 1991 Marcus Ave, New Hyde Park, NY, 11042, USA
| | - Dennis H Oh
- Department of Dermatology, University of California, San Francisco, 4150 Clement Street, San Francisco, CA, 94121, USA
| | - Trilokraj Tejasvi
- Department of Dermatology, University of Michigan Medicine, 1910 Taubman Center, Ann Arbor, MI, 48109, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10021, USA.
| |
Collapse
|
4
|
Maul LV, Jahn AS, Pamplona GSP, Streit M, Gantenbein L, Müller S, Nielsen ML, Greis C, Navarini AA, Maul JT. Acceptance of Telemedicine Compared to In-Person Consultation From the Providers' and Users' Perspectives: Multicenter, Cross-Sectional Study in Dermatology. JMIR DERMATOLOGY 2023; 6:e45384. [PMID: 37582265 PMCID: PMC10457706 DOI: 10.2196/45384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/15/2023] [Accepted: 06/09/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Teledermatology is currently finding its place in modern health care worldwide as a rapidly evolving field. OBJECTIVE The aim of this study was to investigate the acceptance of teledermatology compared to in-person consultation from the perspective of patients and professionals. METHODS This multicenter, cross-sectional pilot study was performed at secondary and tertiary referral centers of dermatology in Switzerland from August 2019 to January 2020. A customized questionnaire addressing demographics and educational data, experience with telemedicine, and presumed willingness to replace in-patient consultations with teledermatology was completed by dermatological patients, dermatologists, and health care workers in dermatology. RESULTS Among a total of 664 participants, the ones with previous telemedicine experience (171/664, 25.8%) indicated a high level of overall experience with it (patients: 73/106, 68.9%, dermatologists: 6/8, 75.0%, and health care workers: 27/34, 79.4%). Patients, dermatologists, and health care workers were most likely willing to replace in-person consultations with teledermatology for minor health issues (353/512, 68.9%; 37/45, 82.2%; and 89/107, 83.2%, respectively). We observed a higher preference for telemedicine among individuals who have already used telemedicine (patients: P<.001, dermatologists: P=.03, and health care workers, P=.005), as well as among patients with higher educational levels (P=.003). CONCLUSIONS This study indicates that the preference for teledermatology has a high potential to increase over time since previous experience with telemedicine and a higher level of education were associated with a higher willingness to replace in-patient consultations with telemedicine. We assume that minor skin problems are the most promising issue in teledermatology. Our findings emphasize the need for dermatologists to be actively involved in the transition to teledermatology. TRIAL REGISTRATION ClinicalTrials.gov NCT04495036; https://classic.clinicaltrials.gov/ct2/show/NCT04495036.
Collapse
Affiliation(s)
- Lara Valeska Maul
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Anna Sophie Jahn
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Gustavo S P Pamplona
- Jules-Gonin Eye Hospital/Fondation Asile des Aveugles, Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
- Rehabilitation Engineering Laboratory (RELab), Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Markus Streit
- Department of Dermatology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Lorena Gantenbein
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Simon Müller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Mia-Louise Nielsen
- Department of Dermatology, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark
| | - Christian Greis
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
5
|
Lindemann H, Bonetzki T, Frank J. Diagnostic spectrum and therapeutic efficiency in teledermatology-Results of the largest cohort study to date. J Dermatol 2023. [PMID: 36890665 DOI: 10.1111/1346-8138.16769] [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: 10/25/2022] [Revised: 01/30/2023] [Accepted: 02/17/2023] [Indexed: 03/10/2023]
Abstract
Timely and comprehensive dermatological care is a major challenge. Digitized medical consultation offers a possibility to overcome this problem. Here, we studied the diagnostic spectrum and treatment success in teledermatology in the largest cohort to date. Over 12 months, 21 725 individuals received a diagnosis and therapeutic advice using the asynchronous image-text method. In the context of quality management, 1802 individuals (~10%) of both sexes with a mean age of 33.7 years (SD 15.36) received a follow-up 3 months after the initial consultation to assess the treatment outcome. Of these, 81.2% did not require a face-to-face consultation. Therapeutic efficiency could be ascertained in 83.3% of the patients, whereas 10.9% did not improve, and 5.8% did not provide an information on the course of therapy. Teledermatology is a useful tool in digitalized medicine and complements the classical in-person dermatological examination, as shown by the high degree of treatment efficacy in this study. Although face-to-face consultations can not and should not be completely substituted by teledermatology it reflects a significant contribution to patient care and justifies the further expansion of digital structures in dermatological care.
