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Graetz I, Huang J, Gopalan A, Muelly E, Millman A, Reed ME. Primary Care Telemedicine and Care Continuity: Implications for Timeliness and Short-term Follow-up Healthcare. J Gen Intern Med 2024:10.1007/s11606-024-08914-4. [PMID: 39020223 DOI: 10.1007/s11606-024-08914-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/25/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND The effectiveness of telemedicine by a patient's own primary care provider (PCP) versus another available PCP is understudied. OBJECTIVE Examine the association between primary care visit modality with timeliness and follow-up in-person healthcare, including variation by visits with the patient's own PCP versus another PCP. DESIGN AND PARTICIPANTS Cohort study including primary care visits in a large, integrated delivery system in 2022. MEASURES Outcomes included timeliness (visit completed within 7 days of scheduling) and in-person follow-up (PCP visits, emergency department (ED) visits, hospitalizations) within 7 days of the index PCP visit. Logistic regression measured the association between visit modality (in-person, video, and audio-only telemedicine) with the patient's own PCP or another PCP and outcomes, adjusting for characteristics. KEY RESULTS Among 4,817,317 primary care visits, 59% were in-person, 27% audio-only, and 14% video telemedicine. Most (71.3%) were with the patient's own PCP. Telemedicine visits were timelier, with modality having a larger association for visits with patient's own PCP versus another PCP (P < 0.001). For visits with patient's own PCPs, return office visit rates were 1.2% for in-person, 5.3% for video, and 6.1% for audio-only. For another PCP, rates were 2.2% for in-person, 7.3% for video, and 8.1% for audio. Follow-up ED visits ranged from 1.4% (in-person) to 1.6% (audio-only) with own PCP, compared to 1.9% (in-person) to 2.3% (audio-only) with another PCP. Differences in return office and ED visits between in-person and telemedicine were larger for visits with another PCP compared to their own PCP (P < 0.001). Follow-up hospitalizations were rare, ranging from 0.19% (in-person with own PCP) to 0.32% (video with another PCP). CONCLUSION Differences in return office and ED visits between in-person and telemedicine were larger when patients saw a less familiar PCP compared to their own PCP, reinforcing the importance of care continuity.
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Affiliation(s)
- Ilana Graetz
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, GA, USA.
| | - Jie Huang
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA, USA
| | - Anjali Gopalan
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA, USA
| | | | - Andrea Millman
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA, USA
| | - Mary E Reed
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA, USA
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2
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Bonica GM, Johns RW, Jadvar H. Telehealth and Telemedicine: Regulatory and Medicolegal Landscape. Clin Nucl Med 2024; 49:644-647. [PMID: 38769654 DOI: 10.1097/rlu.0000000000005254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
ABSTRACT Telehealth and telemedicine experienced remarkable growth during and after the recent COVID-19 pandemic. Telehealth is generally defined as nonclinical services that employ telecommunication technology. Telemedicine refers more specifically to remote clinical services including diagnosis, monitoring, and treatment. Nuclear medicine is no exception in employing telemedicine increasingly in clinical practice for image interpretation and treatment consultation and care delivery supervision. There is no doubt that soon, the use of tele-nuclear medicine will increase, comparable to the employment of telecommunication in other fields of medicine. We review the medicolegal and regulatory aspects of the evolution in the clinical practice of medicine through telehealth and telemedicine.
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Affiliation(s)
| | | | - Hossein Jadvar
- Gould School of Law
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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3
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Hall RW. Telemedicine: a balanced perspective. Pediatr Res 2024:10.1038/s41390-024-03349-3. [PMID: 38902455 DOI: 10.1038/s41390-024-03349-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 06/22/2024]
Affiliation(s)
- Richard Whit Hall
- Division of Neonatology, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital Research Institute, 4301 W Markham, Neonatology, Slot 512B, Little Rock, AR, 72205-7101, USA.
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4
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Olson LM, Perry GN, Yang S, Galyean PO, Zickmund SL, Sorenson S, Pinto NP, Maddux AB, Watson RS, Fink EL. Parents' Experiences Caring for a Child after a Critical Illness: A Qualitative Study. J Pediatr Intensive Care 2024; 13:127-133. [PMID: 38919699 PMCID: PMC11196146 DOI: 10.1055/s-0041-1740450] [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: 07/14/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022] Open
Abstract
Objectives This article described parents' experience and identifies outcomes important to parents following their child's critical illness. Methods Semistructured interviews with 22 female and 4 male parents representing 26 critically ill children with predominately neurologic and respiratory diagnoses. Most children were younger than 5 years at discharge with a median (interquartile range) of 2 (2.0-3.0) years from discharge to interview. Results Many children returned home with life-altering physical and cognitive disabilities requiring months to years of rehabilitation. Parents remembered feeling unprepared and facing an intense, chaotic time when the child first returned home. They described how they suddenly had to center their daily activities around the child's needs amidst competing needs of siblings and partners, and in some cases, the medicalization of the home. They recounted negotiating adjustments almost daily with insurance agencies, medical doctors and therapists, employers, the child, and other family members to keep the family functioning. In the long term, families developed a new norm, choosing to focus on what the child could still do rather than what they could not. Even if the child returned to baseline, parents remembered the adjustments made to keep the child alive and the family functioning. Conclusion Heightened awareness of family experiences after pediatric critical illness will allow health care providers to improve family preparedness for the transition from hospital to home.
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Affiliation(s)
- Lenora M. Olson
- Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, Utah, United States
| | - Grace N. Perry
- Qualitative Research Core, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Serena Yang
- Qualitative Research Core, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Patrick O'Roke Galyean
- Qualitative Research Core, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Susan L. Zickmund
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
| | - Samuel Sorenson
- Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, Utah, United States
| | - Neethi P. Pinto
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Aline B. Maddux
- Department of Pediatrics, Critical Care Medicine, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States
| | - R. Scott Watson
- Department of Pediatrics, Pediatric Critical Care Medicine, University of Washington School of Medicine, Seattle, Washington, United States
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, United States
| | - Ericka L. Fink
- Division of Pediatric Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
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5
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Rizzo L, Barbetta E, Ruberti F, Petz M, Tornesello M, Deolmi M, Fainardi V, Esposito S. The Role of Telemedicine in Children with Obstructive Sleep Apnea Syndrome (OSAS): A Review of the Literature. J Clin Med 2024; 13:2108. [PMID: 38610873 PMCID: PMC11012248 DOI: 10.3390/jcm13072108] [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: 02/27/2024] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
The advent of telemedicine marked a significant turning point in the healthcare landscape, introducing a revolutionary approach to the delivery of medical care. Digital technologies easily connect health professionals and patients, overcoming geographical and temporal barriers. Telemedicine has been used for sleep disorders including obstructive sleep apnea syndrome (OSAS) since the mid-1990s. In adult patients with OSAS, telemedicine is helpful both for consultation and diagnosis, the latter obtained through remote recordings of oxygen saturation and further parameters registered with telemonitored respiratory polygraphy or polysomnography. Remote monitoring can be used to follow up the patient and verify adherence to daily treatments including continuous positive airway pressure (CPAP). In children, studies on the role of telemedicine in OSAS are scarce. This narrative review aims to describe the application of telemedicine in children with obstructive sleep apnea syndrome (OSAS), assessing its advantages and disadvantages. In patients with OSA, telemedicine is applicable at every stage of patient management, from diagnosis to treatment monitoring also in pediatric and adolescent ages. While telemedicine offers convenience and accessibility in healthcare delivery, its application in managing OSAS could be associated with some disadvantages, including limitations in physical examination, access to diagnostic tools, and education and counseling; technology barriers; and privacy concerns. The adoption of a hybrid approach, integrating both in-office and virtual appointments, could effectively meet the needs of children with OSAS. However, more studies are needed to fully assess the effectiveness and safety of telemedicine in the pediatric population.
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Affiliation(s)
- Luisa Rizzo
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Elena Barbetta
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Flaminia Ruberti
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Matilde Petz
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marco Tornesello
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Michela Deolmi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Sanchez GV, Kabbani S, Tsay SV, Bizune D, Hersh AL, Luciano A, Hicks LA. Antibiotic Stewardship in Outpatient Telemedicine: Adapting Centers for Disease Control and Prevention Core Elements to Optimize Antibiotic Use. Telemed J E Health 2024; 30:951-962. [PMID: 37856146 DOI: 10.1089/tmj.2023.0229] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
The rapid expansion of telemedicine has highlighted challenges and opportunities to improve antibiotic use and effectively adapt antibiotic stewardship best practices to outpatient telemedicine settings. Antibiotic stewardship integration into telemedicine is essential to optimize antibiotic prescribing for patients and ensure health care quality. We performed a narrative review of published literature on antibiotic prescribing and stewardship in outpatient telemedicine to inform the adaptation of the Core Elements of Outpatient Antibiotic Stewardship framework to outpatient telemedicine settings. Our narrative review suggests that in-person antibiotic stewardship interventions can be adapted to outpatient telemedicine settings. We present considerations for applying the Core Elements of Outpatient Antibiotic Stewardship to outpatient telemedicine which builds upon growing evidence describing care delivery and quality improvement in this setting. Additional applied implementation research is necessary to inform the application of effective, sustainable, and equitable antibiotic stewardship interventions across the spectrum of outpatient telemedicine.
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Affiliation(s)
- Guillermo V Sanchez
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Kabbani
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon V Tsay
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Destani Bizune
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adam L Hersh
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Angelina Luciano
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lauri A Hicks
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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7
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Kaushik R. Telehealth and Children with Medical Complexity. Pediatr Ann 2024; 53:e74-e81. [PMID: 38466329 DOI: 10.3928/19382359-20240109-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Although use of telehealth may have begun centuries ago and has grown considerably through the 20th century, the coronavirus disease 2019 pandemic skyrocketed telemedicine's reach, including its use in pediatrics. The American Academy of Pediatrics endorses telehealth as a "critical infrastructure to efficiently implement the medical home model of care." Particularly for children with medical complexity (CMC), telehealth offers great promise to improve access to continuous, coordinated primary care, reduce time to pediatric subspecialty care, and support distance education for both pediatric providers and patients and their families. This article details the numerous benefits of telehealth to CMC with an emphasis on its use as an extender of the medical home, describes the venues in which telehealth augments access to safe, high-quality care, presents best practices in engaging in telehealth encounters, and enumerates barriers that may exacerbate current health inequities. We review current published telehealth patient-/caregiver-level, clinician-level, and payor-level outcomes while revealing research gaps and opportunities. [Pediatr Ann. 2024;53(3):e74-e81.].
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8
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Zeineddin S, Macy ML, Bouchard ME, Carroll MS, Linton S, De Boer C, Abdullah F, Ghomrawi H. Disparities in Telemedicine Use Among Children Seen in Surgical Clinics During the COVID-19 Pandemic: Experience of One Tertiary Care Freestanding Children's Hospital. Telemed J E Health 2024; 30:642-650. [PMID: 37910777 DOI: 10.1089/tmj.2023.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Background: Telemedicine use dramatically increased during the COVID-19 pandemic. However, the effects of telemedicine on pre-existing disparities in pediatric surgical access have not been well described. We describe our center's early experience with telemedicine and disparities in patients' access to outpatient surgical care. Methods: A retrospective study of outpatient visits within all surgical divisions from May to December 2020 was conducted. We assessed the rates of scheduled telemedicine visits during that period, as well as the rate of completing a visit after it has been scheduled. Descriptive and logistic regression analyses were used to test for associations between these rates and patient characteristics. Results: Over the study period, 109,601 visits were scheduled. Telemedicine accounted for 6.1% of all visits with lower cancellation rates than in-person visits (26.9% vs. 34.7%). More scheduled telemedicine encounters were observed for older patients, White, English speakers, those with private insurance, and those living in rural areas. Lower odds of telemedicine visit completion were observed among patients with public insurance (odds ratio [OR] 0.7, 95% confidence interval [CI] 0.64-0.77), Spanish language preference (OR 0.84, 95% CI 0.72-0.97), and those living in rural areas (OR 0.73, 95% CI 0.64-0.84). In contrast, higher odds of telemedicine visit completion were associated with a higher Social Deprivation Index score (OR 1.41, 95% CI 1.27-1.58). Telemedicine visit completion was also associated with increasing community-level income and distance from the hospital. Conclusions: Telemedicine use for outpatient surgical care was generally low during the peak of the pandemic, and certain populations were less likely to utilize it. These findings call for further action to bridge gaps in telemedicine use.
