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AlShareef SM, AlWabel AA. Patient Opinions about Virtual Consultations in Saudi Arabia: A Nationwide Cross-Sectional Study. Healthcare (Basel) 2024; 12:1001. [PMID: 38786410 PMCID: PMC11120990 DOI: 10.3390/healthcare12101001] [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: 03/29/2024] [Revised: 04/29/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
There have been no nationwide studies of patient opinions regarding telehealth in Saudi Arabia to identify the factors that might influence patients' perceptions and satisfaction. This was a prospective cross-sectional study of adults in the general population who last engaged with a healthcare practitioner via a virtual appointment. The participants were recruited by convenience sampling across Saudi Arabia between November 2023 and January 2024, completing a questionnaire that gathered data on (i) basic demographic and virtual consultation information and (ii) telehealth service delivery and technology based on the Telehealth Usability Questionnaire. Of the 916 participants, 53.7% were female, with a mean age of 47.2 (14.1) years. Nearly half attended primary care appointments, with the remainder attending a range of hospital specialties. Over 90% preferred having a virtual appointment over an in-person visit. About half had telephone consultations, while about a third had video calls through hospital-provided platforms; >90% found virtual appointments useful and convenient, easy to use, effective, reliable, and produced a favorable clinical interaction; and 97.4% were satisfied with their remote consultation experience despite the technical interruptions. The individuals who were less happy with their virtual consultation were significantly younger, lived in urban areas, attended specialty clinics, were seen by a psychologist, preferred in-person appointments, and had consultations by telephone. These data provide momentum to continue with and expand telehealth, especially through video calls, supported by educational initiatives.
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Affiliation(s)
- Saad Mohammed AlShareef
- Department of Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), P.O. Box 7544, Riyadh 13317, Saudi Arabia
| | - Abdullah Abdulaziz AlWabel
- Seha Virtual Hospital, Ministry of Health, Riyadh 12382, Saudi Arabia
- King Saud University Medical City, King Saud University, Riyadh 12372, Saudi Arabia
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Park C, Lee BC. A Systematic Review of the Effects of Interactive Telerehabilitation with Remote Monitoring and Guidance on Balance and Gait Performance in Older Adults and Individuals with Neurological Conditions. Bioengineering (Basel) 2024; 11:460. [PMID: 38790328 PMCID: PMC11117498 DOI: 10.3390/bioengineering11050460] [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: 04/11/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Recognizing the growing interests and benefits of technology-assisted interactive telerehabilitation in various populations, the aim of this review is to systematically review the effects of interactive telerehabilitation with remote monitoring and guidance for improving balance and gait performance in older adults and individuals with neurological conditions. The study protocol for this systematic review was registered with the international prospective register of systematic reviews (PROSPERO) with the unique identifier CRD42024509646. Studies written in English published from January 2014 to February 2024 in Web of Science, Pubmed, Scopus, and Google Scholar were examined. Of the 247 identified, 17 were selected after initial and eligibility screening, and their methodological quality was assessed with the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. All 17 studies demonstrated balance and gait performance improvement in older adults and in individuals with stroke, Parkinson's disease, and multiple sclerosis following 4 or more weeks of interactive telerehabilitation via virtual reality, smartphone or tablet apps, or videoconferencing. The findings of this systematic review can inform the future design and implementation of interactive telerehabilitation technology and improve balance and gait training exercise regimens for older adults and individuals with neurological conditions.
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Affiliation(s)
- Catherine Park
- Division of Digital Healthcare, Yonsei University, Wonju 26493, Republic of Korea
| | - Beom-Chan Lee
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA
- Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX 77204, USA
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Tensen E, van Buggenum J, Witkamp L, Jaspers MW, Peute LW. The Store-and-Forward Telemedicine Service User-satisfaction Questionnaire: Development and validation of a questionnaire to monitor and assess health care providers' experiences. J Telemed Telecare 2024; 30:131-141. [PMID: 34328383 DOI: 10.1177/1357633x211032409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION With wider adoption of store-and-forward telemedicine accelerating, particularly post-coronavirus disease 2019, it is essential to understand health care providers' (HCPs) satisfaction with digital solutions offered by telemedicine organizations to (continuously) guarantee service quality. We developed the Store-and-Forward Telemedicine Service User-satisfaction Questionnaire to monitor and assess HCPs' experiences with contracted telemedicine organizations. METHODS Questionnaire construction (phase 1) consisted of exploratory literature search on validated telemedicine satisfaction questionnaires, a telemedicine domain and human factors expert focus group, stakeholder focus group (customer service employee and telemedicine account managers), and two pre-testing rounds among 18 HCPs. The pilot questionnaire (phase 2) was sent to 2179 HCPs for validity and reliability assessment. RESULTS Phase 1: Two validated questionnaires (73 items overall) were used as input for Store-and-Forward Telemedicine Service User-satisfaction Questionnaire. Revisions resulted in 61 items. Phase 2: the pilot 61-item Store-and-Forward Telemedicine Service User-satisfaction Questionnaire instrument was completed by 181 of 2179 invited HCPs. Forty-one mandatory items of the pilot Store-and-Forward Telemedicine Service User-satisfaction Questionnaire rated on a 5-point Likert scale were included in psychometric analyses and resulted in six reliable scales: training, communication, organization policy and strategy, interaction platform, usage platform, and working conditions. DISCUSSION The Store-and-Forward Telemedicine Service User-satisfaction Questionnaire is a reliable and valid questionnaire for measuring HCPs' satisfaction with store-and-forward telemedicine services as part of a continuous quality improvement cycle. Reimbursement questions were excluded due to low response. As adoption of telemedicine may be impeded by financial compensation issues, this requires consideration in future telemedicine questionnaires. Store-and-Forward Telemedicine Service User-satisfaction Questionnaire including video consultation items is needed to monitor also synchronous services as these expanded in the coronavirus disease 2019 pandemic.
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Affiliation(s)
- Esmée Tensen
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Ksyos Health Management Research, Amstelveen, the Netherlands
| | - Johan van Buggenum
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Leonard Witkamp
- Ksyos Health Management Research, Amstelveen, the Netherlands
| | - Monique Wm Jaspers
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Linda Wp Peute
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Cabello MKE, De Guzman JE. Utilization of accessible resources in the fabrication of an affordable, portable, high-resolution, 3D printed, digital microscope for Philippine diagnostic applications. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002070. [PMID: 37988332 PMCID: PMC10662710 DOI: 10.1371/journal.pgph.0002070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 09/22/2023] [Indexed: 11/23/2023]
Abstract
Philippine clinical laboratory licensing requirements mandate that diagnostic microscopy for Tuberculosis (TB) sputum microscopy, urinalysis, pap smears, wet smears, an option for complete blood count, stool exams, and malaria thick and thin smears should be accessible and available in health facilities including primary care centers. However, access to these essential diagnostics is hampered by the lack of trained personnel, relatively high costs for supplies and equipment especially in rural and underserved areas. This served as motivation for our team to utilize accessible resources in the form of affordable 3D printers, available CAD software, and components to build our low-cost Openflexure microscope (OFM) prototype. We successfully fabricated our prototype for a total of 310$ with a weight of 525g. We used pathology teaching slides from the Ateneo School of Medicine and Public Health and examined the OFM prototype imaging capabilities. The calculated image resolution was 13% higher compared to an LED light microscope sample captured by a mobile phone at 40x and 15% for 100x. The sampled slide images had adequate clarity with some identifiable cellular features for Rheumatic Heart Disease (RHD), Tuberculosis in soft tissue, and Ascariasis. We were able to correct the color aberrations of the OFM we built and was able to scan images up to 1000x magnification without using oil. Given the features and cost, the OFM prototype can be an attractive and affordable option as an alternative or augmentation to diagnostic microscopy in Philippine primary care. Moreover, it may enable telepathology to support diagnostic microscopy in frontline care.
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Affiliation(s)
- Mark Kristan Espejo Cabello
- Research Faculty, Ateneo de Manila University School of Medicine and Public Health, Center for Research and Innovation, Pasig City, National Capital Region, Philippines
| | - Jeremie E. De Guzman
- Research Faculty, Ateneo de Manila University School of Medicine and Public Health, Center for Research and Innovation, Pasig City, National Capital Region, Philippines
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Lee C, Ahn J, Lee BC. A Systematic Review of the Long-Term Effects of Using Smartphone- and Tablet-Based Rehabilitation Technology for Balance and Gait Training and Exercise Programs. Bioengineering (Basel) 2023; 10:1142. [PMID: 37892872 PMCID: PMC10604191 DOI: 10.3390/bioengineering10101142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
Recent advances in wearable motion sensors, mobile devices, the Internet of Things, and telecommunications have created new potential for telerehabilitation. Recognizing that there is no systematic review of smartphone- or tablet-based balance and gait telerehabilitation technology for long-term use (i.e., four weeks or more), this systematic review summarizes the effects of smartphone- or tablet-based rehabilitation technology on balance and gait exercise and training in balance and gait disorders. The review examined studies written in English published from 2013 to 2023 in Web of Science, Pubmed, Scopus, and Google Scholar. Of the 806 studies identified, 14 were selected, and the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies was applied to evaluate methodological quality. The systematic review concluded that all 14 studies found balance and gait performance improvement after four weeks or more of balance and gait telerehabilitation. Ten of the 14 studies found that carry-over effects (improved functional movements, muscle strength, motor capacity, cognition, and reduced fear of falling and anxiety levels) were maintained for weeks to months. The results of the systematic review have positive technical and clinical implications for the next-generation design of rehabilitation technology in balance and gait training and exercise programs.
