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Savira F, Sanigorski A, Namara KM, Hensher M, Peeters A, Manias E. Perspectives on telehealth implementation in Australia: An exploratory qualitative study with practice managers and general practitioners. Int J Med Inform 2024; 188:105473. [PMID: 38743998 DOI: 10.1016/j.ijmedinf.2024.105473] [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: 12/20/2023] [Revised: 04/22/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND There is a lack of understanding regarding the impact of telehealth on clinical delivery and the feasibility of sustained implementation by health services. The COVID-19 pandemic provided an ideal opportunity to identify factors related to the implementation of telehealth. This study assessed factors that influenced telehealth implementation during COVID-19 in the Western region of Victoria, Australia, from the perspectives of practice managers and general practitioners (GPs). METHODS Employing a qualitative approach, we conducted semi-structured interviews with 14 GPs and 11 practice managers across metropolitan and rural settings in the Western region of Victoria, Australia. Interviews were conducted between December 2021 to June 2022, which included periods during and beyond the peak of the COVID-19 pandemic. Themes were synthesised using the Consolidated Framework for Implementation Research, which comprised five domains: innovation, inner setting, outer setting, individuals and implementation process. An additional domain related to billing and finances was added. RESULTS The innovation domain revealed that telehealth was identified by both stakeholder groups as a critical tool for improving healthcare access for vulnerable patients. GPs highlighted the role of telehealth in follow-up care and the need for extended telephone consultation services. For the implementation process, both stakeholder groups identified a shift in attitudes among GPs from reluctance to acceptance of telehealth. In terms of outer setting, constant changes in regulations posed challenges to administrative staff. Practice managers faced difficulties in acquiring information on changes, but those with robust professional networks were well supported. Initial loss of incentive funding and government-imposed billing methods posed hurdles for clinics. Both stakeholder groups highlighted the need for education around videoconference and a standardised telehealth platform. CONCLUSION Evolving telehealth regulations during the emergence of COVID-19 posed financial, operational and administrative challenges to primary care clinics. To ensure sustainability, policymakers should improve stakeholder communication, set interoperability standards, and ensure sustainable funding for telehealth.
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Affiliation(s)
- Feby Savira
- Deakin University, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Victoria, Australia; Deakin University, Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Geelong, Victoria, Australia
| | - Andrew Sanigorski
- Deakin University, Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Geelong, Victoria, Australia
| | - Kevin Mc Namara
- Deakin University, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Victoria, Australia; Deakin University, Deakin Rural Health, School of Medicine, Warrnambool, Victoria, Australia
| | - Martin Hensher
- University of Tasmania, Menzies Institute for Medical Research, Hobart, Tasmania, Australia
| | - Anna Peeters
- Deakin University, Institute for Health Transformation, School of Health and Social Development, Burwood, Victoria, Australia
| | - Elizabeth Manias
- Deakin University, Deakin Rural Health, School of Medicine, Warrnambool, Victoria, Australia; Deakin University, Centre for Quality and Patient Safety Research, Institute for Health Transformation, School of Nursing and Midwifery, Burwood, Victoria, Australia; Monash University, School of Nursing and Midwifery, Clayton, Victoria, Australia
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Ayatollahi H, Hemmat M, Nourani A, Saviz P. Staff and students' perceptions about using telehealth technology in a medical university: A qualitative study. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1507-1515. [PMID: 35658128 DOI: 10.1080/07448481.2022.2082842] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 04/25/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The use of telehealth technology is a way to promote the health status of the community. The purpose of this study was to investigate staff and students' perceptions about using telehealth technology in a medical university. METHODS This was a qualitative study completed in 2020. The research participants were 26 university staff and students who took part in semi-structured interviews. To analyze the data, the thematic analysis method was used. RESULTS The findings of the present study included five themes, 20 subthemes and 58 categories. The main themes were the current status of providing healthcare services at the university, and the strengths, weaknesses, opportunities and threats of using telehealth technology for the university staff and students. CONCLUSION According to the results, there are many opportunities for using telehealth technology in the medical university. The experiences of other institutes can be used to implement the technology successfully.
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Affiliation(s)
- Haleh Ayatollahi
- Medical Informatics, Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Hemmat
- Health Information Management, Saveh University of Medical Sciences, Saveh, Iran
| | - Aynaz Nourani
- Medical Informatics, Urmia University of Medical Sciences, Urmia, Iran
| | - Proshat Saviz
- Medical Informatics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Endo Y, Woldesenbet S, Tsilimigras DI, Munir MM, Khalil M, Khan MMM, Altaf A, Rashid Z, Catalano G, Odysseas CP, Pawlik TM. Effect of Telemedicine Use on Medical Spending and Health Care Utilization among Patients with Gastrointestinal Cancer. J Gastrointest Surg 2024:S1091-255X(24)00503-1. [PMID: 38901553 DOI: 10.1016/j.gassur.2024.06.009] [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: 04/16/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION We sought to assess the impact of telemedicine on healthcare utilization and medical expenditures among patients with a diagnosis of gastrointestinal (GI) cancer. METHODS Patients with a newly diagnosed GI cancer from 2013 to 2020 were identified from the IBM MarketScan database. Healthcare utilization, total medical outpatient insurance payments within one-year post-diagnosis, and out-of-pocket (OOP) expenses between telemedicine users and non-users were assessed after propensity score matching (PSM). RESULTS Among 32,677 patients with a GI cancer (esophageal, n=1,862, 5.7%; gastric, n=2,009, 6.1%; liver, n=2,929, 9.0%; bile duct, n=597, 1.8%; pancreas, n=3,083, 9.4%; colorectal, n=22,197, 67.9%), a total of 3,063 (9.7%) utilized telemedicine. After PSM (telemedicine users, n=3,064; non-users, n=3,064), telemedicine users demonstrated a higher frequency of clinic visits (median: 5.0 days, IQR 4.0-7.0 vs. non-users: 2.0 days, IQR 2.0-3.0, p<0.001) and fewer potential days missed from daily activities (median: 7.5 days, IQR 4.5-12.5 vs. non-users: 8.5 days, IQR 5.5-13.5, p<0.001). Total medical spending per month and utilization of emergency room visits for telemedicine users was higher versus non-users (median: $10,658, IQR $5,112-$18,528 vs. non-users: $10,103, IQR $4,628-$16,750; 46.8% vs. 42.6%, both p<0.01), while monthly OOP costs were comparable (median: $273, IQR $137-$449 for telemedicine users vs. non-users: $268, IQR $142-$434, p=0.625). CONCLUSION Telemedicine utilization was associated with increased outpatient clinic visits yet reduced potential days missed from daily activities among patients with GI cancer. Telemedicine users tended to have higher ER visits rate and total medical spending per month, although monthly OOP costs were comparable with non-users.
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Affiliation(s)
- Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Mujtaba Khalil
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Muhammad Muntazir Mehdi Khan
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Abdullah Altaf
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Zayed Rashid
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Giovanni Catalano
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Chatzipanagiotou P Odysseas
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
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Scott AM, Sanders S, Atkins T, van der Merwe M, Sunner C, Clark J, Glasziou P. The impact of telehealth care on escalation to emergency care: A systematic review and meta-analysis. J Telemed Telecare 2024:1357633X241259525. [PMID: 38839244 DOI: 10.1177/1357633x241259525] [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: 06/07/2024]
Abstract
OBJECTIVE We compared the impact of accessing healthcare (1) by telehealth (via telephone or video) vs face-to-face; and (2) by telephone vs video telehealth care, on escalation to emergency care. METHODS We searched Medline, Embase and Cochrane CENTRAL to 24 July 2023; and conducted a citation analysis on 19 September 2023. We included randomised controlled trials. Risk of bias was assessed using Cochrane Tool 2. We calculated risk ratios for dichotomous outcomes and standardised mean difference for continuous outcomes. RESULTS Ten trials compared telehealth (five telephone, four video, one both) to face-to-face care. Six were overall low, three some concerns and one high risk of bias. There were no differences between telehealth and face-to-face for visits to the emergency department (RR 1.07, 95% CI 0.89 to 1.29), hospitalisations up to 12 months (RR 0.89, 95% CI 0.56 to 1.41), deaths or other adverse events. Costs of care were similar, as were patient satisfaction scores.Six trials compared telephone to video telehealth: three were overall low, two some concerns, and one high risk of bias. There were no differences between telephone and video for visits to the emergency department (RR 0.67, 95% CI 0.41 to 1.12), hospitalisations (RR 1.04, 95% CI 0.73 to 1.48), deaths, other adverse events, costs, or patient satisfaction. Healthcare provider satisfaction was high. CONCLUSIONS Telehealth care - delivered by telephone or by video - may be an appropriate alternative to face-to-face provision of care, as it does not increase the likelihood of escalation of care to the emergency department for patients in primary care, hospital outpatients, post-discharge patients or residents in aged care.
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Affiliation(s)
- Anna Mae Scott
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Sharon Sanders
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Tiffany Atkins
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | | | - Carla Sunner
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
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Puthumana RM, Grosgogeat CA, Davis JK, Bocanegra LV, Patel S, Ferreira T, Parekh DJ, Gershengorn HB, Koch AL. Telemedicine and Resource Utilization in Pulmonary Clinic. BMC Pulm Med 2024; 24:267. [PMID: 38840112 PMCID: PMC11151562 DOI: 10.1186/s12890-024-03066-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: 08/30/2023] [Accepted: 05/16/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Telemedicine use increased with the Covid-19 pandemic. The impact of telemedicine on resource use in pulmonary clinics is unknown. METHODS This retrospective cohort study identified adults with pulmonary clinic visits at the University of Miami Hospital and Clinics (January 2018-December 2021). The primary exposure was telemedicine versus in-person visits. Standard statistics were used to describe the cohort and compare patients stratified by visit type. Multivariable logistic regression models evaluated the association of telemedicine with resource use (primarily, computed tomography [CT] orders placed within 7 days of visit). RESULTS 21,744 clinic visits were included: 5,480 (25.2%) telemedicine and 16,264 (74.8%) in-person. In both, the majority were < 65-years-old, female, and identified as Hispanic white. Patients seen with telemedicine had increased odds of having CT scans ordered within 7 days (adjusted odds ratio [aOR] 1.34, [95% confidence interval 1.04-1.74]); and decreased odds of chest x-rays (aOR 0.37 [0.23-0.57]). Telemedicine increased odds of contact of any kind with our healthcare system within 30-days (aOR 1.56 [1.29-1.88]) and 90-days (aOR 1.39 [1.17-1.64]). Specifically, telemedicine visits had decreased odds of emergency department visits and hospitalizations (30 days: aOR 0.54 [0.38-0.76]; 90 days: aOR 0.68 [0.52-0.89]), but increased odds of phone calls and electronic health record inbox messages (30 days: aOR 3.44 [2.73-4.35]; 90 days: aOR 3.58 [2.95-4.35]). CONCLUSIONS Telemedicine was associated with an increased odds of chest CT order with a concomitant decreased odds of chest x-ray order. Increased contact with the healthcare system with telemedicine may represent a larger time burden for outpatient clinicians.
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Affiliation(s)
- Rose M Puthumana
- Department of Internal Medicine, University of Miami and Jackson Health Systems, 1611 NW 12th Ave, 1569 NW 17th Ave, Apt 1005, Miami, FL, 33136, 33125, United States of America.
| | - Claire A Grosgogeat
- University of Miami Miller School of Medicine, 1600 NW 10th Ave, Miami, FL, 33136, United States of America
| | - Jenna K Davis
- University of Miami Miller School of Medicine, 1600 NW 10th Ave, Miami, FL, 33136, United States of America
| | - Linda V Bocanegra
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami and Jackson Health Systems, 1600 NW 10th Ave, Miami, FL, 33136, United States of America
| | - Samira Patel
- University of Miami Hospitals and Clinics, 1400 NW 12th Ave, Miami, FL, 33136, United States of America
| | - Tanira Ferreira
- University of Miami Hospitals and Clinics, 1400 NW 12th Ave, Miami, FL, 33136, United States of America
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, 1600 NW 10th Ave, Miami, FL, 33136, United States of America
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, 1600 NW 10th Ave, Miami, FL, 33136, United States of America
| | - Hayley B Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, 1600 NW 10th Ave, Miami, FL, 33136, United States of America
- Albert Einstein College of Medicine, Division of Critical Care Medicine, 1300 Morris Park Ave, The Bronx, NY, 10461, United States of America
| | - Abigail L Koch
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, 1600 NW 10th Ave, Miami, FL, 33136, United States of America
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Barrett S, Howlett O, Lal N, McKinstry C. Telehealth-Delivered Allied Health Interventions: A Rapid Umbrella Review of Systematic Reviews. Telemed J E Health 2024; 30:e1649-e1666. [PMID: 38436265 DOI: 10.1089/tmj.2023.0546] [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: 03/05/2024] Open
Abstract
Introduction: Telehealth is used by allied health professionals to deliver health care remotely. This umbrella review addressed the following questions: (1) What telehealth interventions have been implemented to deliver allied health care? (2) What are the reported clinical benefits, and challenges of the implementation of telehealth delivered allied health interventions? (3) What are the reported experiences of patients and clinicians? Methods: A rapid umbrella systematic review method was utilized. Following a search of five electronic databases, only systematic reviews reporting on telehealth-delivery allied health interventions published in the past 10 years were included. Reported outcomes included clinical effectiveness, implementation factors, and patient/clinician experiences. Methodological quality was established using the A MeaSurement Tool to Assess systematic Reviews 2. Results: After applying eligibility criteria to 571 studies, 26 studies were included. Findings indicate that telehealth-delivered allied health interventions may obtain similar clinical outcomes as compared with face-to-face appointments. Patients reported less stress and valued the reduced need to travel when telehealth was used. Patient satisfaction with telehealth delivered care was equal to face-to-face care, and no differences were noted in the capacity to build therapeutic alliance when using telehealth. Difficulties with technology use were reported by clinicians and patients. Clinicians were identified as needing increased time management skills. Cautious interpretation of findings is recommended due to the quality rating of low to critical low for the majority of individual reviews. Conclusions: Telehealth-delivered care might obtain similar clinical outcomes to face-to-face care; however, difficulties may arise during broad implementation. It is recommended that health services be strategic to overcome implementation barriers and provide targeted support to enable effective, equitable, and sustained allied health service delivery via telehealth.