Collapse
Affiliation(s)
- Hanna Lindemann
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Tim Bonetzki
- Ruhr West University of Applied Sciences, Müheim, Germany
| | - Jorge Frank
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
6
|
Le Bras A, Zarca K, Mimouni M, Durand-Zaleski I. Implementing Technologies: Assessment of Telemedicine Experiments in the Paris Region: Reasons for Success or Failure of the Evaluations and of the Deployment of the Projects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3031. [PMID: 36833723 PMCID: PMC9962222 DOI: 10.3390/ijerph20043031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Telemedicine is increasingly viewed as a tool to provide a wide range of health services. This article presents policy lessons drawn from the evaluation of telemedicine experiments conducted in the Paris region. METHODS We used a mixed method design to study telemedicine projects commissioned by the Paris Regional Health Agency between 2013 and 2017. We combined data analysis of the telemedicine projects, review of the protocols, and interviews with stakeholders. RESULTS We identified the following reasons for disappointing outcomes: the outcome measure was requested too early during the experiments because payers required information for budgetary decisions; and the learning curve, technical problems, diversion of use, insufficient number of inclusions, and a lack of adherence prevented the demonstration of successful outcomes of the projects. CONCLUSION The evaluation of telemedicine should be undertaken after sufficient uptake to ensure barriers to implementation are overcome, and to obtain the sample size necessary for statistical power and reduce the average cost for one telemedicine request. Randomized controlled trials should be encouraged with appropriate funding and the follow-up period should be extended.
Collapse
Affiliation(s)
- Alicia Le Bras
- Hôtel Dieu Hospital, URC Eco Ile-de-France (AP-HP), Unité de Recherche Clinique en Économie de la Santé, 1 Place du Parvis Notre Dame, 75004 Paris, France
| | - Kevin Zarca
- Hôtel Dieu Hospital, URC Eco Ile-de-France (AP-HP), Unité de Recherche Clinique en Économie de la Santé, 1 Place du Parvis Notre Dame, 75004 Paris, France
- Department of Public Health, Henri Mondor-Albert Chenevier Hospitals (AP-HP), 94000 Créteil, France
| | - Maroua Mimouni
- Hôtel Dieu Hospital, URC Eco Ile-de-France (AP-HP), Unité de Recherche Clinique en Économie de la Santé, 1 Place du Parvis Notre Dame, 75004 Paris, France
| | - Isabelle Durand-Zaleski
- Hôtel Dieu Hospital, URC Eco Ile-de-France (AP-HP), Unité de Recherche Clinique en Économie de la Santé, 1 Place du Parvis Notre Dame, 75004 Paris, France
- Department of Public Health, Henri Mondor-Albert Chenevier Hospitals (AP-HP), 94000 Créteil, France
- Faculty of Medicine, University Paris-Est, 75000 Créteil, France
- CRESS UMR 1153, 75004 Paris, France
| | | |
Collapse
|
7
|
Sethuram C, Helmer-Smith M, Karunananthan S, Keely E, Singh J, Liddy C. Electronic consultation in correctional facilities worldwide: a scoping review. BMJ Open 2022; 12:e055049. [PMID: 35922103 PMCID: PMC9352998 DOI: 10.1136/bmjopen-2021-055049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To provide an overview of the use of and evidence for eConsult in correctional facilities worldwide. DESIGN Scoping review. DATA SOURCES Three academic databases (MEDLINE, Embase and CINAHL) were searched to identify papers published between 1990 and 2020 that presented data on eConsult use in correctional facilities. The grey literature was also searched for any resources that discussed eConsult use in correctional facilities. Articles and resources were excluded if they discussed synchronous, patient-to-provider or unsecure communication. The reference lists of included articles were also hand searched. RESULTS Of the 226 records retrieved from the academic literature search and 595 from the grey literature search, 22 were included in the review. Most study populations included adult male offenders in a variety of correctional environments. These resources identified 13 unique eConsult services in six countries. Six of these services involved multiple medical specialties, while the remaining services were single specialty. The available evidence was organised into five identified themes: feasibility, cost-effectiveness, access to care, provider satisfaction and clinical impact. CONCLUSIONS This study identified evidence that the use of eConsult in correctional facilities is beneficial and avoids unnecessary transportation of offenders outside of the facilities. It is feasible, cost-effective, increases access to care, has an impact on clinical care and has high provider satisfaction. Some gaps in the literature remain, and we suggest further research on patient satisfaction, enablers and barriers to implementation, and women, youth and transgender populations in this setting to inform service providers and stakeholders. Despite some gaps, eConsult is evidently an important tool to provide timely, high-quality care to offenders.