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Affiliation(s)
- Chihyeong Lee
- Department of Physical Education, Seoul National University, Seoul 08826, Republic of Korea;
| | - Jooeun Ahn
- Department of Physical Education, Seoul National University, Seoul 08826, Republic of Korea;
- Institute of Sport Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Beom-Chan Lee
- Institute of Sport Science, Seoul National University, Seoul 08826, Republic of Korea
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA
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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.
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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
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Gupta N, Gupta MK, Joshi NK, Mantri N, Sridevi G, Patel M, Goel AD, Singh K, Garg MK, Bhardwaj P. Is telemedicine a holy grail in healthcare policy: clinicians' and patients' perspectives from an Apex Institution in Western India. BMC Health Serv Res 2023; 23:161. [PMID: 36793030 PMCID: PMC9930698 DOI: 10.1186/s12913-022-09013-y] [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: 09/12/2022] [Accepted: 12/27/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND This study aimed to explore the perception of doctors regarding telemedicine consultations and the level of patient satisfaction with the services received through teleconsultations. METHODS This cross-sectional study was conducted on clinicians who provided teleconsultations and patients who received teleconsultations in an Apex healthcare institution in Western India. Semi-structured interview schedules were used to record the quantitative and qualitative information. Clinicians' perceptions and patients' satisfaction were assessed using two different 5-point Likert scales. Data were analyzed using SPSS v.23 using non-parametric tests (Kruskal Wallis and Mann-Whitney U). RESULTS A total of 52 clinicians who delivered teleconsultations and 134 patients who received teleconsultations from those doctors were interviewed in this study. For 69% of doctors, telemedicine was feasible to implement, and for the rest, it was challenging. Doctors believe telemedicine is convenient for patients (77%) and prevents the transmission of infection (94.2%). Difficulty in clinical evaluation (73%), communication (55.7%), network connectivity (34%), diagnosis and investigations (32%), and patients' e-illiteracy (32%) were the most common challenges faced by clinicians. Patients' experiences were positive in terms of ease of registration (82.1%), audio quality (100%), freedom to discuss medicine (94.8%), and comprehension of the diagnoses (88.1%). Patients expressed satisfaction with the length of the teleconsultation (81.4%), the advice and care they received (78.4%), and the manner and communication of the clinicians (78.4%). CONCLUSIONS Though there were some challenges in the implementation of telemedicine, the clinicians perceived it quite helpful. The majority of the patients were satisfied with teleconsultation services. Difficulty in registration, lack of communication, and a deep-rooted mindset of physical consultations were the primary concerns from the patient side.
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Affiliation(s)
- Nainsi Gupta
- grid.463267.20000 0004 4681 1140School of Public Health, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan India
| | - Manoj Kumar Gupta
- School of Public Health, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India. .,Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India.
| | - Nitin Kumar Joshi
- grid.463267.20000 0004 4681 1140School of Public Health, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan India
| | - Neha Mantri
- grid.463267.20000 0004 4681 1140School of Public Health, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan India
| | - G. Sridevi
- grid.463267.20000 0004 4681 1140Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan India
| | - Mamta Patel
- grid.463267.20000 0004 4681 1140School of Public Health, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan India
| | - Akhil Dhanesh Goel
- grid.463267.20000 0004 4681 1140Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan India
| | - Kuldeep Singh
- grid.463267.20000 0004 4681 1140Department of Pediatrics, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan India
| | - M. K. Garg
- grid.463267.20000 0004 4681 1140Department of Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan India
| | - Pankaj Bhardwaj
- grid.463267.20000 0004 4681 1140School of Public Health, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan India ,grid.463267.20000 0004 4681 1140Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan India
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Hilty DM, Serhal E, Crawford A. A Telehealth and Telepsychiatry Economic Cost Analysis Framework: Scoping Review. Telemed J E Health 2023; 29:23-37. [PMID: 35639444 DOI: 10.1089/tmj.2022.0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Introduction: Despite a good evidence base for telepsychiatry (TP), economic cost analyses are infrequent and vary in quality. Methods: A scoping review was conducted based on the research question, "From the perspective of an economic cost analysis for telehealth and telepsychiatry, what are the most meaningful ways to ensure a study/intervention improved clinical care, provided value to participants, had population level impact, and is sustainable?" The search in seven databases focused on keywords in four concept areas: (1) economic cost analysis, (2) evaluation, (3) telehealth and telepsychiatry, and (4) quantifiable health status outcomes. The authors reviewed the full-text articles based on the inclusion (Medical Subject Headings [MeSH] of the keywords) and exclusion criteria. Results: Of a total of 2,585 potential references, a total of 99 articles met the inclusion criteria. The evaluation of telehealth and TP has focused on access, quality, patient outcomes, feasibility, effectiveness, outcomes, and cost. Cost-effectiveness, cost-benefit, and other analytic models are more common with telehealth than TP studies, and these studies show favorable clinical, quality of life, and economic impact. A standard framework for economic cost analysis should include: an economist for planning, implementation, and evaluation; a tool kit or guideline; comprehensive analysis (e.g., cost-effectiveness or cost-benefit) with an incremental cost-effectiveness ratio; measures for health, quality of life, and utility outcomes for populations; methods to convert outcomes into economic benefits (e.g., monetary, quality of adjusted life year); broad perspective (e.g., societal perspective); sensitivity analysis for uncertainty in modeling; and adjustments for differential timing (e.g., discounting and future costs). Conclusions: Technology assessment and economic cost analysis-such as effectiveness and implementation science approaches-contribute to clinical, training, research, and other organizational missions. More research is needed with a framework that enables comparisons across studies and meta-analyses.
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Affiliation(s)
- Donald M Hilty
- Northern California Veterans Administration Health Care System, Mather, California, USA.,Department of Psychiatry & Behavioral Sciences, UC Davis, Sacramento, California, USA
| | - Eva Serhal
- ECHO Ontario Mental Health and ECHO Ontario Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Allison Crawford
- ECHO Ontario Mental Health and ECHO Ontario Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
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Adroher Mas C, Calvo Aroca C, Casadevall Llandrich R, López Seguí F, Martin Carpi J, García-Cuyàs F. Evaluation of the Effectiveness of Telemedicine Visits in a Pediatric Gastroenterology Service in the Context of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15999. [PMID: 36498072 PMCID: PMC9740743 DOI: 10.3390/ijerph192315999] [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: 07/28/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND During the first months of COVID-19, the Gastroenterology, Hepatology and Nutrition service of the Hospital Sant Joan de Déu in Barcelona, a leading pediatric center in Spain, introduced a new model of non-face-to-face care. OBJECTIVE To evaluate the impact of telephone consultations compared to those conducted face-to-face on healthcare utilization. METHODOLOGY Two main indicators of effectiveness are used: the degree of resolution (percentage of first telemedicine visits that did not generate any new visits in the following 4 and 12 months) and the average number of subsequent visits. A distinction was made between visits for general pathologies (less complex) and those for pathologies treated in monographic consultations (chronic or complex pathologies). Effectiveness at 4 and 12 months was also compared. RESULTS After 4 months from the first visit, the degree of resolution is lower in the first telemedicine visits than in face-to-face visits for both general pathologies and those of monographic agendas for chronic and complex pathologies. After twelve months, the first general telemedicine visits are less resolute than face-to-face visits, while the resolution rate is the same for chronic and complex pathology visits. Each telemedicine visit generates on average more visits than face-to-face visits. In the short term, 133.4% more in the case of general visits and 51.4% more in the case of chronic and complex visits. In the long term, general telemedicine visits generate 57.31% more visits, while no statistically significant difference is observed between chronic and complex face-to-face and telemedicine visits. CONCLUSION The results of this study show that the resolution capacity of the non-face-to-face model in pediatric care in the pandemic context is generally lower and generates more successive visits than the face-to-face model. This lower performance of the telemedicine model should be counterbalanced with its advantages.
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Affiliation(s)
- Cristina Adroher Mas
- Sant Joan de Déu Hospital, Catalan Ministry of Health, 08950 Barcelona, Spain
- Center for Research in Health and Economics, Pompeu Fabra University (CRES-UPF), 08002 Barcelona, Spain
| | - Celia Calvo Aroca
- Sant Joan de Déu Hospital, Catalan Ministry of Health, 08950 Barcelona, Spain
- Center for Research in Health and Economics, Pompeu Fabra University (CRES-UPF), 08002 Barcelona, Spain
| | | | - Francesc López Seguí
- Center for Research in Health and Economics, Pompeu Fabra University (CRES-UPF), 08002 Barcelona, Spain
| | - Javier Martin Carpi
- Sant Joan de Déu Hospital, Catalan Ministry of Health, 08950 Barcelona, Spain
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Valk-Draad MP, Bohnet-Joschko S. Nursing Home-Sensitive Hospitalizations and the Relevance of Telemedicine: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12944. [PMID: 36232255 PMCID: PMC9566431 DOI: 10.3390/ijerph191912944] [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: 08/19/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
The aging of society is increasing the number of hospitalizations of nursing home residents. Telemedicine might help reduce the frequency of these potentially risk-associated hospitalizations. This scoping review looked for evidence of a change in the rate of hospitalization and, if mentioned, any cost savings and/or staff acceptance of the use of telemedicine in a nursing home setting. To identify available evidence, the electronic databases PubMed, Livivo, EBSCO and JSTOR were searched (without time or regional constraints) for comparative primary research studies on this topic in peer-reviewed journals. A total of 1127 articles were retrieved and 923 titles and abstracts were screened, with 16 studies published between 2001 and 2022 being included. Telemedicine consultation reduced the hospitalization of nursing home residents in 14/16 and care costs in 8/11 articles. Staff satisfaction was mentioned positively in five studies. Most studies used telemedicine involving medical diagnostic technologies (10), (electronic) health records (9), specialists (9) and specialized nursing staff (11). Few studies had a higher level of evidence: only one randomized clinical trial was included. There is the need for high credibility studies, using guidelines on protocol and reporting, to better understand the hindering and facilitating factors of telemedicine provision in the healthcare of nursing home residents.