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Affiliation(s)
- Stephen Barrett
- Research and Innovation, Bendigo Health Care Group, Bendigo, Victoria, Australia
- La Trobe Rural Health School, Bendigo, Victoria, Australia
| | - Owen Howlett
- La Trobe Rural Health School, Bendigo, Victoria, Australia
- Outpatient Rehabilitation Services, Bendigo Health Care Group, Bendigo, Victoria, Australia
| | - Nalini Lal
- Community Allied Health Services, Bendigo Health Care Group, Bendigo, Victoria, Australia
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Tolu-Akinnawo O, Ezekwueme F, Awoyemi T. Telemedicine in Cardiology: Enhancing Access to Care and Improving Patient Outcomes. Cureus 2024; 16:e62852. [PMID: 38912070 PMCID: PMC11192510 DOI: 10.7759/cureus.62852] [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: 06/21/2024] [Indexed: 06/25/2024] Open
Abstract
Telemedicine has gained significant recognition, particularly since the COVID-19 pandemic. However, its roots date back to its significant role during major epidemic outbreaks such as severe acute respiratory syndrome (SARS), H1N1 and H7N9 influenza, and Middle East respiratory syndrome (MERS), where alternate means of accessing healthcare were adopted to combat the outbreak while limiting the spread of the virus. In Sub-Saharan Africa, telemedicine has supported healthcare delivery, patient and professional health education, disease prevention, and surveillance, starting with its first adoption in Ethiopia in 1980. In the United States, telemedicine has significantly impacted cardiology, particularly at-home monitoring programs, which have proven highly effective for patients with abnormal heart rhythms. Devices such as Holter monitors, blood pressure monitors, and implantable cardioverter-defibrillators have reduced mortality rates and hospital readmissions while improving healthcare efficiency by saving healthcare costs. However, the COVID-19 pandemic accelerated the adoption of telemedicine, as evidenced by a dramatic increase in telemedicine visits at institutions like New York University (NYU) Langone Health during and post-COVID-19 pandemic. In addition, telemedicine has also facilitated cardiac rehabilitation and improved access to specialized cardiology care in rural and underserved areas, reducing disparities in cardiovascular health outcomes. As technology advances, telemedicine is poised to play an increasingly significant role in cardiology and healthcare at large, enhancing patient management, healthcare efficiency, and cost reduction. This review underscores the significance of telemedicine in cardiology, its challenges, and future directions.
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Affiliation(s)
| | - Francis Ezekwueme
- Internal Medicine, University of Pittsburgh Medical Center, Pittsburg, USA
| | - Toluwalase Awoyemi
- Internal Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, GBR
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Charlly N, Swedlund M. Can You Hear Me Now? Patient Perceptions of Telehealth in a Rural Primary Care Population. Telemed J E Health 2024; 30:e1719-e1726. [PMID: 38452338 DOI: 10.1089/tmj.2023.0554] [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: 03/09/2024] Open
Abstract
Background: The COVID-19 pandemic significantly increased telehealth adoption. Rural communities experience challenges relating to telehealth, including a shortage of clinicians, low health literacy, mistrust of medicine, and limited technology access, yet rural perceptions have not been a subject of robust study. The setting of this study was a rural Midwestern family medicine clinic within an academic health system. Methods: Surveys were given to all patients of age 18 or older visiting the clinic over a one-week period. Those who expressed interest were contacted for a semistructured interview. Descriptive statistics and chi-square testing were used to analyze survey results for significant relationships, while interview transcripts were analyzed for themes. Results: Of respondents, 27% indicated prior telehealth use and were more likely to prefer telehealth visits (p = 0.03). Perceptions of telehealth were sorted into themes, including scope of care, convenience, and technology. Telehealth was preferred for discussing test results or mental health. Barriers such as travel time and transportation access favored telehealth. Although more convenient, telehealth was found to be less effective for relationship building. The absence of physical examination during phone visits was a concern. Phone visits were more prevalent due to failure of video-based technology. Conclusions: Despite the potential to address these unique challenges in rural communities, telehealth acceptance is poor. Barriers such as accessibility of technology can be improved through governmental and health systemwide measures. Future work can help develop interventions that counter negative perceptions of telehealth while increasing interest and uptake in rural communities.
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Affiliation(s)
- Nithin Charlly
- Department of Family and Community Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew Swedlund
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Nakamoto CH, Cutler DM, Beaulieu ND, Uscher-Pines L, Mehrotra A. The Impact Of Telemedicine On Medicare Utilization, Spending, And Quality, 2019-22. Health Aff (Millwood) 2024; 43:691-700. [PMID: 38630943 DOI: 10.1377/hlthaff.2023.01142] [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: 04/19/2024]
Abstract
Telemedicine use remains substantially higher than it was before the COVID-19 pandemic, although it has fallen from pandemic highs. To inform the ongoing debate about whether to continue payment for telemedicine visits, we estimated the association of greater telemedicine use across health systems with utilization, spending, and quality. In 2020, Medicare patients receiving care at health systems in the highest quartile of telemedicine use had 2.5 telemedicine visits per person (26.8 percent of visits) compared with 0.7 telemedicine visits per person (9.5 percent of visits) in the lowest quartile of telemedicine use. In 2021-22, relative to those in the lowest quartile, Medicare patients of health systems in the highest quartile had an increase of 0.21 total outpatient visits (telemedicine and in-person) per patient per year (2.2 percent relative increase), a decrease of 14.4 annual non-COVID-19 emergency department visits per 1,000 patients per year (2.7 percent relative decrease), a $248 increase in per patient per year spending (1.6 percent relative increase), and increased adherence for metformin and statins. There were no clear differential changes in hospitalizations or receipt of preventive care.
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Affiliation(s)
| | - David M Cutler
- David M. Cutler, Harvard University and National Bureau of Economic Research, Cambridge, Massachusetts
| | | | | | - Ateev Mehrotra
- Ateev Mehrotra , Harvard University and Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Hall M. Commentary on Spadoni et al. 1. Physiother Can 2024; 76:236-237. [PMID: 38725606 PMCID: PMC11078251 DOI: 10.3138/ptc-2022-0027-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Affiliation(s)
- Mark Hall
- Teaching Professor and MScPT Program Director, Department of Physical Therapy, University of Alberta, Alberta, Canada;
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Prada SI, Toro JJ, Peña-Zárate EE, Libreros-Peña L, Alarcón J, Escobar MF. Impact of a teaching hospital-based multidisciplinary telemedicine programme in Southwestern Colombia: a cross-sectional resource analysis. BMJ Open 2024; 14:e084447. [PMID: 38692730 PMCID: PMC11086581 DOI: 10.1136/bmjopen-2024-084447] [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: 01/18/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Telemedicine, a method of healthcare service delivery bridging geographic distances between patients and providers, has gained prominence. This modality is particularly advantageous for outpatient consultations, addressing inherent barriers of travel time and cost. OBJECTIVE We aim to describe economical outcomes towards the implementation of a multidisciplinary telemedicine service in a high-complexity hospital in Latin America, from the perspective of patients. DESIGN A cross-sectional study was conducted, analysing the institutional data obtained over a period of 9 months, between April 2020 and December 2020. SETTING A high-complexity teaching hospital located in Cali, Colombia. PARTICIPANTS Individuals who received care via telemedicine. The population was categorised into three groups based on their place of residence: Cali, Valle del Cauca excluding Cali and Outside of Valle del Cauca. OUTCOME MEASURES Travel distance, time, fuel and public round-trip cost savings, and potential loss of productivity were estimated from the patient's perspective. RESULTS A total of 62 258 teleconsultations were analysed. Telemedicine led to a total distance savings of 4 514 903 km, and 132 886 hours. The estimated cost savings were US$680 822 for private transportation and US$1 087 821 for public transportation. Patients in the Outside of Valle del Cauca group experienced an estimated average time savings of 21.2 hours, translating to an average fuel savings of US$149.02 or an average savings of US$156.62 in public transportation costs. Areas with exclusive air access achieved a mean cost savings of US$362.9 per teleconsultation, specifically related to transportation costs. CONCLUSION Telemedicine emerges as a powerful tool for achieving substantial travel savings for patients, especially in regions confronting geographical and socioeconomic obstacles. These findings underscore the potential of telemedicine to bridge healthcare accessibility gaps in low-income and middle-income countries, calling for further investment and expansion of telemedicine services in such areas.
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Affiliation(s)
- Sergio Iván Prada
- Subdirección de Investigación e Innovación, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Valle del Cauca, Colombia
- Centro PROESA, Universidad Icesi, Calle 18 No. 122-135, Cali 760032, Colombia
| | - José Joaquín Toro
- Departamento de Costos y Presupuestos, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Colombia
| | - Evelyn E Peña-Zárate
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Valle del Cauca, Colombia
| | - Laura Libreros-Peña
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Valle del Cauca, Colombia
| | - Juliana Alarcón
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Valle del Cauca, Colombia
| | - María Fernanda Escobar
- Unidad de Equidad Global en Salud, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Valle del Cauca, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 No. 122-135, Cali 760032, Colombia
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Olowoyo KS, Esan DT, Adeyanju BT, Olawade DB, Oyinloye BE, Olowoyo P. Telemedicine as a tool to prevent multi-drug resistant tuberculosis in poor resource settings: Lessons from Nigeria. J Clin Tuberc Other Mycobact Dis 2024; 35:100423. [PMID: 38435000 PMCID: PMC10907208 DOI: 10.1016/j.jctube.2024.100423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Background This mini review aims to provide an overview of the role of telemedicine in preventing multi-drug resistant tuberculosis (MDR-TB) in Nigeria. The specific objectives include examining the potential benefits of telemedicine, identifying the challenges associated with its implementation, and highlighting the importance of addressing infrastructure limitations and data privacy concerns. Methods This minireview is based on a comprehensive analysis of existing literature, including scholarly articles, and reports,. A systematic search was conducted using electronic databases, such as PubMed and Google Scholar, to identify relevant publications related to telemedicine and MDR-TB prevention in Nigeria. The selected articles were assessed for their relevance, and key findings were synthesized to provide an overview of the role of telemedicine in addressing the challenges of MDR-TB in Nigeria. Results The review demonstrates that telemedicine has the potential to significantly contribute to MDR-TB prevention efforts in Nigeria. The benefits of telemedicine include improved access to specialized care, enhanced patient adherence to treatment, and potential cost savings. However, challenges such as infrastructure limitations and data privacy concerns need to be addressed for successful implementation. Integrating telemedicine into the healthcare system has the potential to strengthen MDR-TB prevention, particularly in underserved areas, including within Nigeria. Specifically, the integration of telemedicine into the healthcare system can enhance access to specialized care, improve patient adherence, and potentially reduce costs associated with MDR-TB management. Conclusions Addressing infrastructure challenges, ensuring data privacy and security, and fostering trust among healthcare providers and patients are critical for successful implementation of telemedicine. Further research and policy frameworks are needed to guide the effective implementation and scale-up of telemedicine in MDR-TB prevention efforts in Nigeria.
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Affiliation(s)
- Kikelomo S. Olowoyo
- Department of Nursing Science, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
- Department of Internal Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Deborah T. Esan
- Faculty of Nursing Sciences, College of Health Sciences, Bowen University, Iwo, Nigeria
| | - Benedict T. Adeyanju
- Department of Obstetrics and Gynecology, Afe Babalola University/ABUAD Multi-System Hospital, Ado-Ekiti, Nigeria
| | - David B. Olawade
- Department of Allied and Public Health, School of Health, Sport and Bioscience, University of East London, London, United Kingdom
| | - Babatunji E. Oyinloye
- Department of Biochemistry, College of Sciences, Afe Babalola University, Ado-Ekiti, Nigeria and Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa, South Africa
| | - Paul Olowoyo
- Department of Internal Medicine, Federal Teaching Hospital Ido-Ekiti, Nigeria/Afe Babalola University, Ado-Ekiti, Nigeria
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Güneş Öztürk G, Akyıldız D, Karaçam Z. The impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancy: A systematic review and meta-analysis. J Telemed Telecare 2024; 30:607-630. [PMID: 35570738 DOI: 10.1177/1357633x221087867] [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: 11/16/2022]
Abstract
INTRODUCTION Telehealth is an applicable, acceptable, cost-effective, easily accessible, and speedy method for pregnant women. This study aimed to examine the impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancies. METHODS Studies were selected from PubMed, Science Direct, Web of Science, EBSCO, Scopus, and Clinical Key databases according to the inclusion and exclusion criteria from January to February 2021. Cochrane risk-of-bias tools were used in the quality assessment of the studies. RESULTS Four observational and eight randomized controlled studies were included in this meta-analysis (telehealth: 135,875, control: 94,275). It was seen that the number of ultrasound (p < 0.01) and face-to-face visits (p < 0.01), fasting insulin (p < 0.01), hemoglobin A1C before delivery (p < 0.01), and emergency cesarean section rates (p = 0.05) were lower in the telehealth group. In the telehealth group, the women's use of antenatal corticosteroids (p = 0.03) and hypoglycemic medication at delivery (p = 0.03), the total of nursing interventions (p < 0.01), compliance with actual blood glucose measurements (p < 0.01), induction intervention at delivery (p = 0.003), and maternal mortality (p < 0.001) rates were higher. Two groups were similar in terms of the use of medical therapy, total gestational weight gain, health problems related to pregnancy, mode and complications of delivery, maternal intensive care unit admission, fetal-neonatal growth and development, neonatal health problems and mortality, follow-up, and care costs. DISCUSSION Telehealth and routine care yielded similar maternal/neonatal health and cost outcomes. It can be said that telehealth is a safe technique to work with in the management of high-risk pregnancies.