Collapse
Affiliation(s)
- Claire Sethuram
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mary Helmer-Smith
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sathya Karunananthan
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin Keely
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jatinderpreet Singh
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| |
Collapse
|
8
|
Hoff T, Lee DR. Physician Satisfaction With Telehealth: A Systematic Review and Agenda for Future Research. Qual Manag Health Care 2022; 31:160-169. [PMID: 35132008 DOI: 10.1097/qmh.0000000000000359] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The use of telehealth has risen dramatically due to the Covid-19 pandemic and is expected to be a regular part of patient care moving forward. We know little currently about how satisfied physicians are with this type of patient care. The present systematic review examines physician satisfaction with telehealth, as physician acceptance remains vital to telehealth gaining wider and more permanent adoption. METHODS A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review of empirical articles published between 2010 and 2020 that contain a finding examining physician satisfaction with using telehealth, using 4 article databases (PubMed, Web of Science, COCHRANE, and CINAHL), to identify relevant studies. A standardized data abstraction Excel sheet was used to extract relevant information from each of the included studies. Relevant study findings related to physician satisfaction with telehealth were reviewed for each of the 37 studies by the coauthors. RESULTS A total of 37 published studies were included in the review. Thirty-three of the 37 (89%) studies reviewed were classified as having findings showing moderate to high levels of physician satisfaction with telehealth. Just under 60% of the studies focused on physician satisfaction with providing telemedicine to patients (21/37). Twelve other studies focused on physician satisfaction with teleconsultations with other providers. Four studies examined physician satisfaction with both. The type of patient telemedicine or provider teleconsultation performed varied greatly across the 37 studies, with several different diagnoses or care situations included. Research designs used in the studies were less robust, with all studies using primary data for assessing physician satisfaction but only one study providing any type of multivariate analysis of physician satisfaction with telehealth. CONCLUSION The results of this review support the observation that physicians across different specialties, geographic locations, practice locations, and care situations appear satisfied with engaging in telehealth for both patient care and consultations with other physicians. The research on telehealth should be enhanced, given how ubiquitous telehealth has become due to the Covid-19 pandemic. This enhancement should include larger physician sample sizes in studies of telehealth satisfaction; more research focused on telehealth in the primary care setting; and the types of virtual modalities that have become more commonplace for physicians to use due to the Covid-19 pandemic.
Collapse
Affiliation(s)
- Timothy Hoff
- Management, Healthcare Systems, and Health Policy (Dr Hoff), and School of Pharmacy (Dr Lee), Northeastern University, Boston, Massachusetts
| | | |
Collapse
|
9
|
King I, Heidler P. Teleconsultation Services in Pediatric Primary Care in Austria: Upgrading Clinical Decision Support in Primary Health Care Settings. Telemed J E Health 2022; 28:1470-1478. [PMID: 35357947 DOI: 10.1089/tmj.2021.0452] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The general practitioners' increasing comprehensive pediatric health care provision in Austria faces great challenges in ensuring high-quality health care in the future as the shortage of pediatricians continues to grow. Tele-expertise services provide an excellent opportunity to facilitate and strengthen interdisciplinary collaboration and access medical expertise of uncertainties in diagnosis and treatment plans. The purpose of this study was to investigate and evaluate the usability, applicability, and clinical advantages of an Austrian tele-expertise platform for doctors, emphasizing its value to strengthen collaborative efforts to extend and ensure quality care in infant, child, and adolescent health while focusing on diagnostic acceleration, verification, and potential modification of a treatment plan. Materials and Methods: A mixed-method approach included the retrospective evaluation of data provided via Intercom to elicit professional and geographical distribution and analysis of four hypotheses (H1: geographic distribution of initial enquires; H2: pediatric expertise level of the requester; H3: teleconsultations will result in changes in diagnosis and therapeutic decisions; and H4: teleconsultations stimulate cooperation and collaboration between physicians of all specialties). The study was based on survey questionnaires and qualitative semi-structured interviews. Discussion: Benefits were the most apparent in shorter diagnosis times, a potential quality increase in care, and cooperative stimulation. Intended therapy plans were found to be more sensitive to modification. Nevertheless, an overall positive attitude toward the teleconsultation chat became obvious. Moreover, the potential regarding quality improvements in pediatric primary care, shorter diagnosis time, and improved treatment options was found. Conclusions: Outcomes are urging Austrian health authorities to establish political and legal structures for appropriate monetary compensation and broad application of an expert consultation system. The article further highlights the importance of teleconsultations in critical situations, such as pandemic times.