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11
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Khair A, Cromwell PM, Abdelatif A, Boland F, O'Reilly C, Maudarbaccus N, Aremu M, Arumugasamy M, Walsh TN. Text Messaging, Telephone, or In-Person Outpatient Visit to the Surgical Clinic: A Randomized Trial. J Surg Res 2022; 280:226-233. [PMID: 36007481 PMCID: PMC9394432 DOI: 10.1016/j.jss.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Routine outpatient follow-up visits for surgical patients are a source of strain on health-care resources and patients. With the COVID-19 pandemic adding a new urgency to finding the safest follow-up arrangement, text message follow-up might prove an acceptable alternative to a phone call or an in-person clinic visit. METHODS An open-label, three-arm, parallel randomized trial was conducted. The interventions were traditional in-person appointment, a telephone call, or a text message. The primary outcome was the number of postdischarge complications identified. The secondary outcomes were patient satisfaction with follow-up, future preference, default to follow-up, and preference to receiving medical information by text message. RESULTS Two hundred eight patients underwent randomization: 50 in the in-person group, 80 in the telephone group, and 78 in the text message group. There was no difference in the number of reported complications: 5 (10%) patients in the in-person group, 7 (9%) patients in the text group, and 11 (14%) patients in the telephone group (P = 0.613). The preferred method of follow-up was by telephone (106, 61.6%). The least preferred was the in-person follow-up (15, 8.7%, P = 0.002), which also had the highest default rate (44%). CONCLUSIONS There was no evidence that text messages and telephone calls are unsafe and ineffective methods of follow-up. Although most patients are happy to receive results by text message, the majority of patients would prefer a telephone follow-up and are less likely to default by this method. Health-care systems should develop telehealth initiatives when planning health-care services in the wake of the COVID-19 pandemic.
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Affiliation(s)
- Areeg Khair
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul M Cromwell
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Asila Abdelatif
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiona Boland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colum O'Reilly
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nadiim Maudarbaccus
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Muyiwa Aremu
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mayilone Arumugasamy
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tom N Walsh
- Department of Surgery, Connolly Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
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12
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Singleton AC, Raeside R, Hyun KK, Partridge SR, Di Tanna GL, Hafiz N, Tu Q, Tat-Ko J, Sum SCM, Sherman KA, Elder E, Redfern J. Electronic Health Interventions for Patients With Breast Cancer: Systematic Review and Meta-Analyses. J Clin Oncol 2022; 40:2257-2270. [PMID: 35500200 PMCID: PMC9273371 DOI: 10.1200/jco.21.01171] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Ongoing supportive care using electronic health (eHealth) interventions has the potential to provide remote support and improve health outcomes for patients with breast cancer. This study aimed to evaluate the effectiveness of eHealth interventions on patient-reported outcomes (quality of life [QOL], self-efficacy, and mental or physical health) for patients during and after breast cancer treatment and patient-reported experience measures (acceptability and engagement). METHODS Systematic review with meta-analyses (random-effects model) of randomized controlled trials was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Nine databases were searched using a prespecified search strategy. Patient-directed eHealth interventions for adult patients during or after active breast cancer treatment measuring QOL, self-efficacy, and mental (depressive, anxiety, and distress symptoms) or physical (physical activity, nutrition, and fatigue) health outcomes were included. Data from eligible full-text articles were independently extracted by six observers. RESULTS Thirty-two unique studies (4,790 patients) were included. All were health self-management interventions, and most were multicomponent (videos, forums, and electronic reminder systems) websites. Meta-analyses revealed a significant effect of eHealth interventions on QOL (standardized mean difference [SMD], 0.20 [95% CI, 0.03 to 0.36]), self-efficacy (SMD, 0.45 [95% CI, 0.24 to 0.65]), distress (SMD, -0.41 [95% CI,-0.63 to -0.20]), and fatigue (SMD, -0.37 [95% CI, -0.61 to -0.13]). Twenty-five studies (78.1%) measured patient-reported experience measures. Acceptability (n = 9) was high, with high ratings for satisfaction (range, 71%-100%), usefulness (range, 71%-95%), and ease-of-use (range, 73%-92%). Engagement (n = 25) decreased over time, but disease-focused information and interactive support were most engaging. CONCLUSION eHealth interventions may provide an acceptable and effective strategy for improving QOL, distress, self-efficacy, and fatigue among patients with breast cancer.
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Affiliation(s)
- Anna C. Singleton
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia,Anna C. Singleton, PhD, Level 6 Block K Westmead Hospital, Westmead, New South Wales 2753, Australia; Twitter: @DrAnnaSingleton; e-mail:
| | - Rebecca Raeside
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Karice K. Hyun
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia,Department of Cardiology, Concord Repatriation General Hospital, ANZAC Research Institute, Concord, New South Wales, Australia
| | - Stephanie R. Partridge
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia,Prevention Research Collaboration, Charles Perkins Center, The University of Sydney, Sydney, New South Wales, Australia
| | - Gian Luca Di Tanna
- The George Institute for Global Health, University of NSW, Kensington, New South Wales, Australia
| | - Nashid Hafiz
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Qiang Tu
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Justin Tat-Ko
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie Che Mun Sum
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Kerry A. Sherman
- Department of Psychology, Center for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Elisabeth Elder
- Westmead Breast Cancer Institute, Westmead Hospital, Westmead, New South Wales, Australia
| | - Julie Redfern
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia,The George Institute for Global Health, University of NSW, Kensington, New South Wales, Australia
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13
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Philip S, Varshney P, Chander R, Patley R, Dosajh AC, Basavaraju V, Manjunatha N, Kumar CN, Math SB. Telementoring Counseling Skills for Deaddiction Counselors in Punjab During the COVID-19 Pandemic. Indian J Psychol Med 2022; 44:419-421. [PMID: 35949626 PMCID: PMC9301738 DOI: 10.1177/02537176221081777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sharad Philip
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Prateek Varshney
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Rakesh Chander
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Rahul Patley
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Anu Chopra Dosajh
- Dept. of Health and Family Welfare, Mental Health and Deaddiction, Government of Punjab, Chandigarh, Punjab, India
| | - Vinay Basavaraju
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | | | - Suresh Bada Math
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Li MM, Rising KL, Goldberg EM. Transitioning to Telehealth? A Guide to Evaluating Outcomes. HEALTH POLICY AND TECHNOLOGY 2022; 11:100623. [PMID: 35369128 PMCID: PMC8957891 DOI: 10.1016/j.hlpt.2022.100623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives Methods Results Conclusions Public Interest Summary
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Choi ECE, Heng LW, Tan SY, Phan P, Chandran NS. Factors influencing use and perceptions of teledermatology: A mixed-methods study of 942 participants. JAAD Int 2022; 6:97-103. [PMID: 35128487 PMCID: PMC8805506 DOI: 10.1016/j.jdin.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background The protracted COVID-19 pandemic highlights the need for a sustainable telemedicine practice. Objective To understand patient perceptions toward teledermatology. Methods Convergent parallel mixed-methods study of 942 dermatology patients or their caregivers between June 2020 and April 2021. Results Multivariate regression found that youth, increased computer use, willingness to show body areas over photo/video, perceived quality of teledermatology, demand for social distancing and to reduce commute were associated with willingness to use teledermatology. The willingness to use teledermatology declined with the easing of COVID-19 movement restrictions, and 48.5% reported a poorer experience with teledermatology than with in-person consultations. Qualitative data from 26 interviews showed that willingness to use is influenced by pragmatic considerations, emotional factors, and data privacy concerns. These were moderated by the patient's perception of disease severity and need for an accurate diagnosis. Limitations Lack of data prior to the pandemic and during the initial lockdown period. Conclusion The willingness to use teledermatology is influenced by circumstantial factors, technology literacy, views toward teledermatology, and factors driving the purpose of consultation. The declining willingness to use teledermatology with the easing pandemic, lower willingness to pay full in-clinic prices, and poorer experience compared with in-person consultations highlights the need to optimize this mode of delivery.
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Niu N, Zhi X, Zhang L, Wang M, Zhao Y, Yang L, Wu B, Zhu P, Wang N, Zhang M, Wu B, Zhang Y, Meng A. Development and implementation of an “Internet+” management plan for cancer patients with wounds/stomas during the coronavirus disease 2019 pandemic. PRECISION MEDICAL SCIENCES 2022. [DOI: 10.1002/prm2.12055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Niu Niu
- Department of General Surgery Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Xiaoxu Zhi
- Nursing Department Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Liuliu Zhang
- Department of General Surgery Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Meixiang Wang
- Department of General Surgery Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Yun Zhao
- Department of General Surgery Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Lifang Yang
- Outpatient Department Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Bing Wu
- Nursing Department Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Ping Zhu
- Nursing Department Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Na Wang
- Outpatient Department Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Maomao Zhang
- Nursing Department Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Bainv Wu
- Nursing Department Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Yinan Zhang
- Department of General Surgery Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Aifeng Meng
- Nursing Department Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
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Philip S, Patley R, Chander R, Varshney P, Dosajh AC, Vinay B, Manjunatha N, Kumar CN, BadaMath S. A report on successful introduction of tele mental health training for primary care doctors during the COVID 19 pandemic. Asian J Psychiatr 2022; 68:102967. [PMID: 34953218 PMCID: PMC8694884 DOI: 10.1016/j.ajp.2021.102967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/29/2021] [Accepted: 12/14/2021] [Indexed: 12/01/2022]
Abstract
Treatment gaps of 60-70%, reflecting, amongst many other factors, Human Resources shortfalls means that 150 million India never accessed mental healthcare. In Punjab, mental health training is required in primary health centers. A short-term synchronous training was conceptualized by the National Institute of Mental Health and Neurosciences. A total of 114 primary care doctors participated for the training. Substantial positive changes in knowledge, attitudes and practices were noted. Task sharing and capacity building initiatives can be undertaken during the pandemic to meet the demand for mental healthcare service delivery.