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Affiliation(s)
- Gizem Güneş Öztürk
- Division of Midwifery, Faculty of Health Science, Aydın Adnan Menderes University, Aydın, Turkey
| | - Deniz Akyıldız
- Division of Midwifery, Faculty of Health Science, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Zekiye Karaçam
- Division of Midwifery, Faculty of Health Science, Aydın Adnan Menderes University, Aydın, Turkey
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Thanh NX, Waye A, Stewart D, Weatherald J, Lam GY, Stickland MK, Hill MD, Choy J, Chuck AW, Wasylak T. Increased Virtual Visits to Physicians During the COVID-19 Pandemic and Estimated Impact on Physician Compensation: The Case of Lung and Colorectal Cancers, Chronic Obstructive Pulmonary Diseases, and Heart Failure in Alberta, Canada. Telemed J E Health 2024. [PMID: 38656126 DOI: 10.1089/tmj.2023.0630] [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: 04/26/2024] Open
Abstract
Introduction: The COVID-19 pandemic started in Alberta in March 2020 and significantly increased telehealth service use and provision reducing the risk of virus transmission. We examined the change in the number and proportion of virtual visits by physician specialty and condition (chronic obstructive pulmonary diseases [COPD], heart failure [HF], colorectal and lung cancers), as well as associated changes in physician compensation. Methods: A population-based design was used to analyze all processed physician claims comparing the number and proportion of virtual visits and associated physician billings relative to in-person between pre- (2019/2020) and intra-pandemic (2020/2021). Physician compensations were the claim amounts paid by the health insurance. Results: Pre-pandemic (intra-), there were 8,981 (8,897) lung cancer, 9,245 (9,029) colorectal, 37,558 (36,292) HF, and 68,270 (52,308) COPD patients. Each patient had totally 2.3-4.7 (of which 0.4-0.6% were virtual) general practitioner (GP) visits and 0.9-2.3 (0.2-0.7% were virtual) specialist visits per year pre-pandemic. The average number and proportion of per-patient virtual visits to GPs and specialists grew significantly pre- to intra-pandemic by 2,138-4,567%, and 2,201-7,104%, respectively. Given the lower fees of virtual compared with in-person visits, the reduction in physician compensation associated with the increased use of virtual care was estimated at $3.85 million, with $2.44 million attributed to specialist and $1.41 million to GP. Discussion: Utilization of telehealth increased significantly, while the physician billings per patient and physician compensation declined early in the pandemic in Alberta for the four chronic diseases considered. This study forms the basis for future study in understanding the impact of virtual care, now part of the fabric of health care delivery, on quality of care and patient safety, overall health service utilization (such as diagnostic imaging and other investigations), as well as economic impacts to patients, health care systems, and society.
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Affiliation(s)
- Nguyen Xuan Thanh
- Strategic Clinical Networks, Alberta Health Services, Edmonton and Calgary, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Arianna Waye
- Health Evidence & Innovation, Alberta Health Services, Calgary, Alberta, Canada
| | - Douglas Stewart
- Cancer Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Jason Weatherald
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Grace Y Lam
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Medicine Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Michael K Stickland
- Medicine Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael D Hill
- Cardiovascular Health & Stroke Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Clinical Neuroscience, Cumming School of Medicine, University of Calgary & Foothills Medical Centre, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary & Foothills Medical Centre, Calgary, Alberta, Canada
| | - Jonathan Choy
- Virtual Care Access and Navigation, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anderson W Chuck
- Strategic Finance, Alberta Health Services, Edmonton, Alberta, Canada
| | - Tracy Wasylak
- Strategic Clinical Networks, Alberta Health Services, Edmonton and Calgary, Alberta, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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Leonny S, Bowra J, Davis RA, Zuleta N, Hansen K, Large R, Yeung J. Review article: Telehealth in Emergency Medicine in Australasia: Advantages and barriers. Emerg Med Australas 2024. [PMID: 38649791 DOI: 10.1111/1742-6723.14411] [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: 02/08/2023] [Revised: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024]
Abstract
The COVID-19 pandemic catapulted Telehealth to the forefront of Emergency Medicine (EM) as an alternative way of assessing and managing patients. This challenged the traditional idea that EM can only be practised within brick-and-mortar EDs. Many Emergency Physicians may find the idea of practising Telehealth in Emergency Medicine (TEM) confronting, particularly in the absence of training and clear practice guidelines. The purpose of the present paper is to describe the current use of TEM in Australasia, and outline the advantages and barriers in adopting this practice domain.
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Affiliation(s)
- Sheravika Leonny
- My Emergency Doctor, Sydney, New South Wales, Australia
- Peninsula Health, Melbourne, Victoria, Australia
| | - Justin Bowra
- My Emergency Doctor, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Rebecca A Davis
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- RPA Virtual Hospital, Sydney, New South Wales, Australia
| | - Natalia Zuleta
- WA Country Health Service, Perth, Western Australia, Australia
| | - Kim Hansen
- Virtual Emergency Department, Metro North, Brisbane, Queensland, Australia
- Critical Care, Women's and Children's Service Line, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Ruth Large
- New Zealand Telehealth Leadership Group, Christchurch, New Zealand
- Whakarongorau Aotearoa//New Zealand Telehealth Services, Auckland, New Zealand
| | - Justin Yeung
- WA Country Health Service, Perth, Western Australia, Australia
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Wood G, Scheer A, Saundankar J, Tran D, Cordina R, Maiorana A. The effects of telerehabilitation in adults with complex biventricular congenital heart conditions: protocol for a multi-centre, randomised controlled trial-CH-FIT. Trials 2024; 25:239. [PMID: 38581070 PMCID: PMC10998335 DOI: 10.1186/s13063-024-08019-7] [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: 10/04/2023] [Accepted: 02/26/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Accumulated evidence suggests that exercise training exerts beneficial effects on people with congenital heart conditions. These findings are predominantly derived from small, single-centre exercise trials conducted in outpatient rehabilitation facilities. In recent years, the delivery of exercise interventions remotely has increased through digital communications technology (telerehabilitation). However, very little research to date has been conducted into the efficacy of telerehabilitation in people with a congenital heart condition. AIMS To evaluate the effects of a telehealth-delivered exercise intervention in people with a history of a surgical biventricular repair due to a congenital heart condition. METHODS One hundred eligible adolescent (≥ 16 years) and adult participants living with a complex biventricular congenital heart condition will be recruited from four Australian sites and randomised to either (1) a 16-week telehealth-delivered combined (aerobic and resistance) exercise training programme of moderate-to-vigorous intensity or (2) usual care (control group), in a 1:1 allocation, with an 8-month follow-up. OUTCOMES OF INTEREST The primary outcome will be the change in aerobic capacity expressed as peak oxygen uptake (VO2peak). Secondary outcomes will include changes in vascular function, muscle oxygenation, metabolic profile, body composition and musculoskeletal fitness, neurohormonal activation, neurocognitive function, physical activity levels, dietary and nutritional status, and quality of life. Outcomes will be assessed at baseline, 16 weeks, and 12 months (to determine longer-term maintenance potential). DISCUSSION If found to be efficacious, telerehabilitation may be an alternative option for delivering exercise, improving health outcomes, and increasing accessibility to exercise programmes. Efficacy data is required to quantify the clinical significance of this delivery mode of exercise. TRIAL REGISTRATION ACTRN12622000050752 Trial registration date: 17 January 2022 Trial registration URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382635&showOriginal=true&isReview=true Trial registry name: Australian and New Zealand Clinical Trials Registry.
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Affiliation(s)
- Gina Wood
- School of Allied Health, Curtin University, Perth, WA, Australia.
- School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, Australia.
| | - Anna Scheer
- School of Allied Health, Curtin University, Perth, WA, Australia
| | - Jelena Saundankar
- Perth Children's Hospital, Cardiology, Nedlands, Australia
- Sir Charles Gairdner Hospital, Cardiology, Nedlands, Australia
| | - Derek Tran
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Andrew Maiorana
- School of Allied Health, Curtin University, Perth, WA, Australia
- Allied Health Department, Fiona Stanley Hospital, Perth, WA, Australia
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Islam MT, Bruce M, Alam K. Patterns and determinants of healthcare utilization and medication use before and during the COVID-19 crisis in Afghanistan, Bangladesh, and India. BMC Health Serv Res 2024; 24:416. [PMID: 38570763 PMCID: PMC10988829 DOI: 10.1186/s12913-024-10789-4] [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: 04/08/2023] [Accepted: 02/27/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND COVID-19 rapidly spread through South Asian countries and overwhelmed the health systems that were unprepared for such an outbreak. Evidence from high-income countries showed that COVID-19 impacted healthcare utilization, including medication use, but empirical evidence is lacking in South Asia. This study aimed to investigate the effect of COVID-19 on healthcare utilization and medication use in South Asia. METHOD The current study used longitudinal data from the 'Premise Health Service Disruption Survey' 2020 and 2021. The countries of interest were limited to Afghanistan, Bangladesh, and India. In these surveys, data related to healthcare utilization and medication use were collected for three-time points; 'Pre-COVID phase', 'Initial phase of COVID-19 outbreak', and 'One year of COVID-19 outbreak'. Generalized estimating equation (GEE) along with McNemar's test, Kruskal-Wallis test and χ2 test were applied in this study following the conceptualization of Andersen's healthcare utilization model. RESULT The use of healthcare and medication was unevenly impacted by the COVID-19 epidemic in Afghanistan, Bangladesh, and India. Immediately after the COVID-19 outbreak, respondents in Bangladesh reported around four times higher incomplete healthcare utilization compared to pre-COVID phase. In contrast, respondents in Afghanistan reported lower incomplete utilization of healthcare in a similar context. In the post COVID-19 outbreak, non-adherence to medication use was significantly higher in Afghanistan (OR:1.7; 95%CI:1.6,1.9) and India (OR:1.3; 95%CI:1.1,1.7) compared to pre-COVID phase. Respondents of all three countries who sought assistance to manage non-communicable diseases (NCDs) had higher odds (Afghanistan: OR:1.5; 95%CI:1.3,1.8; Bangladesh: OR: 3.7; 95%CI:1.9,7.3; India: OR: 2.3; 95% CI: 1.4,3.6) of non-adherence to medication use after the COVID-19 outbreak compared to pre-COVID phase. CONCLUSION The present study documented important evidence of the influence of COVID-19 epidemic on healthcare utilization and medication use in three countries of South Asia. Lessons learned from this study can feed into policy responses to the crisis and preparedness for future pandemics.
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Affiliation(s)
- Md Tauhidul Islam
- Murdoch Business School, Murdoch University, 6150, Perth, WA, Australia.
| | - Mieghan Bruce
- School of Veterinary Medicine and Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University, 6150, Perth, WA, Australia
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, 6150, Perth, WA, Australia
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Petrie S, Laur C, Rios P, Suarez A, Makanjuola O, Burke E, Bhattacharyya O, Mukerji G. Quality measures of virtual care in ambulatory healthcare environments: a scoping review. BMJ Open 2024; 14:e078214. [PMID: 38569716 PMCID: PMC10989112 DOI: 10.1136/bmjopen-2023-078214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 03/22/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVES Delivery of virtual care increased throughout the COVID-19 pandemic and persisted after physical distancing measures ended. However, little is known about how to measure the quality of virtual care, as current measures focus on in-person care and may not apply to a virtual context. This scoping review aims to understand the connections between virtual care modalities used with ambulatory patient populations and quality measures across the Quintuple Aim (provider experience, patient experience, per capita cost, population health and health equity). DESIGN Virtual care was considered any interaction between patients and/or their circle of care occurring remotely using any form of information technology. Five databases (MEDLINE, Embase, PsycInfo, Cochrane Library, JBI) and grey literature sources (11 websites, 3 search engines) were searched from 2015 to June 2021 and again in August 2022 for publications that analysed virtual care in ambulatory settings. Indicators were extracted, double-coded into the Quintuple Aim framework; patient and provider experience indicators were further categorised based on the National Academy of Medicine quality framework (safety, effectiveness, patient-centredness, timeliness, efficiency and equity). Sustainability was added to capture the potential for continued use of virtual care. RESULTS 13 504 citations were double-screened resulting in 631 full-text articles, 66 of which were included. Common modalities included video or audio visits (n=43), remote monitoring (n=11) and mobile applications (n=11). The most common quality indicators were related to patient experience (n=58 articles), followed by provider experience (n=25 articles), population health outcomes (n=23 articles) and health system costs (n=19 articles). CONCLUSIONS The connections between virtual care modalities and quality domains identified here can inform clinicians, administrators and other decision-makers how to monitor the quality of virtual care and provide insights into gaps in current quality measures. The next steps include the development of a balanced scorecard of virtual care quality indicators for ambulatory settings to inform quality improvement.
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Affiliation(s)
- Samuel Petrie
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Celia Laur
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Patricia Rios
- Women's College Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Ally Suarez
- Women's College Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Oluwatoni Makanjuola
- Women's College Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Emeralda Burke
- Women's College Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Onil Bhattacharyya
- Women's College Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Geetha Mukerji
- Women's College Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Vu K, Rhim HC, McCormack M, Fee J, Gureck A, DeLuca S, Robinson DM, Tenforde AS. Patient-reported outcomes during telehealth versus in-person follow-up visits for patients treated with extracorporeal shockwave therapy. PM R 2024; 16:323-330. [PMID: 37574919 DOI: 10.1002/pmrj.13057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/02/2023] [Accepted: 07/28/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The limited research describing clinical outcomes using telehealth for management of musculoskeletal conditions is primarily within orthopedic surgery care. OBJECTIVE To characterize differences in patient reported outcomes using telehealth compared with in-person follow-up visits in patients with Achilles tendinopathy (AT) or plantar fasciitis (PF) treated using extracorporeal shockwave therapy (ESWT). DESIGN Retrospective chart review. SETTING Outpatient sports medicine clinic. PATIENTS 82 patients with AT and 46 patients with PF. INTERVENTIONS In-person (n = 76) and telehealth (n = 52) follow-up visits. MAIN OUTCOME MEASUREMENTS Victorian Institute of Sports Assessment-Achilles (VISA-A) for AT and Foot and Ankle Ability Measure (FAAM) for PF as well as billing level. RESULTS There was significant improvement from baseline to final VISA-A (p < .01) and FAAM (p < .01) following ESWT. No significant difference existed in the proportion of patients who met the minimal clinically important difference based on in-person (71.1%) versus telehealth (71.2%) follow-up (p = .99). The in-person group demonstrated higher billing levels compared to the telehealth group (Level: 3.5 ± 0.6 vs. 2.8 ± 0.7, p < .01). CONCLUSIONS Given no significant differences in outcomes between two modes of follow-ups, telehealth may serve as an alternative method to guide management of musculoskeletal injuries with ESWT and other procedures.