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Affiliation(s)
- Suhail Zeineddin
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michelle L Macy
- Division of Emergency Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Megan E Bouchard
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michael S Carroll
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children's Research Institute, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Samuel Linton
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Christopher De Boer
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Hassan Ghomrawi
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Medicine (Rheumatology), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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9
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Kahn NF, Asante PG, Guler J, Reyes V, Anan Y, Bocek K, Kidd KM, Richardson LP, Christakis DA, Pratt W, Sequeira GM. Caregiver perspectives on receiving gender-affirming care with their transgender and gender diverse adolescents via telemedicine. LGBTQ+ FAMILY : AN INTERDISCIPLINARY JOURNAL 2024; 20:190-200. [PMID: 38721330 PMCID: PMC11075659 DOI: 10.1080/27703371.2024.2317139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Telemedicine may help improve access to gender-affirming care for transgender and gender diverse (TGD) adolescents. Parents or guardians (i.e., caregivers) of TGD adolescents play a critical role in supporting TGD adolescents in accessing this care. The purpose of this study was to explore caregivers' perspectives regarding their adolescent receiving pediatric gender-affirming care via telemedicine to help providers and health systems optimize this modality for future care delivery. Caregivers (n=18) of TGD adolescents ages 14-17 participated in semi-structured, individual interviews that were transcribed and analyzed qualitatively. Caregivers cited participating in visits from their home environment, decreased anxiety, COVID safety, ability to have more family members attend, no transportation demands, and effective delivery of care as advantages of telemedicine. Disadvantages included dysphoria or discomfort with self-image, impersonal provider-patient interactions, video teleconferencing fatigue, difficulty with portal navigation, connectivity issues, and lack of privacy. Caregivers largely deferred to their child's preference regarding the choice of visit modality, but many reported a preference for the first to be conducted in-person, and follow-up and less complex visits via telemedicine. Health systems should consider these perspectives as they adapt telemedicine infrastructure to better meet the needs of patients and their families.
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Affiliation(s)
- Nicole F Kahn
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Peter G Asante
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Jessy Guler
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Valentino Reyes
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Yomna Anan
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Kevin Bocek
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Kacie M Kidd
- Department of Pediatrics, West Virginia University, Morgantown, West Virginia, USA
| | - Laura P Richardson
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Dimitri A Christakis
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Wanda Pratt
- The Information School, University of Washington, Seattle, Washington, USA
| | - Gina M Sequeira
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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10
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Porri D, Morabito LA, Cavallaro P, La Rosa E, Li Pomi A, Pepe G, Wasniewska M. Time to act on childhood obesity: the use of technology. Front Pediatr 2024; 12:1359484. [PMID: 38434727 PMCID: PMC10904600 DOI: 10.3389/fped.2024.1359484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Childhood obesity is rapidly increasing worldwide and there is an urgent need to implement treatment and prevention programs. Over the last decade, in addition to increasing rates of childhood obesity, we have also observed rapid technological and digital development. The Covid-19 pandemic has largely contributed to both expansions but has also allowed an opening towards a broader vision of medicine, through new therapeutic opportunities such as mobile healthcare. The digital and technological delivery of obesity prevention and treatment programs can represent an innovative tool to support children and families to overcome some limitations and barriers such as the accessibility of programs that prevent them from adopting healthy lifestyle changes. This review aimed to summarize the impact of different digital interventions for children and adolescent affected by obesity.
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Affiliation(s)
| | | | - Paola Cavallaro
- Unit of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
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11
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Cheng L, Peng S, Hao H, Ye D, Xu L, Zuo Y, Huang J. Effect of different screen brightness and devices on online visual acuity test. Graefes Arch Clin Exp Ophthalmol 2024; 262:641-649. [PMID: 37606825 DOI: 10.1007/s00417-023-06206-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/25/2023] [Accepted: 08/05/2023] [Indexed: 08/23/2023] Open
Abstract
PURPOSE This study aimed to study the difference in test results of online visual acuity (VA) test under different devices and screen brightness conditions and to compare online VA test with Early Treatment Diabetic Retinopathy Study (ETDRS). METHODS Healthy volunteers with the best corrected VA of 0.0 LogMAR or higher were recruited. VAs under ETDRS were tested first, and then online VA test (the Stanford Acuity Test, StAT) visual acuities using iPad Air2 and Microsoft Surface pro4 under 50% and 100% screen brightness were performed. The VA results and the testing times were compared between different devices and screen brightness conditions. RESULTS A total of 101 eyes were included in this study. The VA results measured by the StAT were better than those of ETDRS. The VA results measured at 100% screen brightness were better than those of 50% brightness (mean difference, 0.013 logMAR at most, less than 1 letter); the VA results measured by iPad Air2 were better than those of Surface pro4 (mean difference, -0.009 logMAR at most, less than 1 letter). Significantly less time was spent on VA testing under StAT than that under ETDRS. CONCLUSION The impact of screen brightness and the device on the VA results generated by online VA tests was clinically insignificant. In addition, online VA tests are found to be reliable and more time efficient than ETDRS.
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Affiliation(s)
- Lu Cheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, 7 Jinsui Road, Guangzhou, 510060, China
| | - Shi Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, 7 Jinsui Road, Guangzhou, 510060, China
| | - Hua Hao
- Environmental Health Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Dan Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, 7 Jinsui Road, Guangzhou, 510060, China
| | - Liya Xu
- Department of Biology, School of Arts and Sciences, Tufts University, Medford, MA, USA
| | - Yajing Zuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, 7 Jinsui Road, Guangzhou, 510060, China.
| | - Jingjing Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, 7 Jinsui Road, Guangzhou, 510060, China.
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Mulkey SB, Arroyave-Wessel M, Peyton C, Ansusinha E, Gutierrez C, Sorkar A, Cure A, Samper Y, Cure D, Msall ME, Cure C. Harnessing the power of telemedicine to accomplish international pediatric outcome research during the COVID-19 pandemic. J Telemed Telecare 2024; 30:388-392. [PMID: 34962177 PMCID: PMC9237184 DOI: 10.1177/1357633x211063166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The COVID-19 pandemic occurred during planned neurodevelopmental follow-up of Colombian children with antenatal Zika-virus exposure. The objective of the study was to leverage the institution's telemedicine infrastructure to support international clinical child outcome research. In a prospective cohort study of child neurodevelopment (NCT04398901), we used synchronous telemedicine to remotely train a research team and perform live observational assessments of children in Sabanalarga, Colombia. An observational motor and conceptional standardized tool kit was mailed to Colombia; other materials were translated and emailed; team training was done virtually. Children were recruited by team on the ground. Synchronous activities were video-recorded directly to two laptops, each with a telehealth Zoom link to allow simultaneous evaluation of "table" and "standing" activities, and backup recordings were captured directly on the device in Colombia. The U.S. team attended live over Zoom from four states and five distinct locations, made observational notes, and provided real-time feedback. Fifty-seven, 3-4-year-old children with Zika-virus exposure and 70 non-exposed controls were studied during 10 daytrips. Direct laptop recording ensured complete record of child activities due to internet outages. Telemedicine can be used to successfully perform international neurodevelopmental outcome research in children during the COVID-19 pandemic. Telemedicine can benefit global health studies.
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Affiliation(s)
- Sarah B Mulkey
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- Department of Neurology, The George Washington, University School of Medicine and Health Sciences, Washington, DC, USA
- Department of Pediatrics, The George Washington, University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Emily Ansusinha
- Division of Pediatric Infectious Disease, Children's National Hospital, Washington, DC, USA
| | | | | | | | | | | | - Michael E Msall
- Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, University of Chicago Medicine, Chicago, IL, USA
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Castillo-Rodenas M, Vidal-Alaball J, Solanas-Bacardit N, Farràs-Company C, Fuster-Casanovas A, Miró Catalina Q, López Seguí F. Feasibility of a Pediatric Acute Video Consultation Process Among Health Care Professionals in Primary Care in a Rural Setting: Protocol for a Prospective Validation Study. JMIR Res Protoc 2024; 13:e52946. [PMID: 38300693 PMCID: PMC10870202 DOI: 10.2196/52946] [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: 09/20/2023] [Revised: 11/25/2023] [Accepted: 12/04/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND For years, in Catalonia and in the rest of Spain, there has been a deficit and an unequal geographical distribution of health professionals specializing in pediatrics, especially in rural areas. Among the proposals to improve this situation is the promotion of the use of information and communication technologies (ICT) among users and professionals. Moreover, with the outbreak of COVID-19, the use of telehealth has become an essential tool, with an overall increase in non-face-to-face visits, including in primary care pediatrics. In this context, telemedicine, when used in primary care pediatrics, can be an effective means of improving families' access to medical care. Currently, in Catalonia, telemedicine involving patients and health professionals is used in pediatric primary care through telephone consultation and asynchronous teleconsultation (eConsulta). Video consultation is in practice not used, although it could have different applications. OBJECTIVE The aim of this study is to evaluate the feasibility of a video consultation process with physical examination in acute pediatric pathology in rural areas among primary care professionals. In addition, the level of satisfaction with these remote consultations will be assessed from the perspective of both the users and the health care professionals. METHODS We will conduct a prospective experimental study to analyze the possibility of using video consultation in pediatric acute care in primary care in central Catalonia (Spain). A minimum of 170 children aged between 0 and 14 years attending the primary care center (PCC) for acute illness for a period of 1 year will be included in the study. Initially, the telemetric visit, including a physical examination, will include a nurse at the patient and family's side and a pediatrician who will participate remotely. Subsequently, the pediatrician will visit the patient in person and the physical examination and diagnosis made during the remote visit will be compared with the physical examination and diagnosis of the face-to-face visit, which is considered the gold standard. RESULTS Recruitment was planned to begin in the second half of 2023 and continue for at least 1 year. It is anticipated to be a good resource for a variety of acute pediatric conditions in primary care. The evaluation will focus on the feasibility of performing live remote visits and comparing their diagnostic accuracy with that of face-to-face visits. CONCLUSIONS We believe that this study could provide evidence on the feasibility and diagnostic accuracy of video consultation in pediatric acute primary care in a rural setting, as well as on satisfaction with video consultations among both users and professionals. If proven useful in addressing the acute needs of children in a variety of situations, it could become a digital health tool that improves the overall pediatric primary care service in rural areas, for both families and professionals. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52946.
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Affiliation(s)
- Marta Castillo-Rodenas
- Centre d'Atenció Primària Cardona, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Cardona, Spain
| | - Josep Vidal-Alaball
- Cap de la Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
| | - Núria Solanas-Bacardit
- Centre d'Atenció Primària Cardona, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Cardona, Spain
| | - Clotilde Farràs-Company
- Direcció del Centre d'Atenció Primària Cardona, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Cardona, Spain
| | - Aïna Fuster-Casanovas
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Queralt Miró Catalina
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 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, Sant Fruitós de Bages, Spain
| | - Francesc López Seguí
- Chair in ICT and Health, Centre for Health and Social Care Research, University of Vic–Central University of Catalonia, Vic, Spain
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He X, Cui F, Lyu M, Sun D, Zhang X, Shi J, Zhang Y, Jiang S, Zhao J. Key Factors Influencing the Operationalization and Effectiveness of Telemedicine Services in Henan Province, China: Cross-Sectional Analysis. J Med Internet Res 2024; 26:e45020. [PMID: 38180795 PMCID: PMC10799288 DOI: 10.2196/45020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/26/2023] [Accepted: 11/17/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Telemedicine has demonstrated its potential in alleviating the unbalanced distribution of medical resources across different regions. Henan, a province in China with a population of approximately 100 million, is especially affected by a health care divide. The province has taken a proactive step by establishing a regional collaborative platform for telemedicine services provided by top-tier provincial hospitals. OBJECTIVE We aim to identify the key factors that influence the current operationalization and effectiveness of telemedicine services in Henan province. The insights gained from this study will serve as valuable references for enhancing the efficient operation of telemedicine platforms in low- and middle-income regions. METHODS We analyzed service reports from the performance management system of telemedicine services in Henan province throughout 2020. Using descriptive statistics and graphical methods, we examined key influencing factors, such as management competency; device configuration; and hospital capability, capacity, and service efficacy, across hospitals at 2 different tiers. In addition, we used generalized linear models and multiple linear regression models to identify key operational factors that significantly affect the service volume and efficacy of 2 major telemedicine services, namely teleconsultation and tele-education. RESULTS Among the 89 tier 3 hospitals and 97 tier 2 hospitals connected to the collaborative telemedicine platform, 65 (73%) and 55 (57%), respectively, have established standardized management procedures for telemedicine services. As the primary delivery method for telemedicine services, 90% (80/89) of the tier 3 hospitals and 94% (91/97) of the tier 2 hospitals host videoconferencing consultations through professional hardware terminals rather than generic computers. Teleconsultation is the dominant service type, with an average annual service volume per institution of 173 (IQR 37-372) and 60 (IQR 14-271) teleconsultations for tier 3 and tier 2 hospitals, respectively. Key factors influencing the service volume at each hospital include available funding, management competency, the number of connected upper tiers, and the number of professional staff. After receiving teleconsultations from tier 3 (65/89, 73%) and tier 2 (61/97, 63%) hospitals, patients reported significant improvements in their medical conditions. In addition, we observed that service efficacy is positively influenced by management competency, financial incentives, the number of connected upper or lower tiers, and the involvement of participating medical professionals. CONCLUSIONS Telemedicine has become increasingly popular in Henan province, with a notable focus on teleconsultation and tele-education services. Despite its popularity, many medical institutions, especially tier 2 hospitals, face challenges related to management competency. In addition to enhancing the effectiveness of existing telemedicine services, health care decision-makers in Henan province and other low- and middle-income regions should consider expanding the service categories, such as including remote emergency care and telesurgery, which have promise in addressing crucial health care needs in these regions.