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Affiliation(s)
- Sharad Philip
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India.
| | - Rahul Patley
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India.
| | - Rakesh Chander
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India.
| | - Prateek Varshney
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India.
| | - Anu Chopra Dosajh
- Mental Health and Deaddiction, Department of Health and Family Welfare, Government of Punjab, India.
| | - B Vinay
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India.
| | - N Manjunatha
- Tele-Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences, India.
| | - C Naveen Kumar
- Tele-Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences, India.
| | - Suresh BadaMath
- Tele-Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences, India.
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Chawla S, Chawla A, Chawla R, Jaggi S, Singh D, Trehan S. Trained nurse–operated teleophthalmology screening approach as a cost-effective tool for diabetic retinopathy. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-021-01037-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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19
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Podlewska AM, van Wamelen DJ. Parkinson's disease and Covid-19: The effect and use of telemedicine. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 165:263-281. [PMID: 36208904 PMCID: PMC9279001 DOI: 10.1016/bs.irn.2022.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As a result of the Coronavirus Disease 2019 (Covid-19) pandemic the use of telemedicine and remote assessments for patients has increased exponentially, enabling healthcare professionals to reduce the need for in-person clinical visits and, consequently, reduce the exposure to the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). This development has been aided by increased guidance on digital health technologies and cybersecurity measures, as well as reimbursement options within healthcare systems. Having been able to continue to connect with people with Parkinson's Disease (PwP, PD) has been crucial, since many saw their symptoms worsen over the pandemic. Inspite of the success of telemedicine, sometimes even enabling delivery of treatment and research, further validation and a unified framework are necessary to measure the true benefit to both clinical outcomes and health economics. Moreover, the use of telemedicine seems to have been biased towards people from a white background, those with higher education, and reliable internet connections. As such, efforts should be pursued by being inclusive of all PwP, regardless of geographical area and ethnic background. In this chapter, we describe the effect he Covid-19 pandemic has had on the use of telemedicine for care and research in people with PD, the limiting factors for further rollout, and how telemedicine might develop further.
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Sharafkhaneh A, Salari N, Khazaie S, Ghasemi H, Darvishi N, Hosseinian-Far A, Mohammadi M, Khazaie H. Telemedicine and insomnia: a comprehensive systematic review and meta-analysis. Sleep Med 2022; 90:117-130. [DOI: 10.1016/j.sleep.2022.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
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21
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Deighton AJ, Davies C, Bourantas C, Knight C, Woldman S, Deighton J, Azar A, Das D. Investigating consultant-led virtual review as a model for implementing 7-day cardiology services in UK clinical practice. Future Healthc J 2021; 8:e666-e670. [PMID: 34888462 DOI: 10.7861/fhj.2021-0115] [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: 11/27/2022]
Abstract
Background Disparities between weekend and weekday care, termed 'the weekend effect', have led to a UK government pledge to provide 7-day services. Despite this, poor outcomes have led to criticism of the programme. This study consequently sought to evaluate consultant-led virtual review as a model for 7-day cardiology services. Methods Over 4 weekends, cardiology patients underwent virtual review alongside in-person teams. Outcomes included length of stay, same-day discharge and 30-day mortality rates, as well as duration of ward rounds and change in patient management. Patients were surveyed on attitudes towards virtual review. Results Statistical analysis revealed no significant difference in clinical outcomes, while virtual review was noted to significantly decrease time taken (p<0.0001). Attitudes towards virtual review were broadly favourable. Conclusion By demonstrating comparable outcomes compared with conventional review, as well as high acceptability, this study identified virtual review as an effective substitute for in-person care.
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Affiliation(s)
| | | | | | | | | | - James Deighton
- University of Southampton School of Medicine, Southampton, UK
| | - Armita Azar
- Barts and The London School of Medicine and Dentistry, London, UK
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22
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Lopez-Villegas A, Leal-Costa C, Perez-Heredia M, Villegas-Tripiana I, Catalán-Matamoros D. Knowledge Update on the Economic Evaluation of Pacemaker Telemonitoring Systems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212120. [PMID: 34831876 PMCID: PMC8624333 DOI: 10.3390/ijerph182212120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022]
Abstract
(1) Introduction: In the last two decades, telemedicine has been increasingly applied to telemonitoring (TM) of patients with pacemakers; however, presently, its growth has significantly accelerated because of the COVID-19 pandemic, which has pushed patients and healthcare workers alike to seek new ways to stay healthy with minimal physical contact. Therefore, the main objective of this study was to update the current knowledge on the differences in the medium-and long-term effectiveness of TM and conventional monitoring (CM) in relation to costs and health outcomes. (2) Methods: Three databases and one scientific registry were searched (PubMed, EMBASE, Scopus, and Google Scholar), with no restrictions on language or year of publication. Studies published until July 2021 were included. The inclusion criteria were: (a) experimental or observational design, (b) complete economic evaluation, (c) patients with implanted pacemakers, and (d) comparison of TM with CM. Measurements of study characteristics (author, study duration, sample size, age, sex, major indication for implantation, and pacemaker used), analysis, significant results of the variables (analysis performed, primary endpoints, secondary endpoints, health outcomes, and cost outcomes), and further miscellaneous measurements (methodological quality, variables coded, instrument development, coder training, and intercoder reliability, etc.) were included. (3) Results: 11 studies met the inclusion criteria, consisting of 3372 enrolled patients; 1773 (52.58%) of them were part of randomized clinical trials. The mean age was 72 years, and the atrioventricular block was established as the main indication for device implantation. TM was significantly effective in detecting the presence or absence of pacemaker problems, leading to a reduction in the number of unscheduled hospital visits (8.34-55.55%). The cost of TM was up to 87% lower than that of CM. There were no significant differences in health-related quality of life (HRQoL) and the number of cardiovascular events. (4) Conclusions: Most of the studies included in this systematic review confirm that in the TM group of patients with pacemakers, cardiovascular events are detected and treated earlier, and the number of unscheduled visits to the hospital is significantly reduced, without affecting the HRQoL of patients. In addition, with TM modality, both formal and informal costs are significantly reduced in the medium and long term.
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Affiliation(s)
- Antonio Lopez-Villegas
- Social Involvement of Critical and Emergency Medicine, CTS-609 Research Group, Poniente Hospital, 04700 El Ejido-Almería, Spain;
| | - César Leal-Costa
- Nursing Department, University of Murcia, 30120 Murcia, Spain
- Correspondence: ; Tel.: +34-868-889-771
| | - Mercedes Perez-Heredia
- Research Management Department, Primary Care District Poniente of Almería, 04700 El Ejido-Almería, Spain;
| | | | - Daniel Catalán-Matamoros
- UC3M MediaLab, Department of Communication and Media Studies, Madrid University Carlos III, 28903 Madrid, Spain;
- Health Sciences Research Institute, University of Almería, 04120 Almería, Spain
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Assis Acurcio FD, Guerra Junior AA, Marino Calvo MC, Nunes DH, Akerman M, Spinel LF, Garcia MM, Pereira RG, Costa Borysow ID, Silva RR, Azevedo PS, Iacabo Correia Gomes PC, Alvares-Teodoro J. Cost-minimization analysis of teledermatology versus conventional care in the Brazilian National Health System. J Comp Eff Res 2021; 10:1159-1168. [PMID: 34494888 DOI: 10.2217/cer-2021-0124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: Cost-minimization analysis (CMA) comparing the teledermatology service of the State of Santa Catarina, Brazil with the provision of conventional care, from the societal perspective. Patients & methods: All costs related to direct patient care were considered in calculation of outpatient costs. The evaluation was performed using the parameters avoided referrals and profile of hospitalizations. The economic analysis was developed through a decision tree. Results: Totally, 40% of 79,411 tests performed could be managed in primary care, avoiding commuting and expanding the patients' access. The CMA showed the teledermatology service had a cost per patient of US$196.04, and the conventional care of US$245.66. Conclusion: In this scenario, teledermatology proved to be a cost-saving alternative to conventional care, reducing commuting costs.
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Affiliation(s)
- Francisco de Assis Acurcio
- Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde - Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Augusto Afonso Guerra Junior
- Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde - Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Maria Cristina Marino Calvo
- Centro de Ciências da Saúde - Departamento de Saúde Pública, Universidade Federal de Santa Catarina, Florianópolis, Brasil
| | - Daniel Holthausen Nunes
- Serviço de Dermatologia, Hospital Universitário Polyodoro Ernani de São Thiago, Universidade Federal de Santa Catarina, Florianópolis, Brasil
| | - Marco Akerman
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil
| | | | - Marina Morgado Garcia
- Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde - Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Ramon Gonçalves Pereira
- Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde - Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | | | - Pamela Santos Azevedo
- Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde - Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | - Juliana Alvares-Teodoro
- Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde - Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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Zaprutko T, Zaprutko J, Sprawka J, Pogodzińska M, Michalak M, Paczkowska A, Kus K, Nowakowska E, Baszko A. The comparison of Kardia Mobile and Hartmann Veroval 2 in 1 in detecting first diagnosed atrial fibrillation. Cardiol J 2021; 30:762-770. [PMID: 34355779 PMCID: PMC10635734 DOI: 10.5603/cj.a2021.0083] [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: 03/15/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the leading cause of stroke. The European Society of Cardiology (ESC) advises opportunistic AF screening among patients aged ≥ 65 years. Considering this, the aim herein, was compare the feasibility of two different systems of smartphone-based electrocardiogram (ECG) recordings to identify AF among those without a previous arrhythmia history. METHODS Prospective AF screening was conducted at six pharmacies using Kardia Mobile and Hartmann Veroval 2 in 1. A single-lead ECG was acquired by the placement of fingers on the pads. A cardiologist evaluated findings from both devices. RESULTS Atrial fibrillation was identified in 3.60% and previously unknown AF was detected in 1.92% of the study participants. Sensitivity and specificity of the Kardia application in detecting AF were 66.7% (95% confidence interval [CI] 38.4-88.2%) and 98.5% (95% CI 96.7-99.5%), and for Veroval 10.0% (95% CI 0.23-44.5%) and 94.96% (95% CI 92.15-96.98%), accordingly. Inter-rater agreement was k = 0.088 (95% CI 1.59-16.1%). CONCLUSIONS Mobile devices can detect AF, but each finding must be verified by a professional. The Kardia application appeared to be more user-friendly than Veroval. Cardiovascular screening using mobile devices is feasible at pharmacies. Hence it might be considered for routine use.