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Affiliation(s)
- Kevin Vu
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Molly McCormack
- Spaulding National Running Center, Cambridge, Massachusetts, USA
| | - Jonathan Fee
- Spaulding National Running Center, Cambridge, Massachusetts, USA
| | - Ashley Gureck
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Stephanie DeLuca
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - David M Robinson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
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20
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Galanter M, White WL, Hunter B, Khalsa J. Internet-based, continuously available Narcotics Anonymous meetings: a new resource for access to Twelve Step support for abstinence. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024:1-7. [PMID: 38557160 DOI: 10.1080/00952990.2024.2309648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/21/2024] [Indexed: 04/04/2024]
Abstract
Background: A Zoom-based website was developed in 2020 that offers continuous access to online Narcotics Anonymous (NA) meetings for the first time. This website provides immediate access for persons with substance use disorder to support abstinence from substance-related addictive disorders.Objectives: This study is designed to characterize attendees employing this online format; to evaluate their experiences for gaining support to maintain abstinence; and to compare the 24/7 experience to face-to-face (FF) meetings they attend.Methods: An anonymous 33-item survey was made available on the 24/7 NA website that links to the 24/7 meetings. Persons accessing the site could choose to fill out the survey.Results: 530 respondents completed the survey (64.9% female/35.1% male). Most had stable prior involvement in NA. They had attended more 24/7 meetings (14.9, SD 19.7) than FF meetings (4.6, SD 7.8) in the previous month. 86% had previously attended FF meetings, 48% had served as sponsors, and 92% reported that the 24/7 meetings were more comfortable for them than the FF meetings (p < .001, Cohen's d = 0.65) and more supportive of abstinence (p < .001, Cohen's d = 0.91). Of the respondents, 8% were still using drugs, of whom 52% had previously completed some of the Twelve Steps.Conclusions: The 24/7 format provides a new and easily accessible way for NA members to gain support for abstinence and is positively rated by attendees seeking support for recovery from substance use disorders. It may serve as a valuable adjunct to the traditional FF format.
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Affiliation(s)
- Marc Galanter
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - William L White
- Lighthouse Department, Chestnut Health Systems, Punta Gorda, FL, USA
| | - Brooke Hunter
- Lighthouse Department, Chestnut Health Systems, Normal, IL, USA
| | - Jag Khalsa
- National Institute on Drug Abuse, National Institute of Health, Bethesda, MD, USA
- Department of Psychiatry, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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21
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Härkönen H, Lakoma S, Verho A, Torkki P, Leskelä RL, Pennanen P, Laukka E, Jansson M. Impact of digital services on healthcare and social welfare: An umbrella review. Int J Nurs Stud 2024; 152:104692. [PMID: 38301306 DOI: 10.1016/j.ijnurstu.2024.104692] [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: 08/16/2023] [Revised: 11/27/2023] [Accepted: 01/04/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Digital services can be effective and cost-efficient options for treating non-communicable diseases, but generalizability is limited due to heterogeneous treatment effects. This umbrella review aims to evaluate the impact of digital services on population health, costs, and patient and healthcare professional satisfaction, and to identify facilitators and barriers to using digital services in healthcare and social welfare. METHODS The protocol of the study was registered on the 4th of September 2022 to the International Prospective Register of Systematic Reviews, PROSPERO (CRD42022355635). The review was performed using the Centre for Reviews and Dissemination, Cochrane, Ovid Medline, Scopus, and Web of Science in June 2022. The methodological quality of the included reviews was assessed. The impact of digital services was categorized as no evidence, no dominance, and mixed and positive effect. Inductive content analysis was used to identify facilitators and barriers. RESULTS A total of 66 studies were included in the review, 64 % of which were evaluated as high quality. Studies on the impact of digital services in social welfare were not identified. Sixty-five percent of reviews evaluated the impact of digital services on population health with mixed effects; 21 % were on costs with mixed effects; 27 % were on patient satisfaction with positive effects; and 7.6 % were on healthcare professionals' satisfaction with mixed effects. Various features, allocation, end-user support, organized services, and service development facilitated the use of digital services. Correspondingly, barriers were related to service limitations, digital competency, funding- and service strategies, resources and change management. CONCLUSIONS Compared to usual care, digital services had a mixed impact on population health and costs with high satisfaction in patients. Mixed healthcare professionals' satisfaction was associated with the use of digital services, and it was less studied. To ensure successful implementation and sustainability of digital services, attention must be paid to address barriers and supporting facilitators at all levels.
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Affiliation(s)
- Henna Härkönen
- University of Oulu, Research Unit of Health Sciences and Technology (HST), P.O. BOX 8000, FI-90014, Finland.
| | - Sanna Lakoma
- University of Helsinki, Faculty of Medicine, Department of Public Health, P.O. BOX 00020, 00014, Finland
| | - Anastasiya Verho
- University of Helsinki, Faculty of Medicine, Department of Public Health, P.O. BOX 00020, 00014, Finland
| | - Paulus Torkki
- University of Helsinki, Faculty of Medicine, Department of Public Health, P.O. BOX 00020, 00014, Finland
| | | | - Paula Pennanen
- Nordic Healthcare Group, Vattuniemenranta 2, 00210 Helsinki, Finland
| | - Elina Laukka
- Nordic Healthcare Group, Vattuniemenranta 2, 00210 Helsinki, Finland
| | - Miia Jansson
- University of Oulu, Research Unit of Health Sciences and Technology (HST), P.O. BOX 8000, FI-90014, Finland; RMIT University, GPO Box 2476, Melbourne, VIC 3001, Australia
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Law L, Kelly JT, Savill H, Wallen MP, Hickman IJ, Erku D, Mayr HL. Cost-effectiveness of telehealth-delivered diet and exercise interventions: A systematic review. J Telemed Telecare 2024; 30:420-437. [PMID: 35108135 DOI: 10.1177/1357633x211070721] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Telehealth is a promising tool for delivering lifestyle interventions for the management of health conditions. However, limited evidence exists regarding the cost-effectiveness of these interventions. This systematic review aimed to evaluate the current literature reporting on the cost-effectiveness of telehealth-delivered diet and/or exercise interventions. METHODS Four electronic databases (PubMed, CENTRAL, CINAHL and Embase) were searched for published literature from database inception to November 2020. This review adhered to the preferred reporting items for systematic reviews and meta-analyses guidelines and the ISPOR Criteria for Cost-Effectiveness Review Outcomes Checklist. The quality of reporting was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. The extracted data were grouped into subcategories according to telehealth modality, organised into tables and reported narratively. RESULTS Twenty-four studies of controlled trials (11 combined diet and exercise, 9 exercise-only and 4 diet-only telehealth-delivered interventions) were included for data extraction and quality assessment. Interventions were reported as cost-effective in 12 studies (50%), five studies (21%) reported inconclusive results, and seven studies (29%) reported that the interventions were not cost-effective. Telephone interventions were applied in eight studies (33%), seven studies (29%) used internet interventions, six studies (25%) used a combination of internet and telephone interventions, and three studies (13%) evaluated mHealth interventions. Quality of study reporting varied with between 54% and 92% of Consolidated Health Economic Evaluation Reporting Standards items reported. CONCLUSIONS This review suggests that telehealth-delivered lifestyle interventions can be cost-effective compared to traditional care. There is a need for further investigations that employ rigorous methodology and economic reporting, including appropriate decision analytical models and longer timeframes.
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Affiliation(s)
- Lynette Law
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Jaimon T Kelly
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Holly Savill
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Matthew P Wallen
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
- School of Science, Psychology and Sport, Federation University Australia, Mount Helen, Victoria, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Daniel Erku
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Hannah L Mayr
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Health, Queensland, Australia
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Thomas EE, Taylor ML, Ward EC, Hwang R, Cook R, Ross JA, Webb C, Harris M, Hartley C, Carswell P, Burns CL, Caffery LJ. Beyond forced telehealth adoption: A framework to sustain telehealth among allied health services. J Telemed Telecare 2024; 30:559-569. [PMID: 35130099 DOI: 10.1177/1357633x221074499] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION As COVID-19 restrictions reduce globally, services will determine what components of care will continue via telehealth. We aimed to determine the clinician, service, and system level factors that influence sustained use of telehealth and develop a framework to enhance sustained use where appropriate. METHODS This study was conducted across 16 allied health departments over four health service facilities (Brisbane, Australia). It used a multi-method observational study design, involving telehealth service activity data from hospital administrative databases and qualitative interviews with allied health staff (n = 80). Data were integrated and analysed using Greenhalgh's Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework. RESULTS Increased telehealth use during the peak COVID period reverted to in-person activity as restrictions eased. Telehealth is unlikely to be sustained without a clear strategy including determination of roles and responsibilities across the organisation. Clinician resistance due to forced adoption remains a key issue. The main motivator for clinicians to use telehealth was improved consumer-centred care. Benefits beyond this are needed to sustain telehealth and improvements are required to make the telehealth experience seamless for providers and recipients. Data were synthesised into a comprehensive framework that can be used as a blueprint for system-wide improvements and service enhancement or redesign. DISCUSSION Sustainability of telehealth activity beyond the peak COVID period is unlikely without implementation strategies to address consumer, clinician, service, and system factors. The framework can inform how these strategies can be enacted. Whilst developed for allied health disciplines, it is likely applicable to other disciplines.
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Affiliation(s)
- Emma E Thomas
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Monica L Taylor
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Health, and, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - Rita Hwang
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Allied Health, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Renee Cook
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, and, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Allied Health, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Julie-Anne Ross
- Allied Health, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Clare Webb
- Allied Health, Queen Elizabeth II Jubilee Hospital, Metro South Health, Brisbane, Australia
| | - Michael Harris
- Allied Health, Bayside Health Service, Metro South Health, Brisbane, Australia
| | - Carina Hartley
- Allied Health, Logan Hospital, Metro South Health, Brisbane, Australia
| | - Phillip Carswell
- Consumer Advisor, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Clare L Burns
- Speech Pathology Department, Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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Jervis-Rademeyer H, Cheung L, Cesca N, Gauthier C, Walden K, Musselman KE. Implementing Activity-Based Therapy for Spinal Cord Injury Rehabilitation in Canada: Challenges and Proposed Solutions. Healthcare (Basel) 2024; 12:703. [PMID: 38610126 PMCID: PMC11011823 DOI: 10.3390/healthcare12070703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/09/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
Activity-based therapy (ABT) is a therapeutic approach with multiple benefits including promoting neurorecovery and reducing the likelihood of secondary complications in people living with spinal cord injury (SCI). Barriers and facilitators to ABT implementation for SCI rehabilitation have been studied from various perspectives through qualitative research. However, these viewpoints have not been synthesized to identify challenges of and strategies for implementing ABT across the Canadian healthcare system. Thus, the purpose of our study was to examine the current state of ABT in Canadian healthcare settings according to users' perspectives. Our main objectives were to compare barriers and facilitators to ABT implementation across Canadian healthcare settings according to users' perspectives and to identify optimal intervention strategies for ABT delivery across the Canadian healthcare system from acute to community care. We searched Scopus, CINAHL, OvidMedline, and other sources. Eligible articles were qualitative or mixed methods studies exploring ABT for adults with SCI in a Canadian healthcare setting. We analyzed qualitative findings through a thematic synthesis followed by a deductive content analysis. The Mixed Methods Appraisal Tool was used for critical appraisal. Nine articles were included. The thematic synthesis revealed two main themes: (1) factors influencing acceptance and adaptation of ABT across healthcare settings in Canada and (2) proposed solutions. The deductive analysis applied the Behaviour Change Wheel (BCW) to identify limited components of behaviour and appropriate interventions. To address ABT implementation challenges across the Canadian healthcare system, evidence-based interventions should target BCW subcategories of reflective motivation, social opportunity, and physical opportunity.
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Affiliation(s)
- Hope Jervis-Rademeyer
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Lovisa Cheung
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada; (L.C.); (N.C.); (K.E.M.)
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Nicole Cesca
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada; (L.C.); (N.C.); (K.E.M.)
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada
| | - Cindy Gauthier
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC H3N 1X7, Canada
| | - Kristen Walden
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada
| | - Kristin E. Musselman
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada; (L.C.); (N.C.); (K.E.M.)
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
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Alkhuzaee F, Alsharif S, Shukry M. Telemedicine-based medical care compared to in-person medical care for warfarin follow-up: A retrospective propensity score matching cohort study. Am J Health Syst Pharm 2024; 81:e166-e173. [PMID: 38070197 DOI: 10.1093/ajhp/zxad311] [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: 03/22/2024] Open
Abstract
PURPOSE Telemedicine is underutilized in Saudi Arabia, which is a matter of concern, especially since previous literature has showed its equivalence with office visits in providing access to care and convenience for patients while reducing anticoagulation-related bleeding events when appropriate measures are followed. The purpose of this study is to analyze the efficacy of telehealth-based care compared to in-person visit care for warfarin follow-up. METHODS The authors conducted a retrospective chart review comparing the mean percentage of time in the therapeutic range (TTR) of international normalized ratio (INR) values among patients prescribed warfarin from July 2019 to November 2020 at King Faisal Specialist Hospital & Research Center - Jeddah Branch whose anticoagulant therapy was managed via telemedicine or through in-person clinic visits. A subcohort analysis of outcomes in the telemedicine and in-person groups was performed using propensity score matching, and descriptive analysis was done for the entire cohort. RESULTS A total of 350 patient records were included in this retrospective study. Matched analysis for 148 patients using propensity score matching showed that the mean (SD) percentages of TTR were 62.82% (19.46%) and 70.61% (19.83%) in the telemedicine and in-person groups, respectively (P = 0.017). There was no statistical difference in the incidence of major or minor bleeding events, thromboembolic events, and hospital readmission between the two groups. CONCLUSION The study results showed that patients on oral anticoagulation therapy managed through a telemedicine method had a lower overall TTR percentage than a matched group of patients managed through in-person anticoagulant clinic visits, thus demonstrating that using a telemedicine approach alone for warfarin follow-up may not help patients to maintain their INR target level.
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Affiliation(s)
- Fahad Alkhuzaee
- Quality and Medication Safety Department, Pharmaceutical Services Administration, King Abdullah Medical City in Holy Capital, Makkah, Saudi Arabia
| | - Sahar Alsharif
- Clinical and Operational Support Pharmacy, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Center - Jeddah, Jeddah, Saudi Arabia
| | - Murooj Shukry
- Medication Safety & Clinical Support Pharmacy, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Center - Jeddah, Jeddah, Saudi Arabia
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Barnawi NA, Al-Otaibi H, Alkhudairy AI, Alajlan MA, Alajlan RA, Alay SM, Alqahtani SM, Bushnak IA, Abolfotouh MA. Awareness, Knowledge, Attitude, and Skills (AKAS) of Telemedicine and Its Use by Primary Healthcare Providers. Int J Gen Med 2024; 17:1047-1058. [PMID: 38532847 PMCID: PMC10964027 DOI: 10.2147/ijgm.s452641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
Background This study aimed to determine the rate of telemedicine (TM) use and the levels of awareness, knowledge, attitude, and skills of TM among primary healthcare (PHC) providers. Methods In a cross-sectional study, 104 PHC providers were subjected to a validated AKAS scale via Survey Monkey. The tool consists of 4 parameters that users can respond to using a 4-point Likert scale to assess their awareness (12 statements), knowledge (11 statements), attitude (11 statements), and skills (13 statements) on TM. Total and percentage mean scores (PMS) were calculated for each parameter. Participants were categorized in each parameter into three categories: low (≤ 49% score), average (50-70% score), and high (≥ 71% score) levels. The association of AKAS levels with personal characteristics and TM use was investigated. The significance was set at p<0.05. Results One-half of participants (51%) reported current use of TM, and two-thirds (63.5%) reported a high level of AKAS, with a PMS of 72.9±14.7, 95% CI: 70.1-75.7. There were significant associations between the following: years of experience and levels of knowledge (Χ2LT = 6.77, p= 0.009) and skills (Χ2LT = 4.85, p = 0.028), respectively; and total household income and levels of skills (Χ2LT = 6.91, p= 0.009). The rate of TM use was significantly associated with awareness levels (Χ2LT = 6.14, p = 0.013). Lack of training ranked as the first barrier (45.5%), followed by connection problems and tools' unavailability (35.1% each). The participants recommended providing TM training (41.1%) and stabilization of connection and networking signals (30.1%). Conclusion Despite their high level of TM awareness, the rate of TM use by PHC providers is less than satisfactory. Establishing standardized TM training and supporting the network signals are recommended. A large-scale study on the impact of TM integration with PHC services is necessary.