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Affiliation(s)
- Xianying He
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fangfang Cui
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Minzhao Lyu
- School of Electrical Engineering and Telecommunications, University of New South Wales, Sydney, Australia
| | - Dongxu Sun
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xu Zhang
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinming Shi
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yinglan Zhang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Shuai Jiang
- Finance Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Zhao
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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15
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Aleebrahim-Dehkordi E, Soveyzi F, Deravi N, Saghazadeh A, Rezaei N. Mental Healthcare in Pediatrics During the COVID-19 Pandemic: A Call for International Public Health Action. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1458:19-34. [PMID: 39102187 DOI: 10.1007/978-3-031-61943-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
Public health measures associated with coronavirus disease 2019 (COVID-19), such as lockdowns and quarantine of suspected cases, can negatively affect children's mental health status. Although the current crisis provides personal growth and family cohesion opportunities, pitfalls appear to outweigh the benefits. The magnitude and quality of its impact on children depend on several factors, including anxiety, lack of social contact, and a reduced opportunity for stress regulation, along with an increased risk for parental mental health issues, child maltreatment, and domestic violence. Children with special needs and social disadvantages like trauma experiences, disabilities, pre-existing mental illness, e.g., autism spectrum disorders and hyperactivity, and low socioeconomic status, may be at higher risk in this context. Here, the potentials social support can provide for pediatrics, both healthy children and children with special needs, are reviewed after an overview of quarantine's adverse effects on this special population during a pandemic. The most common psychological issues associated with the COVID-19 pandemic are sleep disorders, mood swings, depression, anxiety, decreased attention, stress, irritability, anger, and fear. Moreover, the impact of COVID-19 on children's physical health includes weight gain, reduced physical activity, immune dysregulation, and cardiometabolic disorders. All support systems, involving parents, teachers/school counselors, pediatricians, mental healthcare workers, and Health and Art (HEART) groups, need to enter the scene and make their share of children's mental health care.
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Affiliation(s)
- Elahe Aleebrahim-Dehkordi
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Faezeh Soveyzi
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Radiology Resident at MUMS, Radiology Department Mashhad University of Medical Sciences, Mashhad, Iran
| | - Niloofar Deravi
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Student's Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amene Saghazadeh
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Dr. Qarib St, Keshavarz Blvd, 14194, Tehran, Iran
- MetaCognition Interest Group (MCIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Dr. Qarib St, Keshavarz Blvd, 14194, Tehran, Iran.
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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16
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Qari AH, Almashhadani SS, Balbaid MA, Alharthi YD, Alzahrani AA, Morad MH, Hassan SS. Perceptions of Schoolteachers About Teledentistry Use in Makkah City. Cureus 2024; 16:e51927. [PMID: 38333450 PMCID: PMC10851029 DOI: 10.7759/cureus.51927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES Teledentistry is a combination of communication technology and dentistry. Teledentistry is an alternative and useful way to remotely provide advisory, preventive, and emergency services in places with poor access to dental care. Few studies in Saudi have investigated the implementation of teledentistry at schools or assessed the perceptions of school personnel. This research aimed to evaluate teachers' perceptions about the use of teledentistry to examine schoolchildren in Makkah city. METHODS The study was conducted on 20 intermediate schools randomly selected from different regions of Makkah city using a multistage cluster sampling method. Two data collectors visited the schools to administer the study questionnaire, exploring teachers' perceptions of teledentistry. The questionnaire was adapted from a validated survey based on the technology acceptance model (TAM). Descriptive statistics, analysis of variance, Mann-Whitney U test, and the Kruskal-Wallis tests were conducted to compare the mean differences in participants' perceptions of teledentistry based on their demographics. RESULTS A total of 241 teachers completed the survey, 131 of whom were females (54.4%), and the mean age of participants was 42.5±7 years. Over 80% of participants taught ≥16 classes a week, and their experience ranged from less than a year to more than 31 years. Sixty participants (25%) knew teledentistry before watching the study video. The results revealed a significant difference between male and female teachers regarding perceptions of teledentistry. Female participants had higher scores in TAM dimensions than males. CONCLUSION This survey revealed a generally favorable attitude toward teledentistry utilization in schools. Including non-dental employees, such as teachers to provide such a service will assist in alleviating the shortage or unavailability of dentists at schools. This goes in line with the government's plans to promote telehealth as part of the Saudi Vision 2030.
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Affiliation(s)
| | | | | | | | | | | | - Sherif S Hassan
- Basic and Clinical Oral Sciences, Umm Al-Qura University, Makkah, SAU
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17
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McKenzie C, Titzer M, Hutchinson A, Dodge C, Fergus A. Analysis of a model for pediatric physical therapy and clinical education via telehealth. J Pediatr Rehabil Med 2024; 17:271-288. [PMID: 38457162 PMCID: PMC11307064 DOI: 10.3233/prm-220112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 10/23/2023] [Indexed: 03/09/2024] Open
Abstract
A novel entry-level collaborative clinical learning experience (CLE) in pediatric physical therapy (PT) delivered via telehealth was implemented involving 12 families, 54 DPT students, and 12 clinical instructors (CIs). Children of various ages, a wide range of home environments, and diagnoses received individualized PT via telehealth during a four-week CLE. Retrospective quantitative and qualitative analyses of student documentation, video recordings of sessions, and CI, student, and caregiver survey responses were performed. All children demonstrated qualitative improvements and 73% demonstrated quantitative improvements. CIs, students, and caregivers believed the children benefited from the experience and 98% believed the children were able to work toward their goals. Most students (95%) and CIs (100%) felt that it was a valuable and effective learning experience. Most (>71%) CIs and students believed students were able to learn in all relevant domains of the clinical performance instrument. This model provides a unique CLE for students in both pediatric PT and telehealth.
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Affiliation(s)
- Courtney McKenzie
- Division of Physical Therapy, Shenandoah University, Winchester, VA, USA
| | - Melanie Titzer
- Division of Physical Therapy, Shenandoah University, Winchester, VA, USA
| | - Alyssa Hutchinson
- Division of Physical Therapy, Shenandoah University, Winchester, VA, USA
| | - Camaran Dodge
- Division of Physical Therapy, Shenandoah University, Winchester, VA, USA
| | - Andrea Fergus
- Division of Physical Therapy, Shenandoah University, Winchester, VA, USA
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18
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Tan LO, Ganapathy S. A single centre study of the level of parents' satisfaction with the COVID-19 telemedicine consultation. Eur J Pediatr 2024; 183:213-218. [PMID: 37861792 DOI: 10.1007/s00431-023-05276-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023]
Abstract
Telemedicine is an effective tool for video consultation of COVID-19 patients in the setting of the COVID-19 pandemic. We prospectively determined the level of parents' satisfaction with the COVID-19 telemedicine consultation. This was a single centre prospective study. COVID-19 paediatric patients who were seen in the children's emergency department of KK Women's and Children's Hospital, Singapore, and deemed fit for home recovery were discharged with a COVID-19 telemedicine follow-up in two to three days' time. Paediatric patients who were seen in the COVID-19 telemedicine visits were included in the parents' satisfaction survey. We excluded patients who defaulted their telemedicine visits. The telemedicine satisfaction survey was conducted using an online form consisting of 16 Likert scale questions, sent via text messaging. Our primary outcome was telemedicine satisfaction scores. Our secondary outcome was children's emergency department reattendance or hospital admission within 10 days after the telemedicine consultation. 1238 patients attended the COVID-19 video consultation clinic from 15 December 2021 till 25 March 2022, out of which 476 parents of the COVID-19 patients completed the survey questionnaire. The mean age of the COVID-19 patients was 3.6 years. There was a high level of overall satisfaction among parents of the COVID-19 patients, with a mean score of 6.1 out of 7. 12 out of 16 questions had a positive response (mean score of 6 or more). There was a total of 9 reattendances to children's emergency department, out of which 3 cases needed hospital admission. Conclusion: There was a high level of overall satisfaction with the use of telemedicine in symptomatic COVID-19 paediatric patients. What is Known: • Telemedicine is a cost-effective and feasible mode of delivering health care for conditions such as diabetes, heart disease, and depressive disorder, especially in the setting of the COVID-19 pandemic. What is New: • To gauge the parents' satisfaction with the COVID-19 telemedicine visit, in order to improve the patient and caregiver experience with telemedicine, and to improve the telemedicine service delivery. • Information from this study is crucial in order to prevent unnecessary hospital reattendance due to parental concern from poor telemedicine delivery.
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Affiliation(s)
- Lay Ong Tan
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
| | - Sashikumar Ganapathy
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Eljack MMF, Elhadi YAM, Mahgoub EAA, Ahmed KAHM, Mohamed MTAA, Elnaiem W, Mohamedsharif A, Nour AB, Muhammed AEM, Gebril MSM, Asghar MS, El-Osta A. Physician experiences with teleconsultations amidst conflict in Sudan. Sci Rep 2023; 13:22688. [PMID: 38114741 PMCID: PMC10730898 DOI: 10.1038/s41598-023-49967-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023] Open
Abstract
The current conflict in Sudan severely hinders the accessibility of health services across the country. To address this, several initiatives were proposed including offering services using teleconsultations. This study aimed to assess Sudanese doctors' teleconsultation experience, perception, and concerns during the recent conflict. This cross-sectional survey focused on Sudanese medical officers, residents, specialists, and consultants living inside or outside the country having a practice license from the Sudan Medical Council and conducting teleconsultations with Sudanese patients during the conflict period. The questionnaire was distributed to personal and professional contacts and via social media platforms in the English language among doctors who provided teleconsultation during the conflict. Data analysis was performed using the Statistical Package for Social Sciences software version 26. The study enrolled 2463 clinicians from 17 different specialties, and females represented more than half the sample (56.8%). Internal medicine was the most frequent specialty (36.1%) and the majority (68.7%) of clinicians had less than 5 years of work experience. Voice call was the most frequent platform (50.1%) used for teleconsultation during the conflict and had the highest convenience score (p < 0.01), whereas messaging platforms had the lowest score. Most clinicians (73.3%) agreed that teleconsultations created a trusted patient-physician relationship and provided good-quality care (61.8%). However, 85.1% highlighted the importance of physical touch in medical practice. Clinicians were concerned that incomplete information (81.4%), missed diagnosis (76.8%), medicolegal problems (71.0%), and prescription errors (68.4%) could arise with teleconsultations. Most respondents (70.7%) emphasized the importance of continuing to offer teleconsultation even after the war abated. In conclusion, physicians who participated in the current study agreed that teleconsultation provided quality care even in this dire crisis in Sudan. Based on our study findings, we recommend upscaling telemedicine interventions including teleconsultations at the national level. This would require unified coordination efforts of a wide mix of stakeholders to address concerns identified in the current study.