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Affiliation(s)
- Tomasz Zaprutko
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland.
| | - Joanna Zaprutko
- Second Department of Cardiology, Poznan University of Medical Sciences, HCP Medical Center, Poznan, Poland
| | - Józefina Sprawka
- Student Scientific Society, Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Pogodzińska
- Student Scientific Society, Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
| | - Michał Michalak
- Department of Computer Sciences and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Paczkowska
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Kus
- Second Department of Cardiology, Poznan University of Medical Sciences, HCP Medical Center, Poznan, Poland
| | - Elżbieta Nowakowska
- Department of Pharmacology and Toxicology, University of Zielona Gora, Poland
| | - Artur Baszko
- Second Department of Cardiology, Poznan University of Medical Sciences, HCP Medical Center, Poznan, Poland
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Malek Pascha VA, Sun L, Gilardino R, Legood R. Telemammography for breast cancer screening: a cost-effective approach in Argentina. BMJ Health Care Inform 2021; 28:e100351. [PMID: 34281995 PMCID: PMC8290945 DOI: 10.1136/bmjhci-2021-100351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/22/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Argentina is a low and middle-income country (LMIC) with a highly fragmented healthcare system that conflicts with access to healthcare stated by the country's Universal Health Coverage plan. A tele-mammography network could improve access to breast cancer screening decreasing its mortality. This research aims to conduct an economic evaluation of the implementation of a tele-mammography program to improve access to healthcare. METHODS A cost-utility analysis was performed to explore the incremental benefit of annual tele-mammography screening for at-risk Argentinian women over 40 years old. A Markov model was developed to simulate annual mammography or tele-mammography screening in two hypothetical population-based cohorts of asymptomatic women. Parameter uncertainty was evaluated through deterministic and probabilistic sensitivity analysis. Model structure uncertainty was also explored to test the robustness of the results. RESULTS It was estimated that 31 out of 100 new cases of breast cancer would be detected by mammography and 39/100 by tele-mammography. The model returned an incremental cost-effectiveness ratio (ICER) of £26 051/quality-adjusted life-year (QALY) which is lower than the WHO-recommended threshold of £26 288/QALY for Argentina. Deterministic sensitivity analysis showed the ICER is most sensitive to the uptake and sensitivity of the screening tests. Probabilistic sensitivity analysis showed tele-mammography is cost-effective in 59% of simulations. DISCUSSION Tele-mammography should be considered for adoption as it could improve access to expertise in underserved areas where adherence to screening protocols is poor. Disaggregated data by province is needed for a better- informed policy decision. Telemedicine could also be beneficial in ensuring the continuity of care when health systems are under stress like in the current COVID-19 pandemic. CONCLUSION There is a 59% chance that tele-mammography is cost-effective compared to mammography for at-risk Argentinian women over 40- years old, and should be adopted to improve access to healthcare in underserved areas of the country.
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Affiliation(s)
- Victoria Alba Malek Pascha
- Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Li Sun
- Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Ramiro Gilardino
- Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Rosa Legood
- Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Nugteren MJ, Catarinella FS, Koning OHJ, Hinnen JW. Mobile applications in peripheral arterial disease (PAD): a review and introduction of a new innovative telemonitoring application: JBZetje. Expert Rev Med Devices 2021; 18:581-586. [PMID: 34057375 DOI: 10.1080/17434440.2021.1935876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction:Peripheral arterial disease (PAD) is an occlusive vascular disease of the lower extremities with increasing incidence and prevalence numbers and therefore rising health care costs. Mobile applications have great potential to improve health system efficiency and can assist in overcoming the increasing health care costs. In this review all available mobile applications developed for PAD are summarized and a new innovative application is introduced.Areas covered:Available applications for PAD are scarce and currently aim at prevention, teleconsultation and telemonitoring via questionnaires and activity tracking. Integration in the daily workflow of the physician is an overlooked aspect of these applications. JBZetje is an innovative mobile application that provides remote care, information services and self-service tools, and enables connection with the electronic health record (EHR).Expert opinion:Connection of the application with the EHR generates a complete overview of a patient's current health status. This will reinforce the tendency toward personalized medicine and will probably lead to reduced health care costs and increase the quality of care. Future feasibility studies should answer the question whether the use of mobile applications is feasible in the PAD population.
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Affiliation(s)
- Michael J Nugteren
- Department of Vascular Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, GZ, The Netherlands
| | | | - Olivier H J Koning
- Department of Vascular Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, GZ, The Netherlands
| | - Jan-Willem Hinnen
- Department of Vascular Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, GZ, The Netherlands
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Rezapour A, Hosseinijebeli SS, Faradonbeh SB. Economic evaluation of E-health interventions compared with alternative treatments in older persons' care: A systematic review. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:134. [PMID: 34222509 PMCID: PMC8224483 DOI: 10.4103/jehp.jehp_787_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/26/2020] [Indexed: 06/13/2023]
Abstract
Population aging has increased the need for long-term care of older persons who suffer from multi-morbidity and chronic conditions. Today, the majority of older people are living alone in their home in which they try to cope with highly risky conditions such as sensory impairment, diminished mobility, and medication management. Recent developments in information technologies could improve the access to care for older people as well as reducing the need for full-time caregivers both in homes and institutions such as nursery homes and hospitals. This study aimed to review the economic evaluation of such technological advancements in the care of older people. Through a systematic approach, electronic databases were searched and of 2732 records retrieved, three papers were included in the final review. Three different models of economic evaluation including cost analysis, cost-benefit analysis and cost-effectiveness analysis were applied in these studies in the context of telemedicine and older persons' care. Since the methodological approaches were quite different and the outcomes reported were not consistent between studies, no meta-analysis was applicable and we qualitatively reviewed the papers. All studies have reported cost savings associated with the use of telemedicine technologies such as video visits and smart homes in the care of older persons.
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Affiliation(s)
- Aziz Rezapour
- Health Management and Economics Research Centre, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seyede Sedighe Hosseinijebeli
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Bagheri Faradonbeh
- Health Management and Economics Research Centre, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Adamou M, Jones SL, Fullen T, Galab N, Abbott K, Yasmeen S. Remote assessment in adults with Autism or ADHD: A service user satisfaction survey. PLoS One 2021; 16:e0249237. [PMID: 33765076 PMCID: PMC7993762 DOI: 10.1371/journal.pone.0249237] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/13/2021] [Indexed: 01/15/2023] Open
Abstract
Advances in digital health have enabled clinicians to move away from a reliance on face to face consultation methods towards making use of modern video and web-based conferencing technology. In the context of the COVID-19 pandemic, remote telecommunication methods have become much more common place in mental health settings. The current study sought to investigate whether remote telecommunication methods are preferable to face to face consultations for adults referred to an Autism and ADHD Service during the COVID-19 pandemic. Also, whether there are any differences in preferred consultation methods between adults who were referred for an assessment of Autism as opposed to ADHD. 117 service users who undertook assessment by the ADHD and Autism Service at South West Yorkshire NHS Partnership Foundation Trust from April to September 2020 completed an adapted version of the Telehealth Usability Questionnaire (TUQ). Results demonstrated that service users found remote telecommunication to be useful, effective, reliable and satisfactory. Despite this, almost half of service users stated a general preference for face to face consultations. There was no difference in the choice of methods of contact between Autism and ADHD pathways. Remote telecommunication methods were found to be an acceptable medium of contact for adults who undertook an assessment of Autism and ADHD at an NHS Service during the COVID-19 pandemic.
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Affiliation(s)
- Marios Adamou
- University of Huddersfield, Huddersfield, United Kingdom
| | - Sarah L. Jones
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, United Kingdom
| | - Tim Fullen
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, United Kingdom
| | - Nazmeen Galab
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, United Kingdom
| | - Karl Abbott
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, United Kingdom
| | - Salma Yasmeen
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, United Kingdom
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Khanra S, Mukherjee A, Goyal N, Das B, Munda SK. Service utilization and saved travel cost in telepsychiatry consultation by outpatients at a psychiatric hospital in India during COVID-19 pandemic. Asian J Psychiatr 2021; 57:102568. [PMID: 33535135 PMCID: PMC7840431 DOI: 10.1016/j.ajp.2021.102568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Sourav Khanra
- Central Institute of Psychiatry, Ranchi, 834006, Jharkhand, India.
| | | | - Nishant Goyal
- Central Institute of Psychiatry, Ranchi, 834006, Jharkhand, India.
| | - Basudeb Das
- Central Institute of Psychiatry, Ranchi, 834006, Jharkhand, India.