Collapse
Affiliation(s)
- Isabel King
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland, Australia.,Sunshine Coast Health Institute, Birtinya, Australia
| | - Petra Heidler
- Department for Economy and Health, Danube University Krems, Krems, Austria.,Department of International Trade and Sustainable Economy, IMC University of Applied Sciences Krems, Krems, Austria
| |
Collapse
|
10
|
López-Liria R, Valverde-Martínez MÁ, López-Villegas A, Bautista-Mesa RJ, Vega-Ramírez FA, Peiró S, Leal-Costa C. Teledermatology versus Face-to-Face Dermatology: An Analysis of Cost-Effectiveness from Eight Studies from Europe and the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2534. [PMID: 35270227 PMCID: PMC8909884 DOI: 10.3390/ijerph19052534] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/11/2022] [Accepted: 02/19/2022] [Indexed: 02/04/2023]
Abstract
(1) Background: The aim of this systematic review was to compare the cost-effectiveness of two follow-up methods (face-to-face and telemedicine) used in dermatology in the last ten years. (2) Methods: A search for articles that included economic analyses was conducted in August 2021 in the databases PubMed, Medline, Scielo and Scopus using the following keywords: "Cost-Benefit Analysis", "Dermatology", "Telemedicine", "Primary Health Care", as well as other search terms and following the PICOS eligibility criteria. (3) Results: Three clinical trials and five observational studies were analyzed, providing information for approximately 16,539 patients (including four cost-minimization or saving analyses, three cost-effectiveness analyses, and one cost-utility analysis) in Europe and the United States. They describe the follow-up procedures in each of the cases and measure and analyze the direct and indirect costs and effectiveness. All the articles indicate that teledermatology lowers costs and proves satisfactory to both patients and professionals. (4) Conclusions: Although it has been found that follow-up via teledermatology can be more efficient than traditional hospital follow-up, more work is needed to establish evaluation protocols and procedures that measure key variables more equally and demonstrate the quality of the evidence of said studies.
Collapse
Affiliation(s)
- Remedios López-Liria
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almeria, Spain; (R.L.-L.); (M.Á.V.-M.)
| | - María Ángeles Valverde-Martínez
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almeria, Spain; (R.L.-L.); (M.Á.V.-M.)