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Affiliation(s)
| | | | | | | | | | - Walaa Elnaiem
- Community Department, Faculty of Medicine, University of Alneelain, Khartoum, Sudan
| | - Asma Mohamedsharif
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Alshareef B Nour
- Wad Medani College of Medical Sciences and Technology, Wad Medani, Sudan
| | | | | | | | - Austen El-Osta
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Khubchandani R, Avčin T, Ravelli A. Towards telehealth delivery in pediatric rheumatology practice. Pediatr Rheumatol Online J 2023; 21:145. [PMID: 38105249 PMCID: PMC10726584 DOI: 10.1186/s12969-023-00892-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/06/2023] [Indexed: 12/19/2023] Open
Abstract
INTRODUCTION Much has been written and spoken about telemedicine since about two decades including an article in this journal at the start of the pandemic. It took a global catastrophe to enforce its usage across the world in various medical specialties. Telemedicine however remains unstructured, unregulated and lacks uniformity. DISCUSSION This article highlights the practical learnings and opinions of the authors who provided over two thousand video consults and asynchronous telemedicine services through the entire pandemic. It includes lessons learnt from emerging economies where pediatric rheumatologists are scarce. Pediatric rheumatology, which relies heavily on history, musculoskeletal and skin examination is aptly suited to exploit telemedicine in its synchronous and asynchronous forms. Pediatric tele rheumatology could temporarily address the shortage and uneven distribution of specialists in vast parts of the globe, besides serving as a method of triage and shared care with the primary physician. Reduction of direct and indirect costs and family/primary physician education are additional benefits. There also exist challenges for all stakeholders and it is important to address the latter. CONCLUSION The learnings of the pandemic suggest a vital role for telemedicine in the practice of pediatric rheumatology. This is a fertile area for research and consensus building by international and national pediatric societies and issue position statements like some adult bodies already have. The authors speculate a hybrid system of care in the not-so-distant future.
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Affiliation(s)
- Raju Khubchandani
- Section of Pediatric Rheumatology, SRCC Childrens Hospital, K Khadye Marg Mumbai, Mumbai, India.
| | - Tadej Avčin
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Angelo Ravelli
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini and Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
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Mayfield CA, Priem JS, Effinger T, McGinnis S, Grinton P. School-Based Telemedicine and Reduced Avoidable Emergency Care Among Rural Pediatric Patients. Telemed J E Health 2023; 29:1819-1827. [PMID: 37172309 DOI: 10.1089/tmj.2023.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
Objective: Children living in rural communities have disparate access to preventive health care, shifting the burden of care delivery to emergency services. This study examined the association of school-based telemedicine (SBT) and avoidable emergency department (ED) utilization in rural historically underserved pediatric patients served through an SBT program. Methods: A retrospective analysis was conducted using electronic medical records and claims data from a large integrated health care system serving as the majority health care provider in the area. Participants included all pediatric patients served through an SBT program between 2017 and 2020 across three rural North Carolina counties. The study was a quasi-experimental before/after design comparing 12-month time periods before and after a patient's index virtual care visit. A subset of patients served 12 months before the start of the coronavirus 2019 (COVID-19) pandemic in 2020 was extracted and analyzed separately for a sensitivity analysis. Results: The complete sample included 1,236 patients. The odds of having an avoidable ED visit were reduced by 33% between time periods, and the estimated count of visits was reduced by 26%. (Models were adjusted for race/ethnicity, gender, age, and insurance payer.) No significant differences in unavoidable ED utilization were observed. The sensitivity analysis showed similar trends. Conclusions: Results demonstrate that telemedicine can improve access to health care and may offset the burden of avoidable care through emergency health services. Policy changes and increased use during the COVID-19 pandemic have created an optimal environment for telemedicine expansion to reduce health care access disparities.
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Affiliation(s)
- Carlene A Mayfield
- Department of Community Health, Atrium Health, Charlotte, North Carolina, USA
| | - Jennifer S Priem
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Tiffany Effinger
- Information and Analytics Services, Population Health Analytics, Atrium Health, Charlotte, North Carolina, USA
| | - Sam McGinnis
- Levine Children's Pediatric Center, Atrium Health, Charlotte, North Carolina, USA
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22
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Mete Yeşil A, Özmert EN. Bridging the Access Gap: Telemedicine as a Promising Approach for Developmental Pediatrics. Clin Pediatr (Phila) 2023:99228231216294. [PMID: 38014507 DOI: 10.1177/00099228231216294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- Ayşe Mete Yeşil
- Division of Developmental Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Elif N Özmert
- Division of Developmental Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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23
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Variane GFT, Dahlen A, Pietrobom RFR, Rodrigues DP, Magalhães M, Mimica MJ, Llaguno NS, Leandro DMK, Girotto PN, Sampaio LB, Van Meurs KP. Remote Monitoring for Seizures During Therapeutic Hypothermia in Neonates With Hypoxic-Ischemic Encephalopathy. JAMA Netw Open 2023; 6:e2343429. [PMID: 37966836 PMCID: PMC10652158 DOI: 10.1001/jamanetworkopen.2023.43429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/04/2023] [Indexed: 11/16/2023] Open
Abstract
Importance Neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH) frequently experience seizures, which are associated with adverse outcomes. Efforts to rapidly identify seizures and reduce seizure burden may positively change neurologic and neurodevelopmental outcomes. Objective To describe the onset, treatment, and evolution of seizures in a large cohort of newborns with HIE during TH assisted by a telehealth model and remote neuromonitoring approach. Design, Setting, and Participants This was a prospective, observational, multicenter cohort study performed between July 2017 and December 2021 in 32 hospitals in Brazil. Participants were newborns with HIE meeting eligibility criteria and receiving TH. Data were analyzed from November 2022 to April 2023. Exposure Infants with HIE receiving TH were remotely monitored with 3-channel amplitude-integrated electroencephalography (aEEG) including raw tracing and video imaging, and bedside clinicians received assistance from trained neonatologists and neurologists. Main Outcomes and Measures Data on modified Sarnat examination, presence, timing and seizure type, aEEG background activity, sleep-wake cycling, and antiepileptic drugs used were collected. Descriptive statistical analysis was used with independent t test, χ2, Mann-Whitney test, and post hoc analyses applied for associations. Results A total of 872 cooled newborns were enrolled; the median (IQR) gestational age was 39 (38-40) weeks, 518 (59.4%) were male, and 59 (6.8%) were classified as having mild encephalopathy by modified Sarnat examination, 504 (57.8%) as moderate, and 180 (20.6%) as severe. Electrographic seizures were identified in 296 newborns (33.9%), being only electrographic in 213 (71.9%) and clinical followed by electroclinical uncoupling in 50 (16.9%). Early abnormal background activity had a significant association with seizures. Infants with flat trace had the highest rate of seizures (58 infants [68.2%]) and the greatest association with the incidence of seizures (odds ratio [OR], 12.90; 95% CI, 7.57-22.22) compared with continuous normal voltage. The absence of sleep-wake cycling was also associated with a higher occurrence of seizures (OR, 2.22; 95% CI, 1.67-2.96). Seizure onset was most frequent between 6 and 24 hours of life (181 infants [61.1%]); however, seizure occurred in 34 infants (11.5%) during rewarming. A single antiepileptic drug controlled seizures in 192 infants (64.9%). The first line antiepileptic drug was phenobarbital in 294 (99.3%). Conclusions and Relevance In this cohort study of newborns with HIE treated with TH, electrographic seizure activity occurred in 296 infants (33.9%) and was predominantly electrographic. Seizure control was obtained with a single antiepileptic drug in 192 infants (64.9%). These findings suggest neonatal neurocritical care can be delivered at remote limited resource hospitals due to innovations in technology and telehealth.
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Affiliation(s)
- Gabriel Fernando Todeschi Variane
- Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, Clinical Research Department, São Paulo, Brazil
| | - Alex Dahlen
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, California
| | - Rafaela Fabri Rodrigues Pietrobom
- Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, Clinical Research Department, São Paulo, Brazil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Daniela Pereira Rodrigues
- Protecting Brains and Saving Futures Organization, Clinical Research Department, São Paulo, Brazil
- Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maurício Magalhães
- Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, Clinical Research Department, São Paulo, Brazil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Marcelo Jenné Mimica
- Protecting Brains and Saving Futures Organization, Clinical Research Department, São Paulo, Brazil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Nathalie Salles Llaguno
- Protecting Brains and Saving Futures Organization, Clinical Research Department, São Paulo, Brazil
- Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Danieli Mayumi Kimura Leandro
- Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
- Protecting Brains and Saving Futures Organization, Clinical Research Department, São Paulo, Brazil
| | - Paula Natale Girotto
- Protecting Brains and Saving Futures Organization, Clinical Research Department, São Paulo, Brazil
- Division of Neurosurgery, Associação Paulista para o Desenvolvimento da Medicina, Hospital de Transplantes Euryclides de Jesus Zerbini, São Paulo, São Paulo, Brazil
| | - Leticia Brito Sampaio
- Protecting Brains and Saving Futures Organization, Clinical Research Department, São Paulo, Brazil
- Division of Pediatric Neurology, Faculdade de Medicina Hospital das Clínicas, Instituto da Criança, Universidade de São Paulo, São Paulo, Brazil
| | - Krisa Page Van Meurs
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital Stanford, Palo Alto, California
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Kayaalp GK, Akgün Ö, Demirkan FG, Tanatar A, Çakmak F, Ayaz NA. Parent Views on Telemedicine in Pediatric Rheumatology: A Survey Study. Telemed J E Health 2023; 29:1548-1556. [PMID: 36800172 DOI: 10.1089/tmj.2022.0433] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Objectives: The rapid expansion in the use of telemedicine after the COVID-19 pandemic has led many patients with chronic diseases to seek alternative ways for follow-ups. This study aimed to investigate the demands and opinions of parents of children with rheumatic diseases toward telemedicine and to examine the factors affecting telemedicine preference. Methods: A single-center, cross-sectional, Web-based survey study was conducted. Sociodemographic data, characteristics of the disease, access to the clinic, internet use, and views on telemedicine were assessed. Factors effecting telemedicine preference were evaluated by multivariate analysis. Results: A total of 245 parents have completed the survey. The diagnoses of patients were recurrent fever syndromes (55.1%), juvenile idiopathic arthritis (31.0%), systemic connective tissue diseases (8.2%), and vasculitis (5.7%). The majority of patients came to the clinic by public transport (n = 190, 77.6%). Sixty-eight (27.8%) patients missed at least one outpatient appointment in the last year. Majority (n = 172, 70.2%) of parents stated that they would prefer telemedicine visits if it becomes available. Multivariate analysis revealed that the most related factors to telemedicine preference were higher education level (odds ratio [OR]: 6.69, confidence interval [95% CI]: 2.21-20.25, p = 0.001), missing an appointment (OR: 3.04, 95% CI: 1.41-6.56, p = 0.004), and travel time longer than 1 h (OR: 2.13, 95% CI: 1.13-3.86, p = 0.012). Conclusion: Telemedicine visits are in demand in pediatric rheumatology and should be considered an alternative method to ensure continuity of patient follow-up. A personal approach should be followed when selecting patients for telemedicine.