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Affiliation(s)
- Najla A Barnawi
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Nursing, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | - Hazza Al-Otaibi
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abdulaziz I Alkhudairy
- College of Medicine, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | - Mohammed A Alajlan
- College of Medicine, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | - Renad A Alajlan
- College of Medicine, Imam Muhammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Saeed M Alay
- College of Pharmacy, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | | | - Ibraheem A Bushnak
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mostafa A Abolfotouh
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Huang T, Zhang W, Yan B, Liu H, Girard O. Comparing Telerehabilitation and Home-based Exercise for Shoulder Disorders: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)00836-0. [PMID: 38432330 DOI: 10.1016/j.apmr.2024.02.723] [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: 11/01/2023] [Revised: 01/22/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to quantitatively compare the effects of telerehabilitation and home-based exercise for shoulder disorders. DATA SOURCES We conducted a search for eligible studies in PubMed, EMBASE, Web of Science, Cochrane Library, and MEDLINE databases following Preferred Reporting Items for Systematic Review and Meta-analyses guidelines. STUDY SELECTION Independent reviewers selected randomized controlled trials that compared the effects of telerehabilitation and home-based exercise in individuals with shoulder disorders. DATA EXTRACTION Two reviewers independently conducted data extraction and assessed the risk of bias using the Cochrane Risk of Bias tool. DATA SYNTHESIS A total of 7 studies with 508 participants were included. Compared with home-based exercise, telerehabilitation showed superior improvements in range of motion (flexion: standardized mean difference [SMD] 0.35, 95% confidence interval [CI] 0.14 to 0.56; abduction: SMD 0.37, 95% CI 0.16 to 0.58; external rotation: SMD 0.43, 95% CI 0.22 to 0.64; internal rotation: SMD 0.33, 95% CI 0.08 to 0.58), functional outcomes (Shoulder Pain and Disability Index: SMD -0.37, 95% CI -0.61 to -0.12; shortened Disabilities of the Arm, Shoulder and Hand questionnaire: mean difference [MD] -4.51, 95% CI -8.70 to -0.32), and quality of life (EuroQol Five Dimensions Questionnaire: MD 0.04, 95% CI 0.01 to 0.07). Telerehabilitation was not different from home-based exercise in terms of pain relief (SMD -0.19, 95% CI -0.60 to 0.23). Subgroup analysis demonstrated that telerehabilitation provided significant pain relief when sustained for over 12 weeks (SMD -0.46, 95% CI -0.81 to -0.11). CONCLUSIONS Telerehabilitation is more effective than home-based exercise in improving range of motion, functional outcomes, and quality of life for patients with shoulder disorders. Telerehabilitation significantly outperforms home-based exercise in relieving pain when continued for over 12 weeks.
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Affiliation(s)
- Tian Huang
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Wei Zhang
- School of Sports Engineering, Beijing Sport University, Beijing, China
| | - Bing Yan
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China.
| | - Haoyang Liu
- School of Sports Engineering, Beijing Sport University, Beijing, China
| | - Olivier Girard
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Australia
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MIHEVC M, ZAVRNIK Č, MORI LUKANČIČ M, VIRTIČ POTOČNIK T, PETEK ŠTER M, KLEMENC-KETIŠ Z, POPLAS SUSIČ A. Bottom-Up Analysis of Telemonitoring Costs: A Case Study in Slovenian Primary Care. Zdr Varst 2024; 63:5-13. [PMID: 38156340 PMCID: PMC10751888 DOI: 10.2478/sjph-2024-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/23/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction Telemonitoring improves clinical outcomes in patients with arterial hypertension (AH) and type 2 diabetes (T2D), however, cost structure analyses are lacking. This study seeks to explore the cost structure of telemonitoring for the elderly with AH and T2D in primary care and identify factors influencing costs for potential future expansions. Methods Infrastructure, operational, patient participation, and out-of-pocket costs were determined using a bottom-up approach. Infrastructure costs were determined by dividing equipment and telemonitoring platform expenses by the number of participants. Operational and patient participation costs were determined by considering patient training time, data measurement/review time, and teleconsultation time. The change in out-of-pocket costs was assessed in both groups using a structured questionnaire and 12-month expenditure data. Statistical analysis employed an unpaired sample t-test, Mann-Whitney U test, and chi-square test. Results A total of 117 patients aged 71.4±4.7 years were included in the study. The telemonitoring intervention incurred an annual infrastructure costs of €489.4 and operational costs of €97.3 (95% CI 85.7-109.0) per patient. Patient annual participation costs were €215.6 (95% CI 190.9-241.1). Average annual out-of-pocket costs for both groups were €345 (95% CI 221-469). After 12 months the telemonitoring group reported significantly lower out-of-pocket costs (€132 vs. €545, p<0.001), driven by reduced spending on food, dietary supplements, medical equipment, and specialist check-ups compared to the standard care group. Conclusion To optimise the cost structure of telemonitoring, strategies like shortening the telemonitoring period, developing a national telemonitoring platform, using patient devices, integrating artificial intelligence into platforms, and involving nurse practitioners as telemedicine centre coordinators should be explored.
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Affiliation(s)
- Matic MIHEVC
- Community Health Centre Ljubljana, Primary Healthcare Research and Development Institute, Metelkova ulica 9, 1000Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000Ljubljana, Slovenia
| | - Črt ZAVRNIK
- Community Health Centre Ljubljana, Primary Healthcare Research and Development Institute, Metelkova ulica 9, 1000Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000Ljubljana, Slovenia
| | - Majda MORI LUKANČIČ
- Community Health Centre Ljubljana, Primary Healthcare Research and Development Institute, Metelkova ulica 9, 1000Ljubljana, Slovenia
| | - Tina VIRTIČ POTOČNIK
- Community Health Centre Ljubljana, Primary Healthcare Research and Development Institute, Metelkova ulica 9, 1000Ljubljana, Slovenia
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska ulica 8, 2000Maribor, Slovenia
| | - Marija PETEK ŠTER
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000Ljubljana, Slovenia
| | - Zalika KLEMENC-KETIŠ
- Community Health Centre Ljubljana, Primary Healthcare Research and Development Institute, Metelkova ulica 9, 1000Ljubljana, Slovenia
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska ulica 8, 2000Maribor, Slovenia
| | - Antonija POPLAS SUSIČ
- Community Health Centre Ljubljana, Primary Healthcare Research and Development Institute, Metelkova ulica 9, 1000Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000Ljubljana, Slovenia
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De Guzman KR, Gavanescu D, Smith AC, Snoswell CL. Economic evaluations of telepharmacy services in non-cancer settings: A systematic review. Res Social Adm Pharm 2024; 20:246-254. [PMID: 38195343 DOI: 10.1016/j.sapharm.2024.01.002] [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: 05/30/2023] [Revised: 11/19/2023] [Accepted: 01/04/2024] [Indexed: 01/11/2024]
Abstract
BACKGROUND Telepharmacy is the provision of pharmacy services from a distance to a patient using telecommunications and other technologies. There has been limited research investigating the cost-effectiveness of telepharmacy services. OBJECTIVE To provide a comprehensive review and narrative synthesis of the available economic evidence on telepharmacy services in non-cancer settings. METHOD A systematic literature search of four databases including PubMed, Embase, CINAHL, and EconLit was undertaken to identify economic evaluations comparing telepharmacy services to standard pharmacy care. Abstracts and full texts were screened by two independent reviewers for inclusion against the eligibility criteria. Key economic findings were extracted from included articles to determine the cost-effectiveness of the reported telepharmacy services. RESULTS The review included six studies; two were cost-minimisation analyses, three were cost effectiveness analyses (CEA) and one study conducted both a CEA and cost-utility analysis. Telepharmacy services predominantly relied upon telephone modes of communication, with three that used remote patient monitoring. These services managed a variety of clinical situations which included newly initiated antibiotics, antiretroviral therapy management, and medications for chronic conditions, as well as hypertension management. Articles were of relatively high reporting quality, scoring an average of 83% on the Consolidated Health Economics Reporting Standards checklist. Four of the six studies reported that telepharmacy was less costly than usual care, with two that reported telepharmacy as cost-effective to the healthcare system according to a specified cost-effectiveness threshold. CONCLUSIONS Overall, this review demonstrates that there is emerging evidence that telepharmacy services can be cost-effective compared with standard care in non-cancer settings. Further research is needed to complement these findings, particularly reflecting the increased uptake of telehealth and telepharmacy services since the onset of the Coronavirus disease pandemic.
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Affiliation(s)
- Keshia R De Guzman
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia; School of Pharmacy, The University of Queensland, Brisbane, Australia; Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia.
| | - Danielle Gavanescu
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia; Centre for Innovative Medical Technology, University of Southern Denmark, Denmark
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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Mansoor MA, Siddiqi R. Telehealth Transformation: A Mixed-Methods Study on Organizational Change Processes and Outcomes in a Private Medical Practice. Cureus 2024; 16:e57183. [PMID: 38681288 PMCID: PMC11056098 DOI: 10.7759/cureus.57183] [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: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND This mixed-methods case study investigated the impacts, costs, barriers, and facilitators associated with implementing telehealth services across a private pediatric clinic system. The research examined the effects of telehealth on provider engagement and financial performance. METHODOLOGY Twenty-three clinicians, administrators, and staff across the pediatric clinics were interviewed before and after enterprise-level telehealth adoption to examine change processes amid this innovation. Twelve months of pre- and post-implementation financial records underwent statistical analysis to assess revenue and cost dynamics. Quantitative outcome measures encompassed expenses, revenues, and telehealth visit utilization rates, while qualitative analysis of interviews and focus groups revealed key implementation themes through rigorous inductive coding of participant narratives. RESULTS Results showed significantly increased costs (44%) and revenues (47%) at clinics following virtual care expansion. Monthly telehealth visits per provider exponentially rose over 450%. Qualitatively, 83% of providers appreciated scheduling flexibility benefits, but 68% of staff cited workflow disruptions. CONCLUSIONS Interpretatively, findings demonstrated catalyzed financial and productivity transformations and nuanced perceived disruption amid pronounced appointment capacity expansions. Recommendations encompass updated care coordination protocols, enhanced training and support resources, incentivizing provider usage, and modulating implementation pacing responding to user feedback during large-scale organizational innovation.
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Affiliation(s)
- Masab A Mansoor
- Internal Medicine, Edward Via College of Osteopathic Medicine, Monroe, USA
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Vudathaneni VKP, Lanke RB, Mudaliyar MC, Movva KV, Mounika Kalluri L, Boyapati R. The Impact of Telemedicine and Remote Patient Monitoring on Healthcare Delivery: A Comprehensive Evaluation. Cureus 2024; 16:e55534. [PMID: 38576693 PMCID: PMC10993086 DOI: 10.7759/cureus.55534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/03/2024] [Indexed: 04/06/2024] Open
Abstract
Background Telemedicine and remote patient monitoring have emerged as transformative solutions in contemporary healthcare. This study aimed to conduct a comprehensive evaluation of the impact of these technologies on healthcare delivery, focusing on patient outcomes, economic parameters, and overall satisfaction. Methods A prospective observational study was conducted in various healthcare facilities, involving 186 participants with chronic diseases. Inclusion criteria included patients actively using telemedicine services. Data collection methods included surveys, interviews, and review of medical records, focusing on patient demographics, clinical outcomes, and economic parameters. The intervention involved a seamless integration of telemedicine technologies into the existing health system. Results Primary outcomes revealed significant improvements in patient health, including a decrease in disease-specific markers (mean reduction of 12,000 to 11,000, p = 0.002), a substantial reduction in severity of symptoms (mean reduction from 3,500 to 2,500, p < 0.001), and a general improvement in health status (mean increase from 7,200 to 8,500, p < 0.001). The savings in healthcare costs were evident, with direct costs decreasing from 25,000 to 12,000 (p < 0.001) and indirect costs decreasing from <10,000 to <5,000 (p = 0.004). Secondary results demonstrated increased patient satisfaction with communication (increase from 80% to 95%, p < 0.001) and convenience of services (increase from 75% to 90%, p < 0.001). Patient satisfaction also increased significantly (from 80% to 95%, p < 0.001). Accessibility to healthcare services improved, with a reduction in geographic barriers (increase from 65% to 90%, p < 0.001) and a decrease in the frequency of healthcare utilization (decrease from 2.5 to 1.5, p < 0.001). Conclusion The study provides robust evidence of the positive impact of telemedicine and remote patient monitoring on healthcare delivery. Significant improvements in patient outcomes, coupled with substantial cost savings and increased satisfaction levels, underscore the transformative potential of these technologies.