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Sentiment Analysis and Text Mining of Questionnaires to Support Telemonitoring Programs. INFORMATION 2020. [DOI: 10.3390/info11120550] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While several studies have shown how telemedicine and, in particular, home telemonitoring programs lead to an improvement in the patient’s quality of life, a reduction in hospitalizations, and lower healthcare costs, different variables may affect telemonitoring effectiveness and purposes. In the present paper, an integrated software system, based on Sentiment Analysis and Text Mining, to deliver, collect, and analyze questionnaire responses in telemonitoring programs is presented. The system was designed to be a complement to home telemonitoring programs with the objective of investigating the paired relationship between opinions and the adherence scores of patients and their changes through time. The novel contributions of the system are: (i) the design and software prototype for the management of online questionnaires over time; and (ii) an analysis pipeline that leverages a sentiment polarity score by using it as a numerical feature for the integration and the evaluation of open-ended questions in clinical questionnaires. The software pipeline was initially validated with a case-study application to discuss the plausibility of the existence of a directed relationship between a score representing the opinion polarity of patients about telemedicine, and their adherence score, which measures how well patients follow the telehomecare program. In this case-study, 169 online surveys sent by 38 patients enrolled in a home telemonitoring program provided by the Cystic Fibrosis Unit at the “Bambino Gesù” Children’s Hospital in Rome, Italy, were collected and analyzed. The experimental results show that, under a Granger-causality perspective, a predictive relationship may exist between the considered variables. If supported, these preliminary results may have many possible implications of practical relevance, for instance the early detection of poor adherence in patients to enable the application of personalized and targeted actions.
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Sharif F, Rahman A, Tonner E, Ahmed H, Haq I, Abbass R, Asinger S, Sbai M. Can technology optimise the pre-operative pathway for elective hip and knee replacement surgery: a qualitative study. Perioper Med (Lond) 2020; 9:33. [PMID: 33292556 PMCID: PMC7667783 DOI: 10.1186/s13741-020-00166-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 11/03/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND An ageing population has resulted in a rise in the number of hip and knee replacement surgeries in the UK. The pre-operative pathway is plagued with issues causing long delays and cancellations. Virtual healthcare technologies have a growing evidence base to help solve these issues. One problem of implementing these technologies is the resistance to change mentality from healthcare professionals. By getting their opinions on the place of these technologies within the pre-operative pathway, a united front can be formed to help deliver change. METHODS Sixteen semi-structured interviews were conducted with key stakeholders within the orthopaedic pre-operative pathway at Imperial College Healthcare NHS Trust. General topics included the different technologies that could be used within the pathway, their uses and associated benefits and problems. Interviews were audio-recorded, before being manually transcribed and then analysed to form categories and themes. RESULTS Various uses, benefits and problems were identified by healthcare professionals for each modality of technology. E-forms were seen as a high reward, low-risk intervention. Remote patient monitoring and teleconsultations had their bonuses, but feasibility was a primary concern. Web-based interventions were seen as an intervention of the past, whereas virtual reality was seen as perhaps being ahead of its time. M-health was very positively viewed due to its all-encompassing nature. Digital illiteracy emerged as a consistent problem for most technologies. CONCLUSIONS Current literature, the results from this study and technology trends within society highlight both M-health and E-forms as the 2 most promising virtual healthcare technologies for use in the pre-operative pathway for orthopaedics. Areas such as pre-operative assessment, triaging and prehabilitation are prime candidates for virtual intervention. Future research should also consider including patient opinions on any proposed interventions, as well as taking into account barriers to implementation.
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Affiliation(s)
- Faraz Sharif
- Imperial College London, Faculty of Medicine, South Kensington, London, SW7 2BU UK
| | - Ammar Rahman
- Imperial College London, Faculty of Medicine, South Kensington, London, SW7 2BU UK
| | | | | | - Iqraa Haq
- Imperial College London, Faculty of Medicine, South Kensington, London, SW7 2BU UK
| | - Rami Abbass
- Imperial College London, Faculty of Medicine, South Kensington, London, SW7 2BU UK
| | - Shad Asinger
- Imperial College London, Faculty of Medicine, South Kensington, London, SW7 2BU UK
| | - Magda Sbai
- Guy’s and St Thomas NHS Trust, London, UK
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Seifert A, Batsis JA, Smith AC. Telemedicine in Long-Term Care Facilities During and Beyond COVID-19: Challenges Caused by the Digital Divide. Front Public Health 2020; 8:601595. [PMID: 33194999 PMCID: PMC7649197 DOI: 10.3389/fpubh.2020.601595] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/05/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alexander Seifert
- Center for Gerontology, University of Zurich, Zurich, Switzerland.,School of Social Work, Institute for Integration and Participation, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - John A Batsis
- Division of Geriatric Medicine, Department of Nutrition, Center for Aging & Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia.,Centre for Innovative Technology, University of Southern Denmark, Odense, Denmark
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Jella TK, Samuel LT, Acuña AJ, Emara AK, Kamath AF. Rapid Decline in Online Search Queries for Hip and Knee Arthroplasties Concurrent With the COVID-19 Pandemic. J Arthroplasty 2020; 35:2813-2819. [PMID: 32534864 PMCID: PMC7248628 DOI: 10.1016/j.arth.2020.05.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/10/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In response to the coronavirus disease 2019 (COVID-19) pandemic, US hospitals have canceled elective surgeries. This decline in total joint arthroplasty (TJA) revenue may place financial strain on hospitals. Our goal was to quantify the impact of COVID-19 on the public interest in elective TJA. METHODS The Google Search Volume Index (GSVI) identified the terms "knee replacement," "hip replacement," and "orthopedic surgeon" as the most common to describe TJA. The term "elective surgery cancellation" was also analyzed. Weekly GSVI data were extracted between 04-01-2015 and 04-04-2020. Time series analysis was conducted and state GSVI values were compared with COVID-19 prevalence and unemployment claims. RESULTS The relative public interest in elective TJA has sharply declined since the WHO declaration of COVID-19 as a global pandemic. Between 03-01-2020 and 03-29-2020, the popularity of searches for "knee replacement", "hip replacement," and "orthopedic surgeon" dropped by 62.1%, 52.1%, and 44.3%, respectively. A concurrent spike was observed for the term "elective surgery cancellation." California, New Hampshire, Maine, and Nevada showed a low relative rate for TJA searches, and the highest increase in unemployment claims. CONCLUSION The onset of COVID-19 correlates with declining relative popularity of searches related to elective TJA. Higher volume of COVID-19 cases in certain states may correspond with lower relative search popularity, although this correlation remains unclear. These results portend the possibility of a decline in elective TJA case volume, further straining hospitals. Further research is required to inform stakeholders how best to proceed and determine any sustained effects from the current diminished relative interest in TJA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | | | | | - Atul F. Kamath
- Reprint requests: Atul F. Kamath, MD, Center for Hip Preservation Orthopaedic and Rheumatologic Institute Cleveland Clinic Foundation, 9500 Euclid Avenue, Mailcode A40 Cleveland, OH, 44195
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Lazarus G, Kirchner HL, Siswanto BB. Prehospital tele-electrocardiographic triage improves the management of acute coronary syndrome in rural populations: A systematic review and meta-analysis. J Telemed Telecare 2020; 28:632-641. [PMID: 32996348 DOI: 10.1177/1357633x20960627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Acute coronary syndrome (ACS) patients residing in rural areas are predisposed to higher risk of poor outcomes due to substantial delays in disease management, emphasising the importance of emerging telecardiology technologies in delivering emergency services in such settings. This meta-analysis aimed to investigate the impacts of prehospital telecardiology strategies on the clinical outcomes of rural ACS patients. METHODS A literature search was performed of articles published up to April 2020 through six databases. Included studies were assessed for bias risk using the ROBINS-I tool, and a random-effects model was utilised to estimate effect sizes. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS Twelve studies with a total of 3989 patients were included in this review. Prehospital telecardiology in the form of tele-electrocardiography (tele-ECG) enabled prompt diagnosis and triage, resulting in a decreased door-to-balloon (DTB) time (mean difference = -25.53 minutes, 95% confidence interval (CI) -36.08 to -14.97 minutes; I2 = 98%), as well as lower in-hospital mortality (odds ratio (OR) = 0.57, 95% CI 0.36-0.92) and long-term mortality (OR = 0.52, 95% CI 0.39-0.69) rates, both with negligible heterogeneity (I2 = 0%). GRADE assessment yielded very low to moderate certainty of evidence.Conclusion Prehospital tele-ECG appeared to be an effective and worthwhile approach in the management of rural ACS patients, as shown by moderate quality evidence on lower long-term mortality. Given the uncertainties of the evidence quality on DTB time and in-hospital mortality, future studies with a higher quality of evidence are required to confirm our findings.
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Affiliation(s)
| | - H L Kirchner
- Department of Population Health Sciences, Geisinger Clinic, USA
| | - Bambang B Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Indonesia
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Nguyen M, Waller M, Pandya A, Portnoy J. A Review of Patient and Provider Satisfaction with Telemedicine. Curr Allergy Asthma Rep 2020; 20:72. [PMID: 32959158 PMCID: PMC7505720 DOI: 10.1007/s11882-020-00969-7] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose of Review The purpose of this review is to describe the determinants of satisfaction with telemedicine (TM) and how they compare with in-person visits from both the perspective of patients and of providers. Recent Findings The use of TM will expand only if patients and providers are at least as satisfied with it as they are with in-person visits. Since deviations from expected care can result in reduced satisfaction regardless of the quality of the visit or objective medical outcomes, it is important to understand and to help form those expectations when possible. Patients consistently report 95–100% satisfaction rate with TM when compared with in-person appointments. They tend to cite the convenience of decreased travel times and costs as the main drivers for satisfaction with TM. Providers tend to be satisfied with TM if they have input into its development, there is administrative support, the technology is reliable and easy to use, and if there is adequate reimbursement for its use. Summary Satisfaction with TM is necessary for adoption of this new technology. To improve satisfaction it is important to consider factors that drive it both for patients and for providers.