| | - Antonio López-Villegas
- Social Involvement of Critical and Emergency Medicine, CTS-609 Research Group, Poniente Hospital, 04700 El Ejido, Spain
| | | | | | - Salvador Peiró
- Health Services Research Unit, FISABIO-Public Health, 46020 Valencia, Spain;
| | - Cesar Leal-Costa
- Nursing Department, University of Murcia, 30120 El Palmar, Spain;
| |
Collapse
|
11
|
Berard C, Di Mascio T, Montaleytang M, Couderc AL, Villani P, Honoré S, Daumas A, Correard F. Telemedication Reviews to Optimize Medication Prescription for Older People in Nursing Homes. Telemed J E Health 2021; 28:1225-1232. [PMID: 34958258 DOI: 10.1089/tmj.2021.0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Older people living in nursing homes (NH) are at a higher risk of preventable drug-related adverse events because of age-related physiological changes, polypathology, and polypharmacy. NH residents are particularly exposed to potentially inappropriate medications (PIMs). Many strategies have been developed to improve the quality and the safety of drug prescription in NH, including medication reviews (MRs). Methods: In the context of the application of telemedicine, we developed and are currently implementing a novel hospital expert-based MRs through tele-expertise (or "telemedication review," telemedication reviews hereafter [TMR]) in French NH residents. The impact of these TMR on unplanned hospitalizations 3 months after implementation is assessed. TMR consider all available sociodemographic, clinical, biological, and pharmaceutical data pertaining to the patient and are performed in accordance with their health care objectives. Results: The preliminary results for the 39 TMRs performed to date (September 2021) showed that a total of 402 PIMs were detected, and all residents had at least one PIM. We also present the feasibility and the usefulness of this novel TMR for NH, illustrating these preliminary results with two concrete TMR experiences. Among the 39 TMR performed, the average acceptance rate of expert recommendations made to general practitioners (GP) working in NH was ∼33%. Discussion and Conclusions: The success of this novel TMR depends on how the proposed prescription adjustments made by the hospital expert team are subsequently integrated into health care practices. The low acceptance rate by GP highlights the need to actively involve these professionals in the process of developing TMR, with a view to encouraging them to act on proposed adjustments.
Collapse
Affiliation(s)
- Charlotte Berard
- Pharmacy Department, AP-HM, Marseille, France.,Clinical Pharmacy Unit, Faculty of Pharmacy, Aix-Marseille University, Marseille, France
| | - Thomas Di Mascio
- Pharmacy Department, AP-HM, Marseille, France.,Clinical Pharmacy Unit, Faculty of Pharmacy, Aix-Marseille University, Marseille, France
| | - Maeva Montaleytang
- Pharmacy Department, AP-HM, Marseille, France.,Clinical Pharmacy Unit, Faculty of Pharmacy, Aix-Marseille University, Marseille, France
| | - Anne Laure Couderc
- Internal Medicine, Geriatrics and Therapeutics Department, AP-HM, Marseille, France
| | - Patrick Villani
- Internal Medicine, Geriatrics and Therapeutics Department, AP-HM, Marseille, France
| | - Stephane Honoré
- Pharmacy Department, AP-HM, Marseille, France.,Clinical Pharmacy Unit, Faculty of Pharmacy, Aix-Marseille University, Marseille, France
| | - Aurelie Daumas
- Internal Medicine, Geriatrics and Therapeutics Department, AP-HM, Marseille, France
| | - Florian Correard
- Pharmacy Department, AP-HM, Marseille, France.,Clinical Pharmacy Unit, Faculty of Pharmacy, Aix-Marseille University, Marseille, France
| |
Collapse
|
12
|
Menon AK, Adhya S, Kanitkar M. Health technology assessment of telemedicine applications in Northern borders of India. Med J Armed Forces India 2021; 77:452-458. [PMID: 34594075 PMCID: PMC8459044 DOI: 10.1016/j.mjafi.2021.03.007] [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: 03/04/2020] [Accepted: 03/18/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Economic evaluations of health technology help to decide which interventions are to be continued and which are to be terminated. In the Armed Forces, the provision of efficient medical services requires meticulous planning for optimal utilization of scarce resources. We report a cost analysis of telemedicine and air transportation of casualties, and attempt to identify the strengths, weaknesses, opportunities and threats of telemedicine services. METHODS The costs incurred in telemedicine were compared with the cost of air evacuation. A qualitative assessment of telemedicine was undertaken through in-depth interviews with the hospital authorities and focused group discussions with medical officers and paramedical staff. RESULTS 34.2% of casualties could successfully be stabilized on-site using available healthcare resources with the peripheral hospitals. 18 casualties were managed at the periphery on-site by teleconsultations each year, averting air-transportation efforts. Estimated cost savings achieved in the initial management of casualty by teleconsultation was Rs. 146,111 per case. The strengths of telemedicine are knowledge updation, faster decision making, improved pre-hospital care and improved confidence in case management. CONCLUSION The reduction in air efforts and remote management of casualties make a substantive case for scaling up telemedicine interventions.