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Affiliation(s)
- Gülşah Kavrul Kayaalp
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Özlem Akgün
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Fatma Gül Demirkan
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Ayşe Tanatar
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Figen Çakmak
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
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Solo-Josephson P, Murren-Boezem J, Zettler-Greeley CM. Pediatric, Urgent Care Telemedicine During COVID-19: A Comparative Analysis. Telemed J E Health 2023; 29:1366-1373. [PMID: 36662562 DOI: 10.1089/tmj.2022.0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: Telemedicine holds potential for improving access to care, but to what extent has it been realized? We examined telemedicine utilization within a pediatric health care system into the second year of the COVID-19 pandemic to illuminate maintenance of changes in patient diversity previously observed and to elucidate ongoing opportunities to support health equity. Materials and Methods: This IRB-approved study is a retrospective analysis of completed visits for parent-initiated, urgent care telemedicine services received by a pediatric health care system between June 2020 and July 2021. Unique patient characteristics were compared with those from 2019 (baseline) and early pandemic. Results: Current study patients (n = 9,064) did not differ from patients in either prior time point (n = 5,462) in race, ethnicity, age, or sex (ps > 0.05). Thirteen preferred languages spoken, relative to 5 at the 2019 baseline. Telemedicine was utilized significantly more than baseline among patients accessing government-subsidized health insurance (p < 0.05); utilization among rural patients (1.2%) declined relative to baseline (p < 0.05). Discussion: This research examined demographic changes among patients utilizing urgent care telemedicine throughout the COVID-19 pandemic and illuminated the importance of sustaining the virtual care needs of a more diverse patient population. Conclusion: Unlocking telemedicine's potential has implications for improving health equity. Our research demonstrates that patients seeking virtual care in the "new normal" represent a greater demographic diversity than observed prepandemic. Mitigation strategies used during the pandemic to engage and support a diverse patient population, including regulatory waivers, technological outreach, and translation services, must continue in support of equitable access for all.
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Affiliation(s)
- Patricia Solo-Josephson
- Center for Health Delivery Innovation, Nemours Children's Hospital, Orlando, Florida, USA
- Section on Telehealth Care, American Academy of Pediatrics, Itasca, Illinois, USA
- University of Central Florida College of Medicine, Faculty and Academic Affairs Department, Orlando, Florida, USA
| | - Joanne Murren-Boezem
- Center for Health Delivery Innovation, Nemours Children's Hospital, Orlando, Florida, USA
- Section on Telehealth Care, American Academy of Pediatrics, Itasca, Illinois, USA
- University of Central Florida College of Medicine, Faculty and Academic Affairs Department, Orlando, Florida, USA
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Netson RA, Miller S, Incorvia J, Shah A, Estrada CR, Toomey SL, Taghinia AH. Patient Experience with Virtual Preoperative Consultations in Pediatric Surgical Specialties. J Pediatr Surg 2023; 58:1776-1782. [PMID: 36690572 DOI: 10.1016/j.jpedsurg.2022.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND A cross-sectional study was conducted to assess the comparative effectiveness of virtual visits for preoperative evaluation and surgical decision-making in three pediatric surgical subspecialties. METHODS Patients who underwent surgical procedures in the departments of Urology, Ophthalmology, and Plastic and Oral Surgery at a tertiary care pediatric hospital over a one-year period during the COVID-19 pandemic were included. Patients were assigned to one of three clinical pathways based on their preoperative visit(s): only in-person visit(s) (IP), a combination of in-person and virtual visit(s) (IP/VV), and only virtual visit(s) (VV). Demographics, procedure information, and patient experience survey results were collected. We then assessed variations in procedure types and patient experience scores in these three patient groups. RESULTS There were 431 patients who completed the modified patient experience survey. The most common procedures were circumcision (17%), excision of lesion (16%), and strabismus repair (11%). Survey results were positive, with 90% of participants rating that they would recommend the service to others. No significant differences were found among groups in their demographics, overall care rating, and duration between preoperative clinic visit and procedure. Post-hoc power analysis indicated 87% power to detect a 10% difference in survey ratings between IP and VV cases, confirming non-inferiority in patient satisfaction for virtual preoperative visits. CONCLUSION This study demonstrated the non-inferiority of preoperative virtual visits in three pediatric surgical subspecialties as measured by patient experience scores. Additional studies with more granular scope are necessary to further elucidate telemedicine's safety and efficacy for select diagnoses. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Rebecca A Netson
- Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, United States
| | - Stephanie Miller
- Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, United States
| | - Joseph Incorvia
- Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, United States
| | - Ankoor Shah
- Department of Ophthalmology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA, United States
| | - Carlos R Estrada
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA, United States
| | - Sara L Toomey
- Department of Pediatrics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA, United States
| | - Amir H Taghinia
- Department of Pediatrics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA, United States.
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Shah DA, Sharer R, Sall D, Bay C, Turner A, Bisk D, Peng W, Gifford B, Rosas J, Radhakrishnan P. Racial, Ethnic, and Socioeconomic Differences in Primary Care No-Show Risk with Telemedicine During the COVID-19 Pandemic. J Gen Intern Med 2023; 38:2734-2741. [PMID: 37308779 PMCID: PMC10506986 DOI: 10.1007/s11606-023-08236-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/09/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND The coronavirus 2019 (COVID-19) pandemic resulted in rapid implementation of telemedicine. Little is known about the impact of telemedicine on both no-show rates and healthcare disparities on the general primary care population during the pandemic. OBJECTIVE To compare no-show rates between telemedicine and office visits in the primary care setting, while controlling for the burden of COVID-19 cases, with focus on underserved populations. DESIGN Retrospective cohort study. SETTING Multi-center urban network of primary care clinics between April 2021 and December 2021. PARTICIPANTS A total of 311,517 completed primary care physician visits across 164,647 patients. MAIN MEASURES The primary outcome was risk ratio of no-show incidences (i.e., no-show rates) between telemedicine and office visits across demographic sub-groups including age, ethnicity, race, and payor type. RESULTS Compared to in-office visits, the overall risk of no-showing favored telemedicine, adjusted risk ratio of 0.68 (95% CI 0.65 to 0.71), absolute risk reduction (ARR) 4.0%. This favorability was most profound in several cohorts with racial/ethnic and socioeconomic differences with risk ratios in Black/African American 0.47 (95% CI 0.41 to 0.53), ARR 9.0%; Hispanic/Latino 0.63 (95% CI 0.58 to 0.68), ARR 4.6%; Medicaid 0.58 (95% CI 0.54 to 0.62) ARR 7.3%; Self-Pay 0.64 (95% CI 0.58 to 0.70) ARR 11.3%. LIMITATION The analysis was limited to physician-only visits in a single setting and did not examine the reasons for visits. CONCLUSION As compared to office visits, patients using telemedicine have a lower risk of no-showing to primary care appointments. This is one step towards improved access to care.
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Affiliation(s)
- Dania A Shah
- HonorHealth Internal Medicine, Phoenix, AZ, USA.
| | - Rustan Sharer
- HonorHealth Internal Medicine, Phoenix, AZ, USA
- HonorHealth Clinical Informatics, Phoenix, AZ, USA
- College of Medicine, University of Arizona-Phoenix, Phoenix, AZ, USA
| | - Dana Sall
- HonorHealth Internal Medicine, Phoenix, AZ, USA
- College of Medicine, University of Arizona-Phoenix, Phoenix, AZ, USA
| | - Curt Bay
- Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, USA
| | | | - Dmitry Bisk
- HonorHealth Family Medicine, Phoenix, AZ, USA
| | - Wesley Peng
- HonorHealth Academic Affairs, Phoenix, AZ, USA
| | - Benjamin Gifford
- HonorHealth Internal Medicine, Phoenix, AZ, USA
- HonorHealth Clinical Informatics, Phoenix, AZ, USA
| | - Jennifer Rosas
- Neighborhood Outreach Access to Health (NOAH) Clinic, Phoenix, AZ, USA
| | - Priya Radhakrishnan
- HonorHealth Internal Medicine, Phoenix, AZ, USA
- HonorHealth Clinical Informatics, Phoenix, AZ, USA
- College of Medicine, University of Arizona-Phoenix, Phoenix, AZ, USA
- HonorHealth Academic Affairs, Phoenix, AZ, USA
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Habib S, Alsulaim KB, Mobeirek OA, Alsaeed AM, Albawardi FA, Alqahtani YK, Alsuhaibany AA. Barriers and Facilitators of Telemedicine Among Physicians at a University Hospital. Cureus 2023; 15:e45078. [PMID: 37842354 PMCID: PMC10568357 DOI: 10.7759/cureus.45078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Background and aims This study explored the perceived barriers and facilitators to the implementation of telemedicine among physicians and estimated and compared the prevalence of telemedicine use among physicians before and during coronavirus disease 2019 (COVID-19). Methods This cross-sectional study was conducted at King Saud University in Riyadh. A convenience sample of 163 physicians working at King Khalid University Hospital (KKUH) completed an online survey. Demographic data, patterns of use, and perceived barriers and facilitators of telemedicine were collected using a 5-point Likert scale. Results Our research showed that 61.3% (n = 100) of the physicians surveyed had used telemedicine in their careers. The prevalence of telemedicine before the onset of COVID-19 was 18.4%, whereas during COVID-19, it increased to 59.5%, which is an increase of 330% (P < .001). Most of the respondents (50.9%; n = 83) used it weekly (27%) or occasionally (23.9%). The most prevalent perceived barrier was technical difficulties (68.7%; n = 112), and the most prevalent perceived facilitator was that telemedicine can reduce unnecessary face-to-face appointments (86.5%; n = 141). Conclusion The use of telemedicine to provide health care is on the rise, especially in the case of emergencies. Different specialties face different facilitators and barriers, and the potential of telemedicine implementation depends on the work environment and the needs of the specialty. Several obstacles need to be overcome before telemedicine becomes a consistently used method for providing health care.
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Affiliation(s)
- Syed Habib
- Physiology, King Saud University, Riyadh, SAU
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29
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King N, Wiley M, Rose A, Fergus A. Delivery of School-based Physical Therapy via Telehealth: Perceptions and Attitudes of School-based Physical Therapists. Phys Occup Ther Pediatr 2023; 44:180-197. [PMID: 38410919 DOI: 10.1080/01942638.2023.2228898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/15/2023] [Indexed: 02/28/2024]
Abstract
AIMS School-based physical therapists (SBPTs) rapidly transitioned to telehealth during the pandemic. This study explored the perceptions of, and strategies utilized by, SBPTs delivering therapy via telehealth. METHODS Using a grounded theory qualitative design, semi-structured interviews were completed with 13 SBPTs. Interviews were transcribed and theme coded until saturation was achieved. RESULTS The following themes emerged: supports and education, challenges, strategies promoting success, and the outcomes of telehealth. SBPTs overcame challenges including those associated with technology, communication, space, equipment, and examination. Coaching techniques, incorporation into the daily routine, and the sharing of demonstrations promoted success. Telehealth service delivery was perceived to improve communication with educational teams and families, improve efficiency and productivity, increase access to students, promote an appreciation of the family and home context, and enhance family engagement. SBPTs believe incorporating elements of telehealth in conjunction with in-person delivery is ideal. CONCLUSIONS While the COVID-19 pandemic forced a rapid transition to telehealth for SBPTs, lessons learned could have a long-lasting positive impact on school-based services. The benefits of telehealth should be considered in the delivery of school-based physical therapy services.
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Affiliation(s)
- Natalie King
- Division of Physical Therapy, Shenandoah University, Winchester, VA, USA
| | - Michele Wiley
- Division of Physical Therapy, Shenandoah University, Winchester, VA, USA
| | - Alexa Rose
- Division of Physical Therapy, Shenandoah University, Winchester, VA, USA
| | - Andrea Fergus
- Division of Physical Therapy, Shenandoah University, Winchester, VA, USA
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Zimmermann J, Heilmann ML, Fisch-Jessen M, Hauch H, Kruempelmann S, Moeller H, Nagel L, Nathrath M, Vaillant V, Voelker T, Deckers MJ. Telehealth Needs and Concerns of Stakeholders in Pediatric Palliative Home Care. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1315. [PMID: 37628315 PMCID: PMC10453074 DOI: 10.3390/children10081315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023]
Abstract
Pediatric palliative home care (PPHC) provides care for children, adolescents, and young adults with life-limiting illnesses in their own homes. Home care often requires long travel times for the PPHC team, which is available to the families 24/7 during crises. The complementary use of telehealth may improve the quality of care. In this pilot study we identify the needs and concerns of patients, teams, and other stakeholders regarding the introduction of telehealth. As a first step, focus groups were conducted in three teams. For the second step, semi-structured interviews were conducted with patients and their families (n = 15). Both steps were accompanied by quantitative surveys (mixed methods approach). The qualitative data were analyzed using content analysis. A total of 11 needs were identified, which were prioritized differently. Highest priority was given to: data transmission, video consultation, access to patient records, symptom questionnaires, and communication support. The concerns identified were related to the assumption of deterioration of the status quo. Potential causes of deterioration were thought to be the negative impact on patient care, inappropriate user behavior, or a high level of technical requirements. As a conclusion, we define six recommendations for telehealth in PPHC.