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Affiliation(s)
- Mary Nguyen
- Section of Allergy, Asthma & Immunology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Morgan Waller
- Division of Telemedicine, Children's Mercy Hospital, Kansas City, MO, USA
| | - Aarti Pandya
- Section of Allergy, Asthma & Immunology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Jay Portnoy
- Section of Allergy, Asthma & Immunology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA. .,Division of Telemedicine, Children's Mercy Hospital, Kansas City, MO, USA.
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Sultan AA, Acuña AJ, Samuel LT, Rabin JM, Grits D, Gurd DP, Kuivila TE, Goodwin RC. Utilization of Telemedicine Virtual Visits in Pediatric Spinal Deformity Patients: A Comparison of Feasibility and Patient Satisfaction at a Large Academic Center. J Pediatr Orthop 2020; 40:e712-e715. [PMID: 32235192 DOI: 10.1097/bpo.0000000000001553] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Telemedicine platforms have been developed to support the convenient delivery of health care services to their patients while maintaining appropriate quality of care. However, it is unclear whether they can be utilized effectively in patients with pediatric spinal deformity (PSD). Therefore, this study aimed to evaluate the feasibility and patient satisfaction associated with virtual visit (VV) utilization in PSD patients in comparison to general pediatric orthopaedic indications. METHODS Of the 482 VVs offered to pediatric orthopaedic patients at a large academic health care system between January 1, 2017, and December 31, 2018, a total of 189 VVs conducted by board-certified orthopaedic surgeons were included in the final analysis. Patient satisfaction scores were collected at the end of each VV by patient and parent rankings of the surgeon and the telemedicine service. Data on patients, visits, and connectivity sessions characteristics were collected and statistically compared between PSD visits (n=33) versus those conducted for general pediatric orthopaedic indications (n=156). RESULTS Although PSD patients were older (15±3.7 vs. 12±4.7 y; P<0.01), mostly female (76% vs. 47%, P=0.003), and had longer VVs (8±4.6 vs. 5±3.6 min; P=0.003) versus their general pediatric orthopaedic counterparts, they demonstrated similarly high satisfaction scores for surgeon performance (5±0 vs. 4.8±0.1 points; P=0.08) and overall satisfaction (3±2.4 vs. 3.5±2.1; P=0.23). Approximately 80% of all VVs were conducted over mobile devices. Wait time was substantially less for PSD VVs relative to subsequent office visits (13±10 vs. 41±30 min; P<0.001). CONCLUSIONS Our analysis found that telemedicine VVs provided a convenient alternative to traditional in-office visits for PSD patients. Specifically, we found that PSD patients received faster care with comparable satisfaction. The findings of our present analysis should encourage health care systems to continually evaluate and implement telehealth platforms to improve both the accessibility and appropriate quality of care. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation
| | | | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation
| | - Jacob M Rabin
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation
| | - Daniel Grits
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - David P Gurd
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation
| | | | - Ryan C Goodwin
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation
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Widmar NO, Bir C, Slipchenko N, Wolf C, Hansen C, Ouedraogo F. Online procurement of pet supplies and willingness to pay for veterinary telemedicine. Prev Vet Med 2020; 181:105073. [PMID: 32634751 DOI: 10.1016/j.prevetmed.2020.105073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
Changing consumer shopping behaviors, and specifically the shift towards online procurement of goods and services, have altered the retail landscape of nearly all goods, including pet products and services. Whilst it is known and commonly discussed that less retail business for products and medications is being conducted in clinics than in the past, it is not well documented where that commerce is now taking place, and by what customer segments. For cats, dogs, and other pets, specialty food and food in general was purchased by a high percentage of respondents at the physical store. Sixteen-percent of dog owners, 17 % of cat owners and 14 % of other animal owners purchased prescription food at the veterinarian. Ten percent of dog owners, 10 % of cat owners, and 9 % of other animal owners purchased prescription food from the physical store. A high percentage of cat and dog owners purchased flea and tick preventative, heartworm preventative and prescription medications at the veterinarian, followed by the physical store. Using a choice experiment, both dog and cat owners were willing-to-pay a statistically significant positive amount for having their veterinarian, or a veterinarian in their community (who was not their veterinarian) on the veterinary telemedicine call or video when compared to a veterinarian from outside the community. In relation to the willingness to pay (WTP) for a telemedicine veterinary consultation with a veterinarian outside of the pet owners' community, dog owners were willing to pay $38.04 more for a telemedicine veterinary consultation with their regular veterinarian, and $13.38 more for a telemedicine veterinary consultation with a veterinarian in the dog owners' community. Cat owners had a WTP of $38.12 per call or visit for having their veterinarian as the consultant which was statistically higher than their WTP for a veterinarian in their community, $12.74 when compared to a veterinarian outside their community. When comparing the mean price adjusted WTP between cat and dog owners, there were not any statistically significant differences found. Quantifying pet owner willingness to pay for commonly discussed attributes of telemedicine, such as whether a local veterinarian is consulted (versus a veterinarian from outside the community), facilitates veterinary practice management decision making as practices adjust product and service offerings to meet the changing consumer demand of pet owners in today's marketplace.
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Affiliation(s)
- Nicole Olynk Widmar
- Purdue University, Dept. of Agricultural Economics, 403 West State Street, West Lafayette, IN 47907 United States.
| | - Courtney Bir
- Purdue University, Dept. of Agricultural Economics, 403 West State Street, West Lafayette, IN 47907 United States.
| | - Natalya Slipchenko
- University of California, Davis Agricultural Economics and Econometrics, 2116 Social Sciences and Humanities, One Shields Avenue, Davis, CA 95616, United States.
| | - Christopher Wolf
- Cornell University, Charles H. Dyson School of Applied Economics and Management, 361 Warren Hall, Ithaca, NY 14853, United States.
| | - Charlotte Hansen
- American Veterinary Medical Association, Veterinary Economics Division, 1931N. Meacham Rd. Ste. 100, Schaumburg, IL 60173, United States.
| | - Frederic Ouedraogo
- American Veterinary Medical Association, Veterinary Economics Division, 1931N. Meacham Rd. Ste. 100, Schaumburg, IL 60173, United States.
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Faes L, Bachmann LM, Sim DA. Home monitoring as a useful extension of modern tele-ophthalmology. Eye (Lond) 2020; 34:1950-1953. [PMID: 32405047 PMCID: PMC7784909 DOI: 10.1038/s41433-020-0964-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 01/27/2023] Open
Affiliation(s)
- Livia Faes
- Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Cantonal Hospital Lucerne, Lucerne, Switzerland
| | | | - Dawn A Sim
- Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
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Validation of a Short Questionnaire to Assess Healthcare Professionals' Perceptions of Asynchronous Telemedicine Services: The Catalan Version of the Health Optimum Telemedicine Acceptance Questionnaire. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072202. [PMID: 32218310 PMCID: PMC7178015 DOI: 10.3390/ijerph17072202] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 11/17/2022]
Abstract
Telemedicine is both effective and able to provide efficient care at a lower cost. It also enjoys a high degree of acceptance among users. The Technology Acceptance Model proposed is based on the two main concepts of ease of use and perceived usefulness and is comprised of three dimensions: the individual context, the technological context and the implementation or organizational context. At present, no short, validated questionnaire exists in Catalonia to evaluate the acceptance of telemedicine services amongst healthcare professionals using a technology acceptance model. This article aims to statistically validate the Catalan version of the EU project Health Optimum telemedicine acceptance questionnaire. The study included the following phases: adaptation and translation of the questionnaire into Catalan and psychometric validation with construct (exploratory factor analysis), consistency (Cronbach’s alpha) and stability (test–retest) analysis. After deleting incomplete responses, calculations were made using 33 participants. The internal consistency measured with the Cronbach’s alpha coefficient was good with an alpha coefficient of 0.84 (95%, CI: 0.79–0.84). The intraclass correlation coefficient was 0.93 (95% CI: 0.852–0.964). The Kaiser–Meyer–Olkin test of sampling showed to be adequate (KMO = 0.818) and the Bartlett test of sphericity was significant (Chi-square 424.188; gl = 28; p < 0.001). The questionnaire had two dimensions which accounted for 61.2% of the total variance: quality and technical difficulties relating to telemedicine. The findings of this study suggest that the validated questionnaire has robust statistical features that make it a good predictive model of healthcare professional’s satisfaction with telemedicine programs.
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López Seguí F, Franch Parella J, Gironès García X, Mendioroz Peña J, García Cuyàs F, Adroher Mas C, García-Altés A, Vidal-Alaball J. A Cost-Minimization Analysis of a Medical Record-based, Store and Forward and Provider-to-provider Telemedicine Compared to Usual Care in Catalonia: More Agile and Efficient, Especially for Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062008. [PMID: 32197434 PMCID: PMC7143363 DOI: 10.3390/ijerph17062008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 12/15/2022]
Abstract
Background: Telemedicine (interconsultation between primary and hospital care teams) has been operating in the counties of Central Catalonia Bages, Moianès and Berguedà since 2011, specializing in teledermatology, teleulcers, teleophthalmology and teleaudiometries. For the period until the end of 2019, a total of 52,198 visits were recorded. Objective: To analyze the differential costs between telemedicine and usual care in a semi-urban environment. Methodology: A cost-minimization evaluation, including direct and indirect costs from a societal perspective, distinguishing healthcare and user’s costs, was carried out over a three-month period. Results: Telemedicine saved € 780,397 over the period analyzed. A differential cost favorable to telemedicine of about € 15 per visit was observed, with the patient being the largest beneficiary of this saving (by 85%) in terms of shorter waiting times and travel costs. From the healthcare system perspective, moving the time spent in a hospital care consultation to primary care is efficient in terms of the total time devoted per patient. In social terms and in this context, telemedicine is more efficient than usual care. Conclusion: Allowing users to save time in terms of consultation and travel is the main driver of interconsultation between primary and hospital care savings in a semi-urban context. The telemedicine service is also economically favorable for the healthcare system, enabling it to provide a more agile service, which also benefits healthcare professionals.