Collapse
Affiliation(s)
| | - Saibal Adhya
- Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | | |
Collapse
|
13
|
Rai RS, Mehta N, Larochelle R, Rathi S, Schuman JS. A summary of eye-related visits to a tertiary emergency department. Sci Rep 2021; 11:3823. [PMID: 33589688 PMCID: PMC7884403 DOI: 10.1038/s41598-021-83351-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 01/27/2021] [Indexed: 11/17/2022] Open
Abstract
Timely ophthalmologic consultation is important to ensure patients receive high quality ophthalmologic care in the Emergency Department (ED). Tele-ophthalmology may prove useful in safely and efficiently managing ED eye-related complaints. Prior to implementing such a solution, current consultation patterns must be understood. We aimed to assess case-mix acuity and consultation workflow patterns in the ophthalmology consult service at a tertiary emergency department in New York City. The medical records of patients with eye-related complaints who presented to the ED between January 1, 2015 and December 31, 2015 were reviewed. Visits were retrospectively assigned acuities and the ophthalmologic subspecialty involved in the case was recorded. The number of ophthalmologic consultations ordered and consultant response times were analyzed. Patients who were transferred to the ED for eye-related complaints were included. The ED received 1090 eye-related complaints in this period. 60% were retrospectively assigned low acuity, 27% were assigned medium acuity, and 13% were assigned high acuity. Ophthalmology was consulted on 19% of low, 18% of medium, and 48% of high acuity cases. 44% of complaints involved the anterior segment and 30% involved oculoplastics. 2/3 of transfer patients initially assigned high acuity were downgraded to low acuity upon examination. On average, the consult note was created and signed within 109 and 153 min, respectively, after consult order. ED consults are heavily weighted towards pathology of low-to-medium acuity affecting the anterior segment and ocular adnexa. Currently available tele-ophthalmology technology can potentially address a large volume of eye-related visits.
Collapse
Affiliation(s)
- Ravneet S Rai
- Department of Ophthalmology, New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA.
| | - Nitish Mehta
- Department of Ophthalmology, New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| | - Ryan Larochelle
- Department of Ophthalmology, New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| | - Siddarth Rathi
- Department of Ophthalmology, New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| | - Joel S Schuman
- Department of Ophthalmology, New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| |
Collapse
|
14
|
Clark JJ, Snyder AM, Sreekantaswamy SA, Petersen MJ, Lewis BKH, Secrest AM, Florell SR. Dermatologic care of incarcerated patients: A single-center descriptive study of teledermatology and face-to-face encounters. J Am Acad Dermatol 2021; 85:1660-1662. [PMID: 33434597 DOI: 10.1016/j.jaad.2020.12.076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/18/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Joshua J Clark
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Ashley M Snyder
- Department of Dermatology, University of Utah, Salt Lake City, Utah; Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | | | - Marta J Petersen
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | | | - Aaron M Secrest
- Department of Dermatology, University of Utah, Salt Lake City, Utah; Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Scott R Florell
- Department of Dermatology, University of Utah, Salt Lake City, Utah.
| |
Collapse
|
15
|
Ohannessian R, Yaghobian S, Duong TA, Medeiros de Bustos E, Le Douarin YM, Moulin T, Salles N. Letter to the Editor: France Is the First Country to Reimburse Tele-Expertise at a National Level to All Medical Doctors. Telemed J E Health 2020; 27:378-381. [PMID: 32552392 DOI: 10.1089/tmj.2020.0083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Robin Ohannessian
- Integrative and Clinic Neuroscience Laboratory EA-481, University of Franche-Comté, Besançon, France.,Télémédecine 360, TLM360, Paris, France.,French Society of Digital Health, Paris, France
| | | | - Tu Anh Duong
- Dermatology Department, Henri Mondor Hospital, Créteil, France
| | - Elisabeth Medeiros de Bustos
- Integrative and Clinic Neuroscience Laboratory EA-481, University of Franche-Comté, Besançon, France.,Department of Neurology, University Hospital of Besançon, Besançon, France
| | | | - Thierry Moulin
- Integrative and Clinic Neuroscience Laboratory EA-481, University of Franche-Comté, Besançon, France.,French Society of Digital Health, Paris, France.,Department of Neurology, University Hospital of Besançon, Besançon, France
| | - Nathalie Salles
- French Society of Digital Health, Paris, France.,Department of Clinical Gerontology, Bordeaux University Hospital, Pessac, France
| |
Collapse
|