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Affiliation(s)
- Jannik Zimmermann
- Department of Psychology—Theory and Methodology of Counseling, University of Kassel, 34127 Kassel, Hesse, Germany; (J.Z.)
| | - Marie Luise Heilmann
- Department of Psychology—Theory and Methodology of Counseling, University of Kassel, 34127 Kassel, Hesse, Germany; (J.Z.)
| | - Manuel Fisch-Jessen
- Palliative Care Team for Children Frankfurt, 60599 Frankfurt, Hesse, Germany
| | - Holger Hauch
- Palliative Care Team for Children Giessen, 35392 Giessen, Hesse, Germany
| | | | - Heidi Moeller
- Department of Psychology—Theory and Methodology of Counseling, University of Kassel, 34127 Kassel, Hesse, Germany; (J.Z.)
| | - Laura Nagel
- Department of Psychology—Theory and Methodology of Counseling, University of Kassel, 34127 Kassel, Hesse, Germany; (J.Z.)
| | - Michaela Nathrath
- Palliative Care Team for Children Kassel, 34125 Kassel, Hesse, Germany
| | - Vera Vaillant
- Palliative Care Team for Children Giessen, 35392 Giessen, Hesse, Germany
| | - Thomas Voelker
- Palliative Care Team for Children Kassel, 34125 Kassel, Hesse, Germany
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VanDeWiele MD, Hastings AM, Evans MD, O'Connell MS, Flynn PM. Using the Unified Theory of Acceptance and Use of Technology (UTAUT) to predict the behavioral intent of teledentistry utilization amongst United States adults. J Telemed Telecare 2023:1357633X231182405. [PMID: 37487219 DOI: 10.1177/1357633x231182405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Teledentistry is an innovative health care delivery platform that can potentially improve oral health access and outcomes. The purpose of this study was to predict teledentistry utilization intentions of U.S. adults using the Unified Theory of Acceptance and Use of Technology (UTAUT) as a framework. METHODS This mixed-method, cross-sectional study surveyed 899 participants from two independent samples in August and September 2021. Convenience samples of Minnesota State Fair attendees and ResearchMatch volunteers completed electronic surveys to identify the behavioral intention (BI) for teledentistry use within the next 6 months. Independent variables were the UTAUT constructs of performance expectancy (PE), effort expectancy (EE), social influence (SI), and facilitating conditions (FC). Data were analyzed using univariate analysis and multiple linear regression adjusting for age, gender and educational level. Qualitative analysis used thematic analysis using UTAUT as a coding framework. RESULTS Univariate analysis showed statistical significance between each construct with BI (P < 0.0001). Adjusted multiple linear regression revealed statistical significance between PE and SI with BI (P < 0.0001). Qualitative responses corroborated quantitative results and revealed a lack of teledentistry knowledge. CONCLUSION The majority of participants indicated an intention not to use teledentistry within the next 6 months. The lack of prior experience of telehealth or teledentistry use in addition to lack of knowledge regarding teledentistry may contribute to these results. Future interventions to improve the BI to use teledentistry may benefit from focusing on PE and SI constructs for educational and marketing strategies.
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Affiliation(s)
| | - Angela M Hastings
- Division of Community Outreach and Engagement, University of Minnesota, Minneapolis, MN, USA
| | - Michael D Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Megan S O'Connell
- Division of Dental Hygiene, University of Minnesota, Minneapolis, MN, USA
| | - Priscilla M Flynn
- Division of Dental Hygiene, University of Minnesota, Minneapolis, MN, USA
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Fainardi V, Capoferri G, Tornesello M, Pisi G, Esposito S. Telemedicine and Its Application in Cystic Fibrosis. J Pers Med 2023; 13:1041. [PMID: 37511654 PMCID: PMC10381340 DOI: 10.3390/jpm13071041] [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: 04/12/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
The care of cystic fibrosis (CF) traditionally consists of regular visits to the clinic where a multidisciplinary team can visit the patient, adjust treatments and monitor the disease. During the COVID-19 pandemic when access to hospitals and medical environments was very limited, the role of telemedicine was crucial to keep in touch with patients with chronic diseases such as CF. Increasing evidence demonstrates that electronic health can successfully support healthcare professionals in the management of people with CF. The use of devices connected to digital platforms or smartphones results in a continuous flow of data that can be shared with the clinician and the team in order to improve the knowledge of patients' diseases and the level of care needed. This narrative review aims to describe the application of telemedicine in CF disease with pros and cons. A literature analysis showed that telemedicine has several advantages in the management of patients with CF. With the evolving support of digital technology, telemedicine can promote clinical visits, adherence to daily treatment, including respiratory physiotherapy and physical exercise, early identification of pulmonary exacerbations and management of psychological issues. The main disadvantages are missed physical exam findings, lack of physical contact that can prevent conversation on sensitive topics, lack of access to technology and lack of technological skills. Furthermore, healthcare operators need appropriate training for telemedicine systems and need time to organise and analyse data generated remotely, which may increase the burden of daily work. Hybrid personalised care models that marge telemedicine and traditional care can be an ideal solution.
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Affiliation(s)
- Valentina Fainardi
- Cystic Fibrosis Unit, Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
| | - Gaia Capoferri
- Cystic Fibrosis Unit, Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
| | - Marco Tornesello
- Cystic Fibrosis Unit, Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
| | - Giovanna Pisi
- Cystic Fibrosis Unit, Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
| | - Susanna Esposito
- Cystic Fibrosis Unit, Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
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Kellom KS, Flaherty CM, Cacia J, Christiansen A, Cordero L, Hah J, Kennelly A, Ortiz P, Stefanski K, Wozniak SN, Wallis KE. Provider and Caregiver Perspectives on Telehealth Assessments for Autism Spectrum Disorder in Young Children: A Multimethod DBPNet Study Exploring Equity. J Dev Behav Pediatr 2023; Publish Ahead of Print:00004703-990000000-00111. [PMID: 37315107 DOI: 10.1097/dbp.0000000000001198] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/18/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Telehealth uptake increased dramatically during the COVID-19 pandemic, including for autism spectrum disorder (ASD) assessment by developmental-behavioral pediatric (DBP) clinicians. However, little is known about the acceptability of telehealth or its impact on equity in DBP care. OBJECTIVE Engage providers and caregivers to glean their perspectives on the use of telehealth for ASD assessment in young children, exploring acceptability, benefits, concerns, and its potential role in ameliorating or exacerbating disparities in access to and quality of DBP care. METHODS This multimethod study used surveys and semistructured interviews to describe provider and family perspectives around the use of telehealth in DBP evaluation of children younger than 5 years with possible ASD between 3/2020 and 12/2021. Surveys were completed by 13 DBP clinicians and 22 caregivers. Semistructured interviews with 12 DBP clinicians and 14 caregivers were conducted, transcribed, coded, and analyzed thematically. RESULTS Acceptance of and satisfaction with telehealth for ASD assessments in DBP were high for clinicians and most caregivers. Pros and cons concerning assessment quality and access to care were noted. Providers raised concerns about equity of telehealth access, particularly for families with a preferred language other than English. CONCLUSION This study's results can inform the adoption of telehealth in DBP in an equitable manner beyond the pandemic. DBP providers and families desire the ability to choose telehealth care for different assessment components. Unique factors related to performing observational assessments of young children with developmental and behavioral concerns make telehealth particularly well-suited for DBP care.
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Affiliation(s)
| | - Carina M Flaherty
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jaclyn Cacia
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Audrey Christiansen
- Boston University School of Medicine, Boston, MA
- Division of Developmental-Behavioral Pediatrics Boston Medical Center, Boston MA
| | - Lucero Cordero
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julia Hah
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Annie Kennelly
- Division of Developmental and Behavioral Pediatrics, Akron Children's Hospital, Akron, OH
| | - Priscilla Ortiz
- Language Services Department, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kristen Stefanski
- Division of Developmental and Behavioral Pediatrics, Akron Children's Hospital, Akron, OH
| | - Sarah N Wozniak
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kate E Wallis
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Meyer Center for Developmental Pediatrics & Autism, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Haimowitz RL, Halley TV, Driskill C, Kendall M, Parikh K. Implementing a Post-Discharge Telemedicine Service Pilot to Enhance the Hospital to Home Transition. Hosp Pediatr 2023; 13:508-519. [PMID: 37212032 DOI: 10.1542/hpeds.2022-006989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES The objectives of this study are to (1) describe our postdischarge telemedicine program and (2) evaluate program implementation. METHODS At our single-center tertiary care children's hospital, we launched our postdischarge telemedicine program in April 2020. We used the Template for Intervention Description and Replication framework to describe our pilot program and Proctor's conceptual framework to evaluate implementation over a 9-month period. Retrospective chart review was conducted. Descriptive analyses were used to compare demographics and health care reutilization rates across patients. Implementation outcomes included adoption (rate of scheduled visits) and feasibility (rate of completed visits). Effectiveness outcomes included the rate of postdischarge issues and unscheduled healthcare utilization. RESULTS We established a postdischarge telemedicine program for a general pediatric population that ensured follow-up at a time when in-person evaluation was limited because of the coronavirus disease 2019 pandemic. For implementation evaluation, we included all 107 patients in the pilot program. Adoption was 100% and feasibility was 58%. Eighty-two percent of patients completing a visit reported one or more postdischarge issues. There was no difference in health system reutilization between those who completed a visit and those who did not. CONCLUSIONS Implementation of a postdischarge telemedicine service is achievable and promotes early detection of failures in the hospital to home transition. Directions for future study will include rigorous program evaluation via telemedicine program assessment tools and sustainability efforts that build upon known implementation and health service outcomes.
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Affiliation(s)
- Rachel L Haimowitz
- Division of Hospital Medicine, Children's National Hospital, Washington, District of Columbia
| | - Tina V Halley
- Division of Hospital Medicine, Children's National Hospital, Washington, District of Columbia
| | - Christina Driskill
- Division of Hospital Medicine, Children's National Hospital, Washington, District of Columbia
| | - Morgan Kendall
- Division of Hospital Medicine, Children's National Hospital, Washington, District of Columbia
- Section of Hospital Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kavita Parikh
- Division of Hospital Medicine, Children's National Hospital, Washington, District of Columbia
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Vomer RP, Carfagno D, Lewno A, Shah NP, Farford BA, Kieneker L, Pujalte GGA. Elbow Evaluation Via Telephone and Video Visit. Cureus 2023; 15:e39843. [PMID: 37397649 PMCID: PMC10314807 DOI: 10.7759/cureus.39843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
Background Elbow conditions and pathology are commonly seen in the outpatient clinic. Telephone and video visits can allow for expeditious assessment of elbow complaints, without the added challenges of commuting for a clinic-based evaluation. In the setting of a pandemic, the benefits of telemedicine are apparent, but the time and effort saved from being able to remotely evaluate musculoskeletal conditions are also useful in a non-pandemic situation. In this modern era of telemedicine, protocols need to be developed to provide guidance for a remote elbow evaluation. As with all musculoskeletal conditions, the history about the elbow complaint allows the clinician to develop a differential diagnosis, which is either supported or refuted based on physical examination and diagnostic studies. Appropriate questions asked over a telephone call can provide answers that lead the clinician to a specific diagnosis and treatment plan. Furthermore, responses to these same questions can be further supported by a video assessment of the affected elbow, which may provide additional evidence to support a diagnosis and plan of care. Aims To outline possible questions, responses, and video examination techniques to aid the clinician in elbow examinations conducted via telemedicine. Methods We have created a pathway for step-by-step evaluation to help physicians direct their patients through the typical elements of a thorough elbow examination via telehealth. Results We have created tables of questions, answers, and instructions to help guide the physician through different aspects of a telehealth elbow examination. We have also included a glossary of descriptive images that demonstrate each maneuver. Conclusion This article provides a structured guide to efficiently extracting clinically relevant information during telemedicine examinations of the elbow.