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Affiliation(s)
- Francesc López Seguí
- TIC Salut Social, Catalan Ministry of Health, 08005 Barcelona, Spain;
- CRES&CEXS, Pompeu Fabra University, 08003 Barcelona, Spain
| | - Jordi Franch Parella
- Faculty of Social Sciences, Universitat de Vic-Universitat Central de Catalunya, 08242 Manresa, Spain; (J.F.P.); (X.G.G.)
| | - Xavier Gironès García
- Faculty of Social Sciences, Universitat de Vic-Universitat Central de Catalunya, 08242 Manresa, Spain; (J.F.P.); (X.G.G.)
| | - Jacobo Mendioroz Peña
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain;
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08272 Sant Fruitós de Bages, Spain
| | - Francesc García Cuyàs
- Sant Joan de Déu Hospital, Catalan Ministry of Health, 08950 Barcelona, Spain; (F.G.C.); (C.A.M.)
| | - Cristina Adroher Mas
- Sant Joan de Déu Hospital, Catalan Ministry of Health, 08950 Barcelona, Spain; (F.G.C.); (C.A.M.)
| | - Anna García-Altés
- Agency for Healthcare Quality and Evaluation of Catalonia (AQuAS), Catalan Ministry of Health, 08003 Barcelona, Spain;
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain;
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08272 Sant Fruitós de Bages, Spain
- Correspondence:
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Zhu X, Xu Y, Lu L, Zou H. Patients' perspectives on the barriers to referral after telescreening for diabetic retinopathy in communities. BMJ Open Diabetes Res Care 2020; 8:8/1/e000970. [PMID: 32193199 PMCID: PMC7103829 DOI: 10.1136/bmjdrc-2019-000970] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/11/2019] [Accepted: 12/18/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To understand the referral completion and explore the associated barriers to the referral after telescreening for diabetic retinopathy (DR) among people with vision-threatening DR (VTDR). RESEARCH DESIGN AND METHODS All participants with VTDR after DR telescreening in the communities completed the self-reported questionnaires to assess referral completion and their perspectives on referral barriers. Sociodemographic characteristics and perceived barriers related to incomplete referrals were identified by conducting univariate analysis and multiple logistic regression model. The final model was then built to predict incomplete referral. RESULTS Of the 3362 participants, 46.1% had incomplete referral. Old age and lower education level showed significant association with incomplete referral. Almost all participants had at least one barrier during the referral process. Knowledge-related and attitude-related barriers, including 'Too old to want any more treatment', 'Difficulty in getting time to referral', 'No serious illness requiring treatment at present', 'My eyes are okay', 'Distrust the recommended hospital' and 'Have not been diagnosed or treated before', and logistics-related barrier 'Mobility or transportation difficulties' showed significant association with incomplete referral. CONCLUSIONS The issue of incomplete referral after DR telescreening is serious among individuals with VTDR, particularly in the elder and low education level population. The negativity of knowledge-related and attitude-related factors might be more prominent than logistic barriers in predicting incomplete referral. Therefore, new strategies to improve the compliance with referral assist in optimizing the referral accessibility, and the ongoing educational support to improve the awareness of disease and increase the effectiveness of physician-patient communication.
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Affiliation(s)
- Xiaofeng Zhu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Xu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lina Lu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haidong Zou
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hernández C, Valdera CJ, Cordero J, López E, Plaza J, Albi M. Impact of telemedicine on assisted reproduction treatment in the public health system. J Healthc Qual Res 2019; 35:27-34. [PMID: 31883955 DOI: 10.1016/j.jhqr.2019.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/17/2019] [Accepted: 08/20/2019] [Indexed: 11/26/2022]
Abstract
AIM Telemedicine has helped to make health care more efficient. However, to date no studies have measured its impact on infertility and fertility healthcare. We assessed the potential care benefits and clinical advantages of an initiative implementing electronic patient portal (EPP) for patients scheduled to undergo assisted reproduction treatment, to reduce waiting times for medical consultation and treatment. METHODS This was designed as a retrospective cohort study. The experimental group comprised 1972 referral requests received by the assisted reproduction unit of our institution between 2015 and 2016, which were included in the group receiving telemedicine, while the control group was defined by 283 requests received in 2013, all of which were assigned face-to-face care. RESULTS We found a statistically significant reduction in the experimental group in terms of the days elapsed between the receipt of the assessment request and the first outpatient visit (68 days vs. 180 days, p<.001). Time to initiation of treatment was also significantly lower in this group (169 days vs. 229 days; p<.001). The experimental group contained around 7 times as many patients receiving treatment as the control group. No differences were observed in the pregnancy rate (29.9% vs. 31.1%; p=.77) or in the complication rate (3.2% vs. 0%; p=.16). CONCLUSIONS Use of telemedicine in electronic portal patient form reduces the total waiting time involved in patient requests for infertility treatment and indirectly increases the number of patients treated, causing no negative impact on treatment outcome.
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Affiliation(s)
- C Hernández
- Assisted Reproduction Unit, Fundación Jiménez Díaz, Madrid, Spain; Department of Obstetrics and Gynecology, Fundación Jiménez Díaz, Madrid, Spain
| | - C J Valdera
- Assisted Reproduction Unit, Fundación Jiménez Díaz, Madrid, Spain; Department of Obstetrics and Gynecology, Fundación Jiménez Díaz, Madrid, Spain.
| | - J Cordero
- Assisted Reproduction Unit, Fundación Jiménez Díaz, Madrid, Spain; Department of Obstetrics and Gynecology, Fundación Jiménez Díaz, Madrid, Spain
| | - E López
- Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - J Plaza
- Department of Obstetrics and Gynecology, Fundación Jiménez Díaz, Madrid, Spain
| | - M Albi
- Department of Obstetrics and Gynecology, Fundación Jiménez Díaz, Madrid, Spain
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Zaprutko T, Zaprutko J, Baszko A, Sawicka D, Szałek A, Dymecka M, Telec W, Kopciuch D, Ratajczak P, Michalak M, Rafał D, Szyszka A, Nowakowska E. Feasibility of Atrial Fibrillation Screening With Mobile Health Technologies at Pharmacies. J Cardiovasc Pharmacol Ther 2019; 25:142-151. [PMID: 31578088 DOI: 10.1177/1074248419879089] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia. Thus, the aim of our study was to evaluate the smartphone-based electrocardiogram (ECG) recordings aimed at AF screening at Polish pharmacies. METHODS Prospective AF screening among patients aged ≥65 years was conducted at 10 pharmacies using Kardia Mobile with a dedicated application (Kardia app). Prior AF was a study exclusion criterion. CHA2DS2-VASc score (congestive heart failure, hypertension, age, diabetes mellitus, previous stroke/transient ischemic attack, female sex, and vascular disease) has been collected from every patient. A single-lead ECG has been acquired by the placement of fingers from each hand on the pads. Kardia app diagnosis has been evaluated by the cardiologist. RESULTS A total of 525 ECGs were performed. Kardia app diagnosis was provided in 490 cases. In 437 (89.18%) cases, it was "normal" rhythm, in 17 (3.47%) recordings "possible AF," in 23 (4.69%) ECGs "unreadable," and in 13 (2.65%) "unclassified". After the cardiologist reevaluation, the new AF was identified in 7 (1.33%) patients. Sensitivity and specificity of Kardia app in detecting AF was 100% (95% confidence interval [CI]: 71.5%-100%) and 98.7% (95% CI: 97.3%-99.5%), respectively. The positive predictive value was 64.7% (95% CI: 38.3%-85.7%) and the negative predictive value was 100% (95% CI: 99.2%-100%). CHA2DS2-VASc score was 2.14 ± 0.69 for those with new AF and 3.33 ± 1.26 in the non-AF group. CONCLUSION Kardia app is capable of fast screening and detecting AF with high sensitivity and specificity. The possible diagnosis of AF deserves additional cardiological evaluation. The results obtained in patients with low CHA2DS2-VASc score and "silent" AF confirm the importance of routine AF screening. Cardiovascular screening with the use of mobile health technology is feasible at pharmacies.
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Affiliation(s)
- Tomasz Zaprutko
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznań, Poland
| | - Joanna Zaprutko
- Second Department of Cardiology, Poznan University of Medical Sciences, HCP Medical Center, Poznań, Poland
| | - Artur Baszko
- Second Department of Cardiology, Poznan University of Medical Sciences, HCP Medical Center, Poznań, Poland
| | - Dominika Sawicka
- Student Scientific Society, Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poland
| | - Anna Szałek
- Student Scientific Society, Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poland.,Student Scientific Society, Second Department of Cardiology, Poznan University of Medical Sciences, HCP Medical Center, Poznań, Poland
| | - Magdalena Dymecka
- Student Scientific Society, Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poland
| | - Wojciech Telec
- Second Department of Cardiology, Poznan University of Medical Sciences, HCP Medical Center, Poznań, Poland
| | - Dorota Kopciuch
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznań, Poland
| | - Piotr Ratajczak
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznań, Poland
| | - Michał Michalak
- Department of Computer Sciences and Statistics, Poznan University of Medical Sciences, Poznań, Poland
| | - Dankowski Rafał
- Second Department of Cardiology, Poznan University of Medical Sciences, HCP Medical Center, Poznań, Poland
| | - Andrzej Szyszka
- Second Department of Cardiology, Poznan University of Medical Sciences, HCP Medical Center, Poznań, Poland
| | - Elżbieta Nowakowska
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznań, Poland
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