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Bargeri S, Castellini G, Vitale JA, Guida S, Banfi G, Gianola S, Pennestrì F. Effectiveness of Telemedicine for Musculoskeletal Disorders: Umbrella Review. J Med Internet Res 2024; 26:e50090. [PMID: 38306156 PMCID: PMC10873802 DOI: 10.2196/50090] [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: 06/19/2023] [Revised: 11/02/2023] [Accepted: 11/29/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Several systematic reviews (SRs) assessing the use of telemedicine for musculoskeletal conditions have been published in recent years. However, the landscape of evidence on multiple clinical outcomes remains unclear. OBJECTIVE We aimed to summarize the available evidence from SRs on telemedicine for musculoskeletal disorders. METHODS We conducted an umbrella review of SRs with and without meta-analysis by searching PubMed and EMBASE up to July 25, 2022, for SRs of randomized controlled trials assessing telemedicine. We collected any kind of patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs), and objective measures, including direct and indirect costs. We assessed the methodological quality with the AMSTAR 2 tool (A Measurement Tool to Assess systematic Reviews 2). Findings were reported qualitatively. RESULTS Overall, 35 SRs published between 2015 and 2022 were included. Most reviews (n=24, 69%) were rated as critically low quality by AMSTAR 2. The majority of reviews assessed "telerehabilitation" (n=29) in patients with osteoarthritis (n=13) using PROMs (n=142 outcomes mapped with n=60 meta-analyses). A substantive body of evidence from meta-analyses found telemedicine to be beneficial or equal in terms of PROMs compared to conventional care (n=57 meta-analyses). Meta-analyses showed no differences between groups in PREMs (n=4), while objectives measures (ie, "physical function") were mainly in favor of telemedicine or showed no difference (9/13). All SRs showed notably lower costs for telemedicine compared to in-person visits. CONCLUSIONS Telemedicine can provide more accessible health care with noninferior results for various clinical outcomes in comparison with conventional care. The assessment of telemedicine is largely represented by PROMs, with some gaps for PREMs, objective measures, and costs. TRIAL REGISTRATION PROSPERO CRD42022347366; https://osf.io/pxedm/.
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Affiliation(s)
- Silvia Bargeri
- Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Greta Castellini
- Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Stefania Guida
- Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Silvia Gianola
- Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Mey TM, Ogasawara K. Telehealth Consultation for Malaysian Citizens' Willingness to Pay Assessed by the Double-Bounded Dichotomous Choice Method. Malays J Med Sci 2024; 31:91-102. [PMID: 38456119 PMCID: PMC10917602 DOI: 10.21315/mjms2024.31.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/06/2023] [Indexed: 03/09/2024] Open
Abstract
Background Re-envisioning healthcare in technology tools includes robust utilisation of telehealth, improvement in access, quality, care efficiencies and cost-effectiveness of healthcare services. In reality, the technology's potential to transform healthcare may be limited by the ability to pay for it. This study aims to estimate Malaysian citizens' willingness to pay (WTP) for telehealth consultations and determine the factors contributing to it. This is vital to inform decision-making about expansion, preferences and deployment of a pricing strategy for telehealth services. Methods A random sample of 220 adult Malaysians was surveyed using social network services (SNS). Three different WTP bid arrays were identified and each respondent received a randomly drawn bid price. The WTP fee for using the telehealth consultation for 30 min was measured and estimated using a Double-Bounded Dichotomous Choice (DBDC) and the Random Utility Logit Model. Result The median WTP was estimated to be RM58 (JPY2,198), RM78 (JPY2,956) for 132 respondents' willingness to use telehealth consultation and RM26 (JPY985) for 51 respondents who were unwilling. Further analysis found that WTP is correlated with the perception and willingness of the respondents to use it. Conclusion Despite most respondents being willing to pay for telehealth consultations, sociodemographic characteristics and affordability influenced the process of making decisions about WTP for telehealth consultation. This finding suggests that the private sector can play a crucial role in the deployment of telehealth. However, there may be a need to consider affordability and how to increase access and use of telehealth services.
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Affiliation(s)
- Tan Mey Mey
- Graduate School of Health Sciences, School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Katsuhiko Ogasawara
- Graduate School of Health Sciences, School of Medicine, Hokkaido University, Hokkaido, Japan
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Liang F, Yang X, Peng W, Zhen S, Cao W, Li Q, Xiao Z, Gong M, Wang Y, Gu D. Applications of digital health approaches for cardiometabolic diseases prevention and management in the Western Pacific region. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 43:100817. [PMID: 38456090 PMCID: PMC10920052 DOI: 10.1016/j.lanwpc.2023.100817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/04/2023] [Accepted: 05/23/2023] [Indexed: 03/09/2024]
Abstract
Cardiometabolic diseases (CMDs) are the major types of non-communicable diseases, contributing to huge disease burdens in the Western Pacific region (WPR). The use of digital health (dHealth) technologies, such as wearable gadgets, mobile apps, and artificial intelligence (AI), facilitates interventions for CMDs prevention and treatment. Currently, most studies on dHealth and CMDs in WPR were conducted in a few high- and middle-income countries like Australia, China, Japan, the Republic of Korea, and New Zealand. Evidence indicated that dHealth services promoted early prevention by behavior interventions, and AI-based innovation brought automated diagnosis and clinical decision-support. dHealth brought facilitators for the doctor-patient interplay in the effectiveness, experience, and communication skills during healthcare services, with rapidly development during the pandemic of coronavirus disease 2019. In the future, the improvement of dHealth services in WPR needs to gain more policy support, enhance technology innovation and privacy protection, and perform cost-effectiveness research.
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Affiliation(s)
- Fengchao Liang
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Xueli Yang
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, 22 Qixiangtai Rd, Tianjin 300070, People's Republic of China
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, 22 Qixiangtai Rd, Tianjin 300070, People's Republic of China
| | - Wen Peng
- Nutrition and Health Promotion Center, Department of Public Health, Medical College, Qinghai University, 251 Ningda Road, Xining City 810016, People's Republic of China
- Qinghai Provincial Key Laboratory of Prevention and Control of Glucolipid Metabolic Diseases with Traditional Chinese Medicine, Xining 810008, People's Republic of China
| | - Shihan Zhen
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Wenzhe Cao
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Qian Li
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Zhiyi Xiao
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Mengchun Gong
- Institute of Health Management, Southern Medical University, No. 1023-1063, Shatai South Road, Guangzhou 510515, People's Republic of China
| | - Youfa Wang
- The First Affiliated Hospital of Xi'an Jiaotong University Public Health Institute, Global Health Institute, School of Public Health, International Obesity and Metabolic Disease Research Center, Xi'an Jiaotong University, Xi'an 710061, People's Republic of China
| | - Dongfeng Gu
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
- School of Medicine, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
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Nadeau V, Osuji E, Dennett L, Ferguson-Pell M. Identifying and Overcoming the Barriers to Virtual Electromyography Assessments: A Scoping Review. Telemed J E Health 2024; 30:354-363. [PMID: 37585548 DOI: 10.1089/tmj.2023.0121] [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: 08/18/2023] Open
Abstract
Introduction: Electromyography (EMG) assessments have been conducted virtually more frequently in recent years, leading researchers to explore the barriers to EMG assessments in a telehealth setting and how to overcome them. Methods: A scoping review was conducted according to the methodology described by Arksey and O'Malley. A comprehensive search using controlled vocabulary and keywords for two concepts, EMG and telehealth, was conducted using Medline and EMBASE on February 7, 2022. Two independent reviewers screened titles, abstracts, and full-text articles. Two reviewers also extracted the data and described the findings in a descriptive analysis. Results: A total of 248 articles were screened during the abstract and title review, of which 64 full texts were screened for eligibility. Of these, 15 publications met the inclusion criteria. Most articles were published in 2018 or later (66.7%). The most frequently mentioned barrier to conducting a virtual EMG assessment was poor data and signal transmission (53.3%). Another frequently mentioned barrier was poor patient usability (33.3%). Solutions most frequently reported related to patient usability (33.3%). These included interactive instructions and video chat to monitor and provide the patient with technical support. Conclusion: The last 4 years have seen an increase in articles published on EMGs' use in telehealth to monitor or diagnose patients. Further research is required to determine if the proposed solutions have improved clinical outcomes for the patient.
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Affiliation(s)
- Valerie Nadeau
- Faculty of Rehabilitation Medicine, University of Alberta Edmonton, Edmonton, Alberta, Canada
| | - Emmanuella Osuji
- Faculty of Rehabilitation Medicine, University of Alberta Edmonton, Edmonton, Alberta, Canada
| | - Liz Dennett
- Scott Health Sciences Library, University of Alberta Edmonton, Edmonton, Alberta, Canada
| | - Martin Ferguson-Pell
- Faculty of Rehabilitation Medicine, University of Alberta Edmonton, Edmonton, Alberta, Canada
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Neves AL, van Dael J, O'Brien N, Flott K, Ghafur S, Darzi A, Mayer E. Use and impact of virtual primary care on quality and safety: The public's perspectives during the COVID-19 pandemic. J Telemed Telecare 2024; 30:393-401. [PMID: 34935535 DOI: 10.1177/1357633x211066235] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION With the onset of Coronavirus disease (COVID-19), primary care has swiftly transitioned from face-to-face to virtual care, yet it remains largely unknown how this has impacted the quality and safety of care. We aim to evaluate patient use of virtual primary care models during COVID-19, including change in uptake, perceived impact on the quality and safety of care and willingness of future use. METHODOLOGY An online cross-sectional survey was administered to the public across the United Kingdom, Sweden, Italy and Germany. McNemar tests were conducted to test pre- and post-pandemic differences in uptake for each technology. One-way analysis of variance was conducted to examine patient experience ratings and perceived impacts on healthcare quality and safety across demographic characteristics. RESULTS Respondents (n = 6326) reported an increased use of telephone consultations ( + 6.3%, p < .001), patient-initiated services ( + 1.5%, n = 98, p < 0.001), video consultations ( + 1.4%, p < .001), remote triage ( + 1.3, p < 0.001) and secure messaging systems ( + 0.9%, p = .019). Experience rates using virtual care technologies were higher for men (2.4 ± 1.0 vs. 2.3 ± 0.9, p < .001), those with higher literacy (2.8 ± 1.0 vs. 2.3 ± 0.9, p < .001), and participants from Germany (2.5 ± 0.9, p < .001). Healthcare timeliness and efficiency were the dimensions most often reported as being positively impacted by virtual technologies (60.2%, n = 2793 and 55.7%, n = 2,401, respectively), followed by effectiveness (46.5%, n = 1802), safety (45.5%, n = 1822), patient-centredness (45.2%, n = 45.2) and equity (42.9%, n = 1726). Interest in future use was highest for telephone consultations (55.9%), patient-initiated digital services (56.1%), secure messaging systems (43.4%), online triage (35.1%), video consultations (37.0%) and chat consultations (30.1%), although significant variation was observed between countries and patient characteristics. DISCUSSION Future work must examine the drivers and determinants of positive experiences using remote care to co-create a supportive environment that ensures equitable adoption and use. Comparative analysis between countries and health systems offers the opportunity for policymakers to learn from best practices internationally.
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Affiliation(s)
- Ana Luisa Neves
- Imperial NIHR Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Jackie van Dael
- Imperial NIHR Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Niki O'Brien
- Imperial NIHR Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Kelsey Flott
- Imperial NIHR Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Saira Ghafur
- Imperial NIHR Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ara Darzi
- Imperial NIHR Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Erik Mayer
- Imperial NIHR Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
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Connolly SL, Sherman SE, Dardashti N, Duran E, Bosworth HB, Charness ME, Newton TJ, Reddy A, Wong ES, Zullig LL, Gutierrez J. Defining and Improving Outcomes Measurement for Virtual Care: Report from the VHA State-of-the-Art Conference on Virtual Care. J Gen Intern Med 2024; 39:29-35. [PMID: 38252238 PMCID: PMC10937867 DOI: 10.1007/s11606-023-08464-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/06/2023] [Indexed: 01/23/2024]
Abstract
Virtual care, including synchronous and asynchronous telehealth, remote patient monitoring, and the collection and interpretation of patient-generated health data (PGHD), has the potential to transform healthcare delivery and increase access to care. The Veterans Health Administration (VHA) Office of Health Services Research and Development (HSR&D) convened a State-of-the-Art (SOTA) Conference on Virtual Care to identify future virtual care research priorities. Participants were divided into three workgroups focused on virtual care access, engagement, and outcomes. In this article, we report the findings of the Outcomes Workgroup. The group identified virtual care outcome areas with sufficient evidence, areas in need of additional research, and areas that are particularly well-suited to be studied within VHA. Following a rigorous process of literature review and consensus, the group focused on four questions: (1) What outcomes of virtual care should we be measuring and how should we measure them?; (2) how do we choose the "right" care modality for the "right" patient?; (3) what are potential consequences of virtual care on patient safety?; and (4) how can PGHD be used to benefit provider decision-making and patient self-management?. The current article outlines key conclusions that emerged following discussion of these questions, including recommendations for future research.
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Affiliation(s)
- Samantha L Connolly
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Scott E Sherman
- Virtual Care Consortium of Research (VC CORE), VA New York Harbor Healthcare System, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Navid Dardashti
- Virtual Care Consortium of Research (VC CORE), VA New York Harbor Healthcare System, New York, NY, USA
| | - Elizabeth Duran
- Virtual Care Consortium of Research (VC CORE), VA New York Harbor Healthcare System, New York, NY, USA
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - Michael E Charness
- Chief of Staff of the VA Boston Healthcare System, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Terry J Newton
- Director of Clinical Analytics, VA Office of Connected Care, Washington, DC, USA
| | - Ashok Reddy
- General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Edwin S Wong
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - Jeydith Gutierrez
- Center for Access and Delivery Research, Iowa City VA Healthcare System, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
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Altamimi AA, Brennan-Jones CG, Robinson M, Kuthubutheen J, Herbert H, Tran TT, Veselinović T, Edmunds M, Oremulé B, Alenezi EM, Richmond PC, Choi RS, Li I. A hospital-based asynchronous ENT telehealth service for children with otitis media: Cost-minimisation and improved access. J Telemed Telecare 2024:1357633X231223994. [PMID: 38295365 DOI: 10.1177/1357633x231223994] [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: 02/02/2024]
Abstract
AIM The purpose of this study is to explore the effectiveness of a hospital-based asynchronous ear, nose, and throat (ENT) telehealth service (the Ear Portal) in reducing cost and improving access for children with otitis media. METHODS Participants were recruited to the Ear Portal from a tertiary hospital ENT waiting list. Ear and hearing assessments were conducted during appointments by the Ear Portal research assistant, and data was stored for an asynchronous review by the Ear Portal multidisciplinary team. A cost-minimisation analysis was conducted for the Ear Portal and the standard care pathways. Waiting times to provide care for both pathways were calculated for children with semi-urgent (i.e. Category 2) and non-urgent (i.e. Category 3) referrals. RESULTS The running cost for the Ear Portal was $67.70 for initial appointments and $37.34 for follow-up appointments. Conversely, the running cost for the standard care pathway was $154.65 for initial appointments and $86.10 for follow-up appointments. A total of 223 appointments were required to offset the initial Ear Portal investment of $19,384.00. The median waiting time for the Ear Portal from initial contact to care plan delivery was <30 days, whereas the median waiting times for children in the standard care pathway were 291 days (interquartile range (IQR) = 117) for Category 2 and 371 days (IQR = 311) for Category 3 referrals. CONCLUSION Under the current circumstances, the Ear Portal service can reduce costs for the health care system by reducing marginal costs per patient in addition to providing ENT specialist care within the clinically recommended timeframes.