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Affiliation(s)
- Rock P Vomer
- Family Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, USA
- Family and Community Health, Orthopedics, Sports Medicine, Duke University, Durham, USA
| | - David Carfagno
- Sports Medicine, Scottsdale Sports Medicine Institute, Scottsdale, AFG
| | - Adam Lewno
- Sports Medicine, University of Michigan, Ann Arbor, USA
| | - Neil P Shah
- Family and Community Medicine, Mayo Clinic, Jacksonville, USA
| | | | | | - George G A Pujalte
- Family Medicine, Orthopedics, and Sports Medicine, Mayo Clinic, Jacksonville, USA
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Sarkari ZZ, Fish C. Potential use of telemedicine in paediatrics: a single-centre retrospective review. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001819. [PMID: 36882229 PMCID: PMC10008200 DOI: 10.1136/bmjpo-2022-001819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Recent advancements and adoption of telemedicine have affected all aspects of healthcare including paediatrics. While telemedicine has the potential to increase access to paediatric care, the limitations of this service in its current iteration bring into question its usefulness for direct replacement of in-person care, particularly in an acute or urgent care setting. This retrospective review demonstrates that only a small percentage of in-person visits to our practice would have resulted in definitive diagnosis and treatment if facilitated via telemedicine. There is a need for better and more widespread data collection techniques and tools suitable for paediatric remote care implementation before telemedicine becomes a useful diagnostic and treatment tool in an acute or urgent care setting.
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Cheng AL, Liu J, Bravo S, Miller JC, Pahlevan NM. Screening left ventricular systolic dysfunction in children using intrinsic frequencies of carotid pressure waveforms measured by a novel smartphone-based device. Physiol Meas 2023; 44:10.1088/1361-6579/acba7b. [PMID: 36753767 PMCID: PMC11073485 DOI: 10.1088/1361-6579/acba7b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/08/2023] [Indexed: 02/10/2023]
Abstract
Objective.Children with heart failure have higher rates of emergency department utilization, health care expenditure, and hospitalization. Therefore, a need exists for a simple, non-invasive, and inexpensive method of screening for left ventricular (LV) dysfunction. We recently demonstrated the practicality and reliability of a wireless smartphone-based handheld device in capturing carotid pressure waveforms and deriving cardiovascular intrinsic frequencies (IFs) in children with normal LV function. Our goal in this study was to demonstrate that an IF-based machine learning method (IF-ML) applied to noninvasive carotid pressure waveforms can distinguish between normal and abnormal LV ejection fraction (LVEF) in pediatric patients.Approach. Fifty patients ages 0 to 21 years underwent LVEF measurement by echocardiogram or cardiac magnetic resonance imaging. On the same day, patients had carotid waveforms recorded using Vivio. The exclusion criterion was known vascular disease that would interfere with obtaining a carotid artery pulse. We adopted a hybrid IF- Machine Learning (IF-ML) method by applying physiologically relevant IF parameters as inputs to Decision Tree classifiers. The threshold for low LVEF was chosen as <50%.Main results.The proposed IF-ML method was able to detect an abnormal LVEF with an accuracy of 92% (sensitivity = 100%, specificity = 89%, area under the curve (AUC) = 0.95). Consistent with previous clinical studies, the IF parameterω1was elevated among patients with reduced LVEF.Significance.A hybrid IF-ML method applied on a carotid waveform recorded by a hand-held smartphone-based device can differentiate between normal and abnormal LV systolic function in children with normal cardiac anatomy.
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Affiliation(s)
- Andrew L Cheng
- Division of Pediatric Cardiology, Children’s Hospital Los Angeles, Los Angeles, CA, United States of America
| | - Jing Liu
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Stephen Bravo
- Division of Pediatric Cardiology, Children’s Hospital Los Angeles, Los Angeles, CA, United States of America
| | - Jennifer C Miller
- Division of Pediatric Cardiology, Children’s Hospital Los Angeles, Los Angeles, CA, United States of America
| | - Niema M Pahlevan
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
- Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, CA, United States of America
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Enneking B, Ryan T, Tang Q, James C, Rouse M, Curtin M, Keehn RM. Acceptability and Access Metrics for Telehealth Consultation of Pediatric Neurodevelopmental Disabilities During COVID-19. J Pediatr Health Care 2023; 37:200-207. [PMID: 36175312 DOI: 10.1016/j.pedhc.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We report caregiver agreement to attend telehealth neurodevelopmental consultation during COVID-19, demographic differences in agreement, reasons families declined, and clinical access metrics before and during COVID-19. METHOD Data were gathered from telehealth referrals and consultations from April to July 2020. Schedulers documented agreement status and reasons for the decline. Wait time, lag time, and missed appointment rates were calculated to measure access. RESULTS Ninety-one percent agreed to attend telehealth consultation; 55% of those who declined preferred in-person services. There were no demographic differences between those who accepted, declined, or did not respond. The median wait time from referral to appointment was 60 days. Missed appointment rates were consistent with prepandemic rates. DISCUSSION Findings support literature suggesting patients are agreeable to telehealth. They diverged from evidence suggesting telehealth reduces missed appointments. Overall, results indicate telehealth is an acceptable alternative; however, further telehealth innovation is needed to address existing disparities.
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Schiestl C, Zamparelli M, Meuli M, Hartmann-Fritsch F, Cavaliere A, Neuhaus K, Reichmann E, Böttcher-Haberzeth S. Life threatening non-accidental burns, pandemic dependent telemedicine, and successful use of cultured Zurich Skin in a neonate – A case report. BURNS OPEN 2023. [DOI: 10.1016/j.burnso.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
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Haffner DN, Bauer Huang SL. Using Telemedicine to Overcome Barriers to Neurodevelopmental Care from the Neonatal Intensive Care Unit to School Entry. Clin Perinatol 2023; 50:253-268. [PMID: 36868709 DOI: 10.1016/j.clp.2022.10.006] [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: 03/05/2023]
Abstract
Dedicated Neonatal Intensive Care Unit (NICU) follow-up programs are recommended for ongoing surveillance for infants at high-risk for future neurodevelopmental impairment (NDI). Systemic, socioeconomic, and psychosocial barriers remain for referrals and the continued neurodevelopmental follow-up of high-risk infants. Telemedicine can help overcome these barriers. Telemedicine allows standardization of evaluations, increased referral rates, and reduced time to follow-up as well as increased therapy engagement. Telemedicine can expand neurodevelopmental surveillance and support all NICU graduates, facilitating the early identification of NDI. However, with the recent expansion of telemedicine during the COVID-19 pandemic, new barriers related to access and technological support have arisen.
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Affiliation(s)
- Darrah N Haffner
- Division of Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital and the Ohio State University, 700 Children's Dr, Columbus, OH 43205, USA.
| | - Sarah L Bauer Huang
- Department of Pediatric and Developmental Neurology, Department of Neurology, Washington University in Saint Louis School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA
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Yılmaz Çelebi M, Kıymet E, Böncüoğlu E, Şahinkaya Ş, Cem E, Düzgöl M, Akaslan Kara A, Ötiken Arıkan K, Besin D, Bayram SN, Devrim İ. Follow-Up of Cases with the Telemedicine Method During the COVID-19 Pandemic: An Alternative Strategy for Reduction of Hospital Workload and Hospital-Related Transmissions. Telemed J E Health 2023; 29:454-458. [PMID: 35833790 DOI: 10.1089/tmj.2021.0613] [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: 11/13/2022] Open
Abstract
Background: This study evaluated the effect of telemedicine use in children with COVID-19 to reduce the workload of health care facilities. Methods: This study was conducted at Dr. Behçet Uz Children's Hospital between October and December 2020. The complaints of the children who were called because of positivity for severe acute respiratory syndrome-CoV-2-PCR were questioned and also the duration of talk was recorded. Children were classified according to their symptoms. Cases with severe symptoms were invited to the hospital and were hospitalized according to their clinical findings. Results: The median age of 506 patients reached was 10.8 ± 5.5. Phone calls lasted <3 min in 498 (98.6%) cases. Only 33 (6.5%) patients with severe symptoms were invited to the hospital, and 6 (18.2%) of these cases were hospitalized. Conclusion: During the pandemic, interviews with patients through telephone may help to reduce the patient burden and to prevent the contact of healthy individuals.
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Affiliation(s)
- Miray Yılmaz Çelebi
- Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Elif Kıymet
- Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Elif Böncüoğlu
- Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Şahika Şahinkaya
- Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Ela Cem
- Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Mine Düzgöl
- Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Aybüke Akaslan Kara
- Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Kamile Ötiken Arıkan
- Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Dorukhan Besin
- Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Süleyman Nuri Bayram
- Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - İlker Devrim
- Department of Paediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
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Clemmons NG, Coates E, McLeod A. Understanding the benefits of child-parent psychotherapy delivered via telehealth during the COVID-19 pandemic. CHILDRENS HEALTH CARE 2023. [DOI: 10.1080/02739615.2023.2179489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
| | - Erica Coates
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC, USA
| | - Alison McLeod
- Department of Psychology, Georgetown University, Washington, DC, USA
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Kahn NF, Anan YH, Bocek KM, Christakis DA, Richardson LP, Pratt W, Sequeira GM. Understanding Transgender and Gender-Diverse Youth's Experiences Receiving Care via Telemedicine: Qualitative Interview Study. JMIR Pediatr Parent 2023; 6:e42378. [PMID: 36745775 PMCID: PMC10055384 DOI: 10.2196/42378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Access to virtual care has increased since the beginning of the COVID-19 pandemic, yet little is known about transgender and gender-diverse (TGD) youth's experiences and perspectives on receiving care via telemedicine. OBJECTIVE The purpose of this study was to explore these experiences to (1) inform necessary changes to the provision of pediatric gender-affirming care and (2) help providers and health systems determine if and how telemedicine should be made available post pandemic. METHODS Youth (aged 14-17 years) who completed a telemedicine visit in the Seattle Children's Gender Clinic were invited to participate in a semistructured interview exploring perceived advantages or disadvantages of telemedicine and preferred visit modalities. Interview transcriptions were analyzed by 2 research team members using an inductive thematic analysis framework. RESULTS A total of 15 TGD youth completed an interview. Commonly cited advantages of telemedicine were convenience and comfort with having visits in their own environments. Reported disadvantages included technical issues, discomfort with the impersonal nature, lack of familiarity with the platform, and privacy concerns. Overall, slightly more youth preferred in-person visits over telemedicine, referencing both specific characteristics of the clinical visit (ie, initial vs return and complexity) and proximity to the clinic as reasons for this preference. Although a plurality of TGD youth preferred in-person visits, they also recognized the value of telemedicine and the impact it may have in facilitating access to care. CONCLUSIONS Given the variations in needs and visit complexity, our study supports the provision of both in-person and telemedicine modalities as options for pediatric gender-affirming care.
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Affiliation(s)
- Nicole F Kahn
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.,Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Yomna H Anan
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Kevin M Bocek
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Dimitri A Christakis
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Laura P Richardson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.,Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Wanda Pratt
- The Information School, University of Washington, Seattle, WA, United States
| | - Gina M Sequeira
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.,Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
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Dickey AM, Wasko MM. Digital Disparities in Patient Adoption of Telemedicine. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2023. [DOI: 10.4018/ijhisi.318043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Telemedicine's growth during the COVID-19 pandemic exposed digital and health disparities in U.S. communities. Public health advocates suggest disparities in healthcare access may be mitigated through free or low-cost broadband. However, prior research shows that many factors influence patient adoption of information technologies; therefore, increasing access to broadband alone is insufficient. This paper advances a patient-centered model of telemedicine (TM) adoption supported by qualitative interview data. The model illustrates that patient adoption of TM is driven by a complex sociotechnical system comprised of technology factors, structural factors underlying the provider's provision of TM, and individual patient factors. Findings highlight the importance of the physical place of the TM visit, the need for experienced TM healthcare workers and technology support for patients, the impact of provider-mandated technology on task-technology fit (TTF), and the strength of the patient-provider relationship. These factors affect patient perceptions of TTF and ultimately TM adoption.
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Stewart MK, Allison MK, Grant Hunthrop MS, Marshall SA, Cornell CE. Outcomes Research on Telemedicine-Delivered Gender-Affirming Health Care for Transgender Youth Is Needed Now: A Call to Action. Transgend Health 2023; 8:1-5. [PMID: 36824385 PMCID: PMC9942169 DOI: 10.1089/trgh.2021.0063] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
This article is a call to action for outcomes research on telemedicine-delivered gender-affirming health care (GAH) for transgender youth. Transgender youth, especially rural youth, are severely underserved and face many obstacles to GAH. Telemedicine reduces access barriers for underserved populations, but telemedicine for this population can be complex. Our literature search identified only five studies exploring the use of telemedicine for GAH for transgender youth. Coronavirus disease 2019 (COVID-19)-related regulatory and reimbursement changes for telemedicine may have increased transgender youths' access to such care. Research is urgently needed to increase understanding regarding access, satisfaction, safety, and health-related outcomes of telemedicine-delivered GAH for transgender youth.