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Affiliation(s)
- Ali Ah Altamimi
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Medical School, The University of Western Australia, Perth, Western Australia
- Faculty of Life Sciences, Kuwait University, Kuwait
| | - Christopher G Brennan-Jones
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Medical School, The University of Western Australia, Perth, Western Australia
- Perth Children's Hospital, Perth, Western Australia
- School of Allied Health, Curtin University, Perth, Western Australia
| | - Monique Robinson
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
| | - Jafri Kuthubutheen
- Medical School, The University of Western Australia, Perth, Western Australia
- Perth Children's Hospital, Perth, Western Australia
| | - Hayley Herbert
- Medical School, The University of Western Australia, Perth, Western Australia
- Perth Children's Hospital, Perth, Western Australia
| | | | - Tamara Veselinović
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- School of Human Sciences, The University of Western Australia, Perth, Western Australia
| | - Melinda Edmunds
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- School of Allied Health, Curtin University, Perth, Western Australia
| | - Babatunde Oremulé
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Paediatric ENT Department, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Eman Ma Alenezi
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Medical School, The University of Western Australia, Perth, Western Australia
- Faculty of Allied Health Sciences, Kuwait University, Kuwait
| | - Peter C Richmond
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Medical School, The University of Western Australia, Perth, Western Australia
- Perth Children's Hospital, Perth, Western Australia
| | - Robyn Sm Choi
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- School of Human Sciences, The University of Western Australia, Perth, Western Australia
| | - Ian Li
- School of Management and Marketing, Curtin University, Perth, Western Australia
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Guerrier G, Ohayon J, Rothschild PR, Baillard C. Is it safe to use telephone for anaesthesia consultation in high-risk patients before non-invasive surgery? A pilot study in ophthalmology. J Telemed Telecare 2024:1357633X231222661. [PMID: 38280210 DOI: 10.1177/1357633x231222661] [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: 01/29/2024]
Abstract
BACKGROUND Although telemedicine with video support for preoperative evaluation has been found effective, there is limited research on anaesthesia consultation by phone without video support, particularly among high-risk patients. To evaluate the effectiveness, safety and potential benefits of performing pre-anaesthesia evaluation by phone before eye surgery in patients having non-invasive surgery, we performed an observational study in a French teaching hospital. METHOD All elective patients having elective ophthalmic surgery were included to have a consultation by phone instead of an in-person consultation, regardless of the type of anaesthesia or ASA score. The incidence of day-of-surgery cancellations, patient satisfaction and time/distance saved through phone consultations were assessed. RESULTS From February to October 2022, data of 3480 patients were analyzed, including 370 (11%) high-risk patients (ASA 3-4). Anaesthesia-related day-of-surgery cancellation rate was 0.5% (n = 20) due to non-compliance with pre-operative instructions. No cancellation was due to inadequate pre-operative evaluation. No difference in cancellation rate was observed between low-risk patients and high-risk patients. Telephone consultations saved patients a mean of 126 min and 86 km. A younger age, an active status and living far from the hospital were associated with phone consultation preference. CONCLUSION Phone anaesthesia consultation seems to be effective and safe before ophthalmic surgery, regardless of patient's perioperative risk. In addition, phone consultation provides significant time and distance savings. Our results must be confirmed through a multicentric randomised study comparing phone and traditional consultation in ophthalmology as well as in other non-invasive surgical procedures in a high-risk patients population.
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Affiliation(s)
- Gilles Guerrier
- Department of Anaesthesia and Intensive Care, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Centre de Recherche des Cordeliers, INSERM, Paris, France
| | - Johanna Ohayon
- Department of Anaesthesia and Intensive Care, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre-Raphaël Rothschild
- Université de Paris, Centre de Recherche des Cordeliers, INSERM, Paris, France
- Department of Ophthalmology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Baillard
- Department of Anaesthesia and Intensive Care, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
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Foldager Jeppesen S, Vilhjálmsson R, Åvik Persson H, Kristensson Hallström I. Parental satisfaction with paediatric care with and without the support of an eHealth device: a quasi-experimental study in Sweden. BMC Health Serv Res 2024; 24:41. [PMID: 38195486 PMCID: PMC10777543 DOI: 10.1186/s12913-023-10398-7] [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: 02/07/2023] [Accepted: 11/29/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The period after a child is discharged from hospital is generally described as challenging for the parents. Their satisfaction with the health services received is an important indicator of the quality of care. eHealth devices are increasingly used in health care to support communication with parents. Differences in levels of parental satisfaction by modality of provided care or by parental background are largely unknown. This study aimed to describe satisfaction with health care between sociodemographic groups of parents, who either received or did not receive an eHealth device for communication between parents and hospital staff as a supplement to routine care after a child's discharge from neonatal or paediatric surgery departments. METHODS Data from a quasi-experimental study was collected in the south of Sweden, between 2019 and 2021. The Pediatric Quality of Life Inventory™ (PedsQL) Healthcare Satisfaction Generic Module was used to assess the parents' satisfaction with different dimensions of health care. Seventy parents of children hospitalized in a neonatal or a paediatric surgery department were enrolled in intervention (eHealth device, n = 36) and control (no eHealth device, n = 34) groups. RESULTS The parents reported high overall satisfaction with the health care provided and were also highly satisfied within different dimensions of care. Moreover, they reported high satisfaction with using an eHealth device, although having support from the eHealth device was related to neither higher nor lower levels of satisfaction with care. There was a significant difference between fathers and mothers in the multivariate sub-analysis in certain instances regarding satisfaction with communication and the level of inclusion. CONCLUSIONS Parents were very satisfied with the health care provided, whether or not they received eHealth. Further research looking at groups with and without the support of an eHealth device is required to further develop future paediatric and neonatal care interventions. Communication and support through eHealth can be a tool to alleviate the distress parents experience after their child's hospital admission, accommodate the family's transfer to home, and increase satisfaction with care, but it needs to be evaluated before being implemented. TRIAL REGISTRATION Clinical Trials NCT04150120, first registration 4/11/2019.
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Affiliation(s)
| | - Rúnar Vilhjálmsson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Helene Åvik Persson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
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Manes MR, Burnfield JM, Boersma K, Peoples J, Davis A, Beneciuk JM, Bialosky J, Jordan K, Osborne R. Virtual Rehabilitation and COVID-19: Varied Adoption and Satisfaction Among Patients and Providers Participating in a Multi-Site Survey Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580231222334. [PMID: 38166514 PMCID: PMC10768633 DOI: 10.1177/00469580231222334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 01/04/2024]
Abstract
The COVID-19 pandemic compelled rapid healthcare adaptations including increased use of telehealth (TH) and virtual care (VC) to provide rehabilitation services. This multi-site cross-sectional survey study examined rehabilitation patients' and providers' experiences with service delivery during the COVID-19 pandemic, including the use of TH/VC. Patients and providers who received or provided rehabilitation services were recruited from 1 of 3 large, post-acute rehabilitation systems located in the Southeastern and Midwestern United States during the COVID-19 pandemic. Participants rated personal satisfaction with rehabilitation services received or rendered during the pandemic and willingness to use TH/VC in the future. Questions also addressed accessibility, ease of use, and perceived barriers to TH/VC use. The adoption and personal satisfaction of TH/VC for rehabilitation care varied between patients and providers. Patients reported higher levels of satisfaction compared to providers (P < .001). Patients who did not use TH/VC had higher satisfaction than those who did (P < .05). Patients were less willing than providers to use TH/VC (P < .001). Those who used TH/VC prior to the pandemic were more willing to use post-pandemic (P < .001). Patients reported TH/VC was useful in increasing health services accessibility yet were neutral as to the ability of TH/VC to improve outcomes. Patients and providers agreed that TH/VC was easy to learn and use. Medical providers found TH/VC more useful than therapy providers. Participants who used TH/VC during the pandemic are more willing to use the service again in the future. Understanding patient and provider preferences and perspectives is key to the continued use of TH/VC in rehabilitation care.
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Affiliation(s)
- Mindi R. Manes
- Brooks Rehabilitation, Brooks Center for Research Analytics and Outcomes, Jacksonville, FL, USA
| | - Judith M. Burnfield
- Madonna Rehabilitation Hospitals, Institute for Rehabilitation Science and Engineering, Lincoln, NE, USA
| | - Kelsey Boersma
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA
| | - Jason Peoples
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA
| | - Anita Davis
- Brooks Rehabilitation, Brooks Clinical Research Center, Jacksonville, FL, USA
| | - Jason M. Beneciuk
- Brooks Rehabilitation, Brooks Clinical Research Center, Jacksonville, FL, USA
- University of Florida, Department of Physical Therapy, Gainesville, FL, USA
| | - Joel Bialosky
- Brooks Rehabilitation, Brooks Clinical Research Center, Jacksonville, FL, USA
- University of Florida, Department of Physical Therapy, Gainesville, FL, USA
| | - Katelyn Jordan
- Brooks Rehabilitation, Brooks Clinical Research Center, Jacksonville, FL, USA
| | - Raine Osborne
- Brooks Rehabilitation, Brooks Clinical Research Center, Jacksonville, FL, USA
- University of North Florida, Department of Physical Therapy, Jacksonville, FL, USA
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Toll K, Moullin JC, Andrew S, Williams A, Varhol R, Carey TA, Robinson S. Enhancing the implementation of provider-to-provider telehealth in rural and remote areas: A mixed methods study protocol. Digit Health 2024; 10:20552076241242790. [PMID: 38571877 PMCID: PMC10989039 DOI: 10.1177/20552076241242790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
Background Virtual healthcare solutions are proposed as a way to combat the inequity of access to healthcare in rural and remote areas, and to better support the front-line providers who work in these areas. Rural provider-to-provider telehealth (RPPT) connects rural and remote clinicians to a 'hub' of healthcare specialists who can increase access to emergency and specialised healthcare via an integrated model. Reported benefits for the place-based provider include enhanced knowledge, expanded professional development opportunities, improved scope of practice, and increased confidence in treating more complex cases. These reported benefits could have implications for supporting and futureproofing our health workforce in terms of productivity, burnout, recruitment, and retention. Methods The research uses an explanatory sequential mixed methods approach across multiple phases to evaluate the current implementation of Western Australia Country Health Service's (WACHS) Command Centre (CC) services and explore factors associated with their differential use. The primary population of interest and participants in this study are the place-based providers in country Western Australia (WA). Patient data constitutes the secondary population, informing the access and reach of CC services into country WA. Data collection will include service data, an online survey, and semi-structured interviews with the primary population. The data will be interpreted to inform evidence-based strategies and recommendations to improve the implementation and sustainment of RPPT. Discussion Innovative and sustained workforce models and solutions are needed globally. Virtual healthcare, including provider-to-provider models, demonstrate potential, especially in rural and remote areas, designed to increase access to specialised expertise for patients and to support the local workforce. This research will generate new data around behaviour, perceptions, and value from the WACHS rural and remote workforce about provider-to-provider telehealth, to explore the implementation and investigate strategies for the long-term sustainment of RPPT services.
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Affiliation(s)
- Kaylie Toll
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Joanna C Moullin
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Stephen Andrew
- WA Country Health Service, Command Centre, Perth, Western Australia, Australia
| | - Aled Williams
- WA Country Health Service, Command Centre, Perth, Western Australia, Australia
| | - Richard Varhol
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Timothy A Carey
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Suzanne Robinson
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Fantini MC, Loddo E, Petrillo AD, Onali S. Telemedicine in inflammatory bowel disease from its origin to the post pandemic golden age: A narrative review. Dig Liver Dis 2024; 56:1-6. [PMID: 37330279 DOI: 10.1016/j.dld.2023.05.035] [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: 02/16/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/19/2023]
Abstract
Inflammatory bowel disease (IBD), a chronic intestinal inflammatory disorder encompassing ulcerative colitis and Crohn's disease can be disabling and often requires lifelong treatment and follow-up. Digital health technologies and distance-management tools are less costly alternatives for IBD management and clinical monitoring. This review discusses how telephone/videoconference appointments enable treatment optimization from an early disease stage, provide complementary value-based patient care and educational resources, and allow consistent follow-up with a high standard of care. Replacing/supplementing traditional clinical consultations with telemedicine reduces healthcare utilization costs and the need for in-person consultations. The COVID-19 pandemic has accelerated the evolution of telemedicine in IBD, with several studies conducted since 2020 reporting high levels of patient satisfaction. Home-based injectable formulations coupled with telemedicine may become permanently embedded in healthcare systems in the post-pandemic period. While telemedicine consultations are well-accepted by many patients with IBD, they do not suit all patients or are not preferred (e.g., by elderly who do not have the means or ability to understand the associated technology). Ultimately, use of telemedicine should be decided by the patient and careful consideration is required to ensure that the patient is willing and capable of a successful remote visit.
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Affiliation(s)
- Massimo Claudio Fantini
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Azienda Ospedaliero-Universitaria (AOU) di Cagliari, Cagliari, Italy.
| | - Erica Loddo
- Azienda Ospedaliero-Universitaria (AOU) di Cagliari, Cagliari, Italy
| | - Amalia Di Petrillo
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Sara Onali
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Azienda Ospedaliero-Universitaria (AOU) di Cagliari, Cagliari, Italy
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De Guzman KR, Snoswell CL, Caffery LJ, Smith AC. Economic evaluations of videoconference and telephone consultations in primary care: A systematic review. J Telemed Telecare 2024; 30:3-17. [PMID: 34617819 DOI: 10.1177/1357633x211043380] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Telehealth services using videoconference and telephone modalities have been increasing exponentially in primary care since the coronavirus pandemic. The challenge now is ensuring that these services remain sustainable. This review investigates the cost-effectiveness of videoconference and telephone consultations in primary care settings, by summarizing the available published evidence. METHODS A systematic search of PubMed, Embase, Scopus, and CINAHL databases was used to identify articles published from January 2000 to July 2020, using keyword synonyms for telehealth, primary care, and economic evaluation. Databases were searched, and title, abstract, and full-text reviews were conducted. Article reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. RESULTS Twenty articles were selected for inclusion, with 12 describing telephone triage services, seven describing telehealth substitution services, and one describing another telehealth service in primary care. These services were delivered by nurses, doctors, and allied health clinicians. Of the 20 included studies, 11 used cost analyses, five used cost-minimization analyses, and four used one or more methods, including either a cost-consequence analysis, a cost-utility analysis, or a cost-effectiveness analysis. CONCLUSIONS Telephone and videoconference consultations in primary care were cost-effective to the health system when deemed clinically appropriate, clinician when time was used efficiently, and when overall demand on health services was reduced. The societal benefits of telehealth consultations should be considered an important part of telehealth planning and should influence funding reform decisions for telehealth services in primary care.
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Affiliation(s)
- Keshia R De Guzman
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Innovative Medical Technology, The University of Southern Denmark, Odense, Denmark
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El Ansari W, Saad MO. Virtual Care? Telepharmacy in Critical Care Settings for Patient-Centered Care and Multidisciplinary Collaboration: A Scoping Review of Activities, Benefits, Economic Impact, Challenges, and Knowledge Gaps. Telemed J E Health 2024; 30:21-35. [PMID: 37406291 DOI: 10.1089/tmj.2023.0067] [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: 07/07/2023] Open
Abstract
Background: Very few studies have investigated telepharmacy (TP) in critical care. This scoping review undertook this task. Methods: We searched the following five electronic databases (PubMed, Embase, WoS, Scopus, CINAHL). Data were extracted from the articles and mapped out. Arksey and O'Malley's 6-step framework was used, and data synthesis identified activities, benefits, economic impact, challenges, and knowledge gaps of TP in critical care. Results: Out of 77 reports retrieved, 14 were included in the review as per inclusion criteria. Eight studies (57%) were published since 2020, and 9 (64%) were from the United States. Tele-ICU was in place before TP implementation in six studies (43%). TP used a range of synchronous/asynchronous communications. Studies reported wide assortment of reactive/scheduled TP activities. Patient outcomes were evaluated in one study of sedation-related TP interventions but they were not different despite improved compliance with sedation protocol. Most common clinical interventions/drugs included glycemic, electrolyte, and antimicrobial therapy management and antithrombotic agents among others. Acceptance of TP interventions was 75% or more in four studies and 51-55% in two studies. Benefits of TP included resolved drug-related problems, increased compliance with guidelines, maintained interactions with other health care providers, and patient safety among others. Three studies (21%) reported cost avoidance with TP interventions. Challenges included communication, intervention documentation, tracking implementation of recommendations, and monetary/financial and legislative/regulatory issues. Knowledge gaps comprised lack of frameworks for implementation/evaluation of TP in critical care, methodological aspects, lack of patient-specific outcomes, as well as institution/health-system aspects, and documentation systems, cost, legislative, and sustainability issues. Conclusions: TP in critical care is underpublished, and comprehensive frameworks for its implementation and evaluation remain lacking. Assessments are needed to evaluate the effect of TP in critical care on patient-specific outcomes, its economic and legal dimensions, methods to sustain it, as well as the role of documentation systems, collaboration models, and institutional characteristics.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
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Muschol J, Heinrich M, Heiss C, Hernandez AM, Knapp G, Repp H, Schneider H, Thormann U, Uhlar J, Unzeitig K, Gissel C. Digitization of Follow-Up Care in Orthopedic and Trauma Surgery With Video Consultations: Health Economic Evaluation Study From a Health Provider's Perspective. J Med Internet Res 2023; 25:e46714. [PMID: 38145481 PMCID: PMC10775022 DOI: 10.2196/46714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/15/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Recommendations for health care digitization as issued with the Riyadh Declaration led to an uptake in telemedicine to cope with the COVID-19 pandemic. Evaluations based on clinical data are needed to support stakeholders' decision-making on the long-term implementation of digital health. OBJECTIVE This health economic evaluation aims to provide the first German analysis of the suitability of video consultations in the follow-up care of patients in orthopedic and trauma surgery, investigate the financial impact on hospital operations and personnel costs, and provide a basis for decisions on digitizing outpatient care. METHODS We conducted a randomized controlled trial that evaluated video consultations versus face-to-face consultations in the follow-up care of patients in orthopedic and trauma surgery at a German university hospital. We recruited 60 patients who had previously been treated conservatively or surgically for various knee or shoulder injuries. A digital health app and a browser-based software were used to conduct video consultations. The suitability of telemedicine was assessed using the Telemedicine Satisfaction Questionnaire and the EQ-5D-5L questionnaire. Economic analyses included average time spent by physician per consultation, associated personnel costs and capacities for additional treatable patients, and the break-even point for video consultation software fees. RESULTS After 4 withdrawals in each arm, data from a total of 52 patients (telemedicine group: n=26; control group: n=26) were used for our analyses. In the telemedicine group, 77% (20/26) of all patients agreed that telemedicine provided for their health care needs, and 69% (18/26) found telemedicine an acceptable way to receive health care services. In addition, no significant difference was found in the change of patient utility between groups after 3 months (mean 0.02, SD 0.06 vs mean 0.07, SD 0.17; P=.35). Treatment duration was significantly shorter in the intervention group (mean 8.23, SD 4.45 minutes vs mean 10.92, SD 5.58 minutes; P=.02). The use of telemedicine saved 25% (€2.14 [US $2.35]/€8.67 [US $9.53]) in personnel costs and increased the number of treatable patients by 172 annually, assuming 2 hours of video consultations per week. Sensitivity analysis for scaling up video consultations to 10% of the hospital's outpatient cases resulted in personnel cost savings of €73,056 (US $ 80,275.39) for a senior physician. A total of 23 video consultations per month were required to recoup the software fees of telemedicine through reduced personnel costs (break-even point ranging from 12-38 in the sensitivity analysis). CONCLUSIONS Our study supports stakeholders' decision-making on the long-term implementation of digital health by demonstrating that video consultations in the follow-up care of patients in orthopedic and trauma surgery result in cost savings and productivity gains for clinics with no negative impact on patient utility. TRIAL REGISTRATION German Clinical Trials Register DRKS00023445; https://drks.de/search/en/trial/DRKS00023445.
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Affiliation(s)
- Jennifer Muschol
- Department of Health Economics, Justus Liebig University, Giessen, Germany
| | - Martin Heinrich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Christian Heiss
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Alher Mauricio Hernandez
- Bioinstrumentation and Clinical Engineering Research Group, Bioengineering Department, Engineering Faculty, Universidad de Antioquia, Medellín, Colombia
| | - Gero Knapp
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Holger Repp
- Department of Health Economics, Justus Liebig University, Giessen, Germany
| | - Henning Schneider
- Institute of Medical Informatics, Justus Liebig University, Giessen, Germany
| | - Ulrich Thormann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Johanna Uhlar
- Institute of Medical Informatics, Justus Liebig University, Giessen, Germany
| | - Kai Unzeitig
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Christian Gissel
- Department of Health Economics, Justus Liebig University, Giessen, Germany
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Vista FES, Tamondong-Lachica DR. A comparison of the characteristics of adult medicine patients seeking telemedicine consultations versus in-person consultations in a Philippine public hospital. Proc AMIA Symp 2023; 37:80-88. [PMID: 38173998 PMCID: PMC10761184 DOI: 10.1080/08998280.2023.2263255] [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] [Received: 04/27/2023] [Accepted: 09/20/2023] [Indexed: 01/05/2024] Open
Abstract
Background Telemedicine employs the use of technology to increase access to health care. This is especially relevant in developing countries where accessibility is an important issue. In developed countries, studies have shown that despite greater availability and accessibility, there are still disparities in telemedicine use. In the Philippines, however, it is unknown what factors are related to telemedicine use since its underutilization precludes proper characterization of telemedicine patients. We sought to compare the characteristics of telemedicine patients and patients consulting in-person in the internal medicine outpatient department of a Philippine public hospital. Methods This is a retrospective descriptive study. Chart reviews were done for patients who consulted from May 2021 to July 2021. They were classified as either having telemedicine consults only or having in-person consults only. Each group was characterized and compared according to demographics, socioeconomic characteristics, health behaviors, and reasons for consultation. Results Unadjusted analyses showed that younger, single, or employed individuals were more likely to use telemedicine. However, in adjusted analyses, no demographic factors were associated with telemedicine use. Only the patient type and medical concern were significantly different between patient groups in this public hospital setting. New patients and those consulting for clearance/referral purposes or endocrine-related symptoms were more likely to seek teleconsults. Conclusions The findings showed which patients are more likely to use telemedicine in the Philippines. Continued telemedicine use for these patients should be explored to complement in-person medical care.
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Affiliation(s)
| | - Diana R. Tamondong-Lachica
- College of Medicine, University of the Philippines Manila, Manila, Philippines
- Department of Medicine, University of the Philippines Manila Philippine General Hospital, Manila, Philippines
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Thomas EE, Chambers R, Phillips S, Rawstorn JC, Cartledge S. Sustaining telehealth among cardiac and pulmonary rehabilitation services: a qualitative framework study. Eur J Cardiovasc Nurs 2023; 22:795-803. [PMID: 36468293 DOI: 10.1093/eurjcn/zvac111] [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: 05/06/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 12/18/2023]
Abstract
AIMS As we move into a new phase of the COVID-19 pandemic, cardiac and pulmonary services are considering how to sustain telehealth modalities long-term. It is important to learn from services that had greater telehealth adoption and determine factors that support sustained use. We aimed to describe how telehealth has been used to deliver cardiac and pulmonary rehabilitation services across Queensland, Australia. METHODS AND RESULTS Semi-structured interviews (n = 8) and focus groups (n = 7) were conducted with 27 cardiac and pulmonary clinicians and managers from health services across Queensland between June and August 2021. Interview questions were guided by Greenhalgh's Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework. Hybrid inductive/deductive framework analysis elicited six main themes: (i) Variable levels of readiness; (ii) Greater telehealth uptake in pulmonary vs. cardiac rehabilitation; (iii) Safety and risk management; (iv) Client willingness-targeted support required; (v) Equity and access; and (vi) New models of care. We found that sustained integration of telehealth in cardiac and pulmonary rehabilitation will require contributions from all stakeholders: consumers (e.g. co-design), clinicians (e.g. shared learning), health services (e.g. increasing platform functionality), and the profession (e.g. sharing resources). CONCLUSION There are opportunities for telehealth programmes servicing large geographic areas and opportunities to increase programme participation rates more broadly. Centralized models of care serving large geographic areas could maximize sustainability with current resource limitations; however, realizing the full potential of telehealth will require additional funding for supporting infrastructure and workforce. Individuals and organizations both have roles to play in sustaining telehealth in cardiac and pulmonary services.
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Affiliation(s)
- Emma E Thomas
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Ground Floor, Building 33, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland 4102, Australia
| | - Rebecca Chambers
- Healthcare Excellence and Innovation, Metro North Health, Cartwright St, Windsor, QLD 4030, Australia
| | - Samara Phillips
- Clinical Improvement Unit, Metro South Health, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland 4102, Australia
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Susie Cartledge
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia
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Chen JS, Lin MC, Yiu G, Thorne C, Kulasa K, Stewart J, Nudleman E, Freeby M, Han MA, Baxter SL. Barriers to Implementation of Teleretinal Diabetic Retinopathy Screening Programs Across the University of California. Telemed J E Health 2023; 29:1810-1818. [PMID: 37256712 PMCID: PMC10714257 DOI: 10.1089/tmj.2022.0489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 06/02/2023] Open
Abstract
Aim: To describe barriers to implementation of diabetic retinopathy (DR) teleretinal screening programs and artificial intelligence (AI) integration at the University of California (UC). Methods: Institutional representatives from UC Los Angeles, San Diego, San Francisco, Irvine, and Davis were surveyed for the year of their program's initiation, active status at the time of survey (December 2021), number of primary care clinics involved, screening image quality, types of eye providers, image interpretation turnaround time, and billing codes used. Representatives were asked to rate perceptions toward barriers to teleretinal DR screening and AI implementation using a 5-point Likert scale. Results: Four UC campuses had active DR teleretinal screening programs at the time of survey and screened between 246 and 2,123 patients at 1-6 clinics per campus. Sites reported variation between poor-quality photos (<5% to 15%) and average image interpretation time (1-5 days). Patient education, resource availability, and infrastructural support were identified as barriers to DR teleretinal screening. Cost and integration into existing technology infrastructures were identified as barriers to AI integration in DR screening. Conclusions: Despite the potential to increase access to care, there remain several barriers to widespread implementation of DR teleretinal screening. More research is needed to develop best practices to overcome these barriers.
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Affiliation(s)
- Jimmy S. Chen
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Mark C. Lin
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Glenn Yiu
- Department of Ophthalmology and Vision Science, University of California Davis Health, Sacramento, California, USA
| | - Christine Thorne
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Kristen Kulasa
- Department of Endocrinology, University of California San Diego, La Jolla, California, USA
| | - Jay Stewart
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Eric Nudleman
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Matthew Freeby
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Maria A. Han
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Sally L. Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
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Miles DT, Goodwin TM, Wilson AW, Doty JF. Workers' Compensation: The Burden on Healthcare Resource Utilization After Foot and Ankle Surgery. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202312000-00003. [PMID: 38038489 PMCID: PMC10686597 DOI: 10.5435/jaaosglobal-d-23-00211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/01/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION The purpose of this study is to investigate the amount of healthcare resources dedicated to patients with WC after common foot or ankle procedures compared with a procedure-matched control group. METHODS A retrospective review was performed of patients with WC and without WC undergoing foot and ankle procedures. Measures of healthcare burden included clinical communications, documents, prescriptions, office visits, and days to return to work and clinic discharge. RESULTS Collectively, 142 patients met the inclusion criteria. Patients with workers' compensation had increased office communication encounters (P < 0.001), processed documents (P < 0.001), medication prescriptions (P < 0.001), number of office visits (P < 0.001), number of days until return to work (P < 0.001), and days until final disposition from clinic (P < 0.001). Patients with workers' compensation were more likely to have postoperative complications (OR 2.1; 95% CI, 1.0 to 4.3; P = 0.04), secondary surgeries (OR 8.2; 95% CI, 2.3 to 29.4; P < 0.001), and new complaints during the perioperative period (OR 1.9; 95% CI, 0.9 to 4.0; P = 0.07) but were less likely to cancel appointments (OR 0.41; 95% CI, 0.19 to 0.86; P = 0.02). DISCUSSION When undergoing common foot and ankle orthopaedic procedures, patients with WC demonstrated increased healthcare utilization of resources. This included more office staff work burden dedicated to patients with WC for longer amounts of time, effectively doubling the effort of a non-WC cohort.
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Affiliation(s)
- Daniel T. Miles
- From the Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN
| | - Tyler M. Goodwin
- From the Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN
| | - Andrew W. Wilson
- From the Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN
| | - Jesse F. Doty
- From the Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN
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