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Affiliation(s)
- Mary Kathryn Stewart
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mary Kathryn Allison
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Address correspondence to: M. Kathryn Allison, PhD, MPH, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 755, Little Rock, AR 72205, USA,
| | - Myca S. Grant Hunthrop
- Arkansas Commission on Child Abuse, Rape, and Domestic Violence, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sarah Alexandra Marshall
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Carol E. Cornell
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Ali D, O'Brien S, Hull L, Kenny L, Mandy W. 'The key to this is not so much the technology. It's the individual who is using the technology': Perspectives on telehealth delivery for autistic adults during the COVID-19 pandemic. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:552-564. [PMID: 35791666 PMCID: PMC10076158 DOI: 10.1177/13623613221108010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT The COVID-19 pandemic meant that a lot of healthcare services had to move online, such as to video-calls, or to telephone. However, not many studies have looked at how autistic adults feel about this kind of service delivery. It is important to know this, as autistic people may have poorer health than non-autistic people, and they may also struggle to access services more than non-autistic people. This study asked 11 autistic adults (aged 27-67 years), seven family members/carers (aged 44-75) reporting about autistic adults and six service providers about their experiences of accessing or providing a telehealth service. These experiences were collected through interviews, which were then analysed through thematic analysis. Two main themes were: technology aids communication and access - except when it doesn't, and in/flexibility. The themes pointed out some positive aspects of telehealth delivery, including improved communication and decreased stress. The themes also pointed out negative aspects of telehealth, such as increased rigidity of the healthcare system, amplifying pre-existing barriers. Because autistic people have many barriers to accessing healthcare, this study encourages researchers and healthcare providers to think about how such barriers could be addressed through telehealth, and about the possible limitations of telehealth for some autistic people.
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Affiliation(s)
- Dorota Ali
- Autistica, London, UK.,King's College London, UK
| | | | - Laura Hull
- University of Bristol, UK.,University College London, UK
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Information technology and artificial intelligence support in management experiences of the pediatric designated hospital during the COVID-19 epidemic in 2022 in Shanghai. INTELLIGENT MEDICINE 2023; 3:16-21. [PMID: 36091921 PMCID: PMC9444255 DOI: 10.1016/j.imed.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 01/31/2023]
Abstract
Objective To describe the information technology and artificial intelligence support in management experiences of the pediatric designated hospital in the wave of COVID-19 in Shanghai. Methods We retrospectively concluded the management experiences at the largest pediatric designated hospital from March 1st to May 11th in 2022 in Shanghai. We summarized the application of Internet hospital, face recognition technology in outpatient department, critical illness warning system and remote consultation system in the ward and the structed electronic medical record in the inpatient system. We illustrated the role of the information system through the number and prognosis of patients treated. Results The COVID-19 designated hospitals were built particularly for critical patients requiring high-level medical care, responded quickly and scientifically to prevent and control the epidemic situation. From March 1st to May 11th, 2022, we received and treated 768 children confirmed by positive RT-PCR and treated at our center. In our management, we use Internet Information on the Internet Hospital, face recognition technology in outpatient department, critical illness warning system and remote consultation system in the ward, structed electronic medical record in the inpatient system. No deaths or nosocomial infections occurred. The number of offline outpatient visits dropped, from March to May 2022, 146,106, 48,379, 57,686 respectively. But the outpatient volume on the internet hospital increased significantly (3,347 in March 2022 vs. 372 in March 2021; 4,465 in April 2022 vs. 409 in April 2021; 4,677 in May 2022 vs. 538 in May 2021). Conclusions Information technology and artificial intelligence has provided significant supports in the management. The system might optimize the admission screening process, increases the communication inside and outside the ward, achieves early detection and diagnosis, timely isolates patients, and timely treatment of various types of children.
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Nguyen BK, Eltahir HZ, Barinsky GL, Ying YLM, Hsueh WD. Telemedicine and Otolaryngology in the COVID-19 Era. Ann Otol Rhinol Laryngol 2023; 132:148-154. [PMID: 35227085 PMCID: PMC9834621 DOI: 10.1177/00034894221081613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The global Coronavirus disease 2019 (COVID-19) pandemic has resulted in an expansion of telemedicine. The purpose of this study is to present our experience with outpatient telemedicine visits within a single institution's Department of Otolaryngology during the initial COVID-19 era. STUDY DESIGN Retrospective chart review. METHODS This was a single-institution study conducted within the Department of Otolaryngology at an urban tertiary care center. Data on outpatient visits was obtained from billing and scheduling records from January 6 to May 28, 2020. Visits were divided into "pre-shutdown" and "post-shutdown" based on our state's March 23, 2020 COVID-19 shutdown date. RESULTS A total of 3447 of 4340 (79.4%) scheduled visits were completed in the pre-shutdown period as compared to 1451 of 1713 (84.7%) in the post-shutdown period. The proportion of telemedicine visits increased (0.7%-81.2%, P < .001). Overall visit completion rate increased following the shutdown (80.2%-84.7%, P < .001). Subspecialties with an increase in visit completion rate were general (76.9%-88.0%, P = .002), otology (77.4%-87.2%, P < .001), and rhinology (80.0%-86.2%, P = .003). Patients with Medicaid and Medicare had higher appointment completion rates following the transition to telemedicine visits (80.7%-85.7%, P = .002; 76.9%-84.7%, P = .001). Older age was associated with decreased appointment cancellation pre-shutdown (OR 0.994 [0.991-0.997], P < .001) but increased appointment cancellation post-shutdown (OR 1.008 [1.001-1.014], P = .015). Mean COVID-19 risk scores were unchanged (P = .654). CONCLUSIONS COVID-19 has led to major changes in outpatient practice, with a significant shift from in-person to telemedicine visits following the mandatory shutdown. An associated increase in appointment completion rates was observed, reflecting a promising viable alternative to meet patient needs during this unprecedented time.
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Affiliation(s)
- Brandon K. Nguyen
- Department of Otolaryngology – Head and
Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA,Brandon Nguyen, MD, Department of
Otolaryngology – Head and Neck Surgery, Rutgers University School of Medicine,
90 Bergen Street, Suite 8100, Newark, NJ 07103, USA.
| | - Hafiah Z. Eltahir
- Department of Otolaryngology – Head and
Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gregory L. Barinsky
- Department of Otolaryngology – Head and
Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Yu-Lan Mary Ying
- Department of Otolaryngology – Head and
Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Wayne D. Hsueh
- Department of Otolaryngology – Head and
Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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Esposito S, Rosafio C, Antodaro F, Argentiero A, Bassi M, Becherucci P, Bonsanto F, Cagliero A, Cannata G, Capello F, Cardinale F, Chiriaco T, Consolaro A, Dessì A, Di Mauro G, Fainardi V, Fanos V, Guarino A, Li Calzi G, Lodi E, Maghnie M, Manfredini L, Malorgio E, Minuto N, Modena MG, Montori R, Moscatelli A, Patrone E, Pescio E, Poeta M, Ravelli A, Spelta M, Suppiej A, Vai S, Villa L, Zanini R, Botti R, Gaddi AV. Use of Telemedicine Healthcare Systems in Pediatric Assistance at Territorial Level: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP) and of the Syndicate of Family Pediatrician Doctors (SIMPeF). J Pers Med 2023; 13:jpm13020198. [PMID: 36836432 PMCID: PMC9964859 DOI: 10.3390/jpm13020198] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
Technological innovation can contribute to a reorganization of healthcare, particularly by supporting the shift in the focus of care from the hospital to the territory, through innovative citizen-centered models, and facilitating access to services in the territory. Health and social care delivery modalities, enabled by telemedicine, are crucial in this regard. The objective of this Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, is to define a standard for its use at the territorial level in various declinations in the pediatric field; this paper also identifies priority areas for its application and the types of services that most require intervention and investment. The changes that are underway in digital transformation in all sectors are unstoppable, and for the digital transformation to take place in a productive sense, the contribution of not only all health professionals, but also of patients, is necessary. From this perspective, authors from different backgrounds were involved in the drafting of this Consensus and, in the future, other figures, primarily patients, are expected to be involved. In fact, this belongs to the vision of connected care, in which the citizen/patient actively participates in the treatment path so that they are assisted in a personalized, predictive and preventive way. The future scenario must be able to provide for the involvement of patients from the initial stages of planning any treatment path, even in the pediatric age, and increasing, where possible, the proximity of the health service to the families.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence:
| | | | | | - Alberto Argentiero
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marta Bassi
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | | | | | | | - Giulia Cannata
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Fabio Capello
- UO Territorial Pediatrics, Primary Care Department, AUSL Bologna, 40126 Bologna, Italy
| | - Fabio Cardinale
- UOC of Pediatrics and ED with an Allergy-Pneumological and Immuno-Rheumatological Focus, Giovanni XXIII Pediatric Hospital, University of Bari, 70124 Bari, Italy
| | - Tiziana Chiriaco
- Health Department, ASL Roma 3, 00125 Rome, Italy
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Alessandro Consolaro
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy
| | - Angelica Dessì
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | | | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Vassilios Fanos
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | - Alfredo Guarino
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giada Li Calzi
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Lodi
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Luca Manfredini
- Pediatric Pain and Palliative Care Service, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | | | - Nicola Minuto
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Maria Grazia Modena
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | | | - Andrea Moscatelli
- UOC Anesthesia and Intensive Care, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Patrone
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Elena Pescio
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Marco Poeta
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Angelo Ravelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Maddalena Spelta
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Agnese Suppiej
- Pediatric Clinic, University of Ferrara, 44124 Ferrara, Italy
| | - Sergio Vai
- Alma Mater University, 40126 Bologna, Italy
| | - Luca Villa
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | | | - Renato Botti
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Antonio Vittorino Gaddi
- Center for Metabolic Diseases and Atherosclerosis, University of Bologna, 40126 Bologna, Italy
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Jaén-Extremera J, Afanador-Restrepo DF, Rivas-Campo Y, Gómez-Rodas A, Aibar-Almazán A, Hita-Contreras F, Carcelén-Fraile MDC, Castellote-Caballero Y, Ortiz-Quesada R. Effectiveness of Telemedicine for Reducing Cardiovascular Risk: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12030841. [PMID: 36769487 PMCID: PMC9917681 DOI: 10.3390/jcm12030841] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of death globally. There are six cardiovascular risk factors: diabetes, hypertension, hypercholesterolemia, overweight, sedentary lifestyle and smoking. Due to the low attendance of healthy people in the health system, the use of telemedicine can influence the acquisition of a heart-healthy lifestyle. OBJECTIVE this systematic review and meta-analysis aimed to determine the effectiveness of telemedicine and e-health in reducing cardiovascular risk. METHODS A systematic review and meta-analysis were carried out using the PubMed, Scopus, Cinhal and WOS databases. Randomized controlled studies between 2017 and 2022 in which telemedicine was used to reduce any of the risk factors were included. The methodological quality was assessed using the "PEDro" scale. RESULTS In total, 763 studies were obtained; after the review, 28 target articles were selected and finally grouped as follows: 13 studies on diabetes, six on hypertension, seven on obesity and two on physical activity. For all of the risk factors, a small effect of the intervention was seen. CONCLUSIONS although the current evidence is heterogeneous regarding the statistically significant effects of telemedicine on various cardiovascular risk factors, its clinical relevance is undeniable; therefore, its use is recommended as long as the necessary infrastructure exists.
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Affiliation(s)
- Jesús Jaén-Extremera
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | | | - Yulieth Rivas-Campo
- Faculty of Human and Social Sciences, University of San Buenaventura, Santiago de Cali 760016, Colombia
| | - Alejandro Gómez-Rodas
- Faculty of Health Sciences and Sport, University Foundation of the Área Andina, Pereira 660004, Colombia
| | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
- Correspondence:
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | | | | | - Raúl Ortiz-Quesada
- Department of Anatomy and Embryology, Faculty of Medicine, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18014 Granada, Spain
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