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Ashour AS, Abd El-Wahab BS, Wahba MA, Fotiadis DI. DMpDP: a Diagnostic Multiple-patient DermoFeature Profile store-and-forward teledermoscopy system. Med Biol Eng Comput 2024; 62:973-996. [PMID: 38110832 PMCID: PMC10948560 DOI: 10.1007/s11517-023-02982-0] [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: 03/03/2023] [Accepted: 11/28/2023] [Indexed: 12/20/2023]
Abstract
Telehealth demand is rapidly growing along with the necessity of providing wide-scale services covering multiple patients at the same time. In this work, the development of a store-and-forward (SAF) teledermoscopy system was considered. The dermoFeatures profile (DP) was proposed to decrease the size of the original dermoscopy image using its most significant features in the form of a newly generated diagonal alignment to generate a small-sized image DP, which is based on the extraction of a weighted intensity-difference frequency (WIDF) features along with morphological features (MOFs). These DPs were assembled to establish a Diagnostic Multiple-patient DermoFeature Profile (DMpDP). Different arrangements are proposed, namely the horizontally aligned, the diagonal-based, and the sequential-based DMpDPs to support the SAF systems. The DMpDPs are then embedded in a recorded patient-information signal (RPS) using a weight factor β to boost the transmitted patient-information signal. The effect of the different transform domains, β values, and number of DPs within the DMpDP were investigated in terms of the diagnostic classification accuracy at the receiver based on the extracted DPs, along with the recorded signal quality evaluation metrics of the recovered RPS. The sequential-based DMpDP achieved the highest classification accuracy, under - 5 dB additive white Gaussian noise, with a realized signal-to-noise ratio of 98.79% during the transmission of 248 DPs using β = 100, and spectral subtraction filtering.
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Affiliation(s)
- Amira S Ashour
- Department of Electronics and Electrical Communications Engineering, Faculty of Engineering, Tanta University, Tanta, Egypt.
| | - Basant S Abd El-Wahab
- Department of Electronics and Electrical Communications Engineering, Faculty of Engineering, Tanta University, Tanta, Egypt
| | - Maram A Wahba
- Department of Electronics and Electrical Communications Engineering, Faculty of Engineering, Tanta University, Tanta, Egypt
| | - Dimitrios I Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Dept. of Materials Science and Engineering, University of Ioannina, GR 45110, Ioannina, Greece
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, FORTH, GR 45110, Ioannina, Greece
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Li Y, Pope C, Damonte J, Spates T, Maa A, Chen S, Yeung H. Barriers and Facilitators to Teledermatology and Tele-Eye Care in Department of Veterans Affairs Provider Settings: Qualitative Content Analysis. JMIR DERMATOLOGY 2024; 7:e50352. [PMID: 38324360 PMCID: PMC10882469 DOI: 10.2196/50352] [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: 06/30/2023] [Revised: 11/04/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Veterans Affairs health care systems have been early adopters of asynchronous telemedicine to provide access to timely and high-quality specialty care services in primary care settings for veterans living in rural areas. Scant research has examined how to expand primary care team members' engagement in telespecialty care. OBJECTIVE This qualitative study aimed to explore implementation process barriers and facilitators to using asynchronous telespecialty care (teledermatology and tele-eye care services). METHODS In total, 30 participants including primary care providers, nurses, telehealth clinical technicians, medical and program support assistants, and administrators from 2 community-based outpatient clinics were interviewed. Semistructured interviews were conducted using an interview guide, digitally recorded, and transcribed. Interview transcripts were analyzed using a qualitative content analysis summative approach. Two coders reviewed transcripts independently. Discrepancies were resolved by consensus discussion. RESULTS In total, 3 themes were identified from participants' experiences: positive perception of telespecialty care, concerns and challenges of implementation, and suggestions for service refinement. Participants voiced that the telemedicine visits saved commute and waiting times and provided veterans in rural areas more access to timely medical care. The mentioned concerns were technical challenges and equipment failure, staffing shortages to cover both in-person and telehealth visit needs, overbooked schedules leading to delayed referrals, the need for a more standardized operation protocol, and more hands-on training with formative feedback among supporting staff. Participants also faced challenges with appointment cancellations and struggled to find ways to efficiently manage both telehealth and in-person visits to streamline patient flow. Nonetheless, most participants feel motivated and confident in implementing telespecialty care going forward. CONCLUSIONS This study provided important insights into the positive perceptions and ongoing challenges in telespecialty care implementation. Feedback from primary care teams is needed to improve telespecialty care service delivery for rural veterans.
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Affiliation(s)
- Yiwen Li
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, United States
| | - Charlene Pope
- Charleston Veterans Affairs Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC, United States
| | - Jennifer Damonte
- Clinical Resource Hub, Veterans Affairs Veterans Integrated Service Network 7, Atlanta, GA, United States
| | - Tanika Spates
- Clinical Resource Hub, Veterans Affairs Veterans Integrated Service Network 7, Atlanta, GA, United States
| | - April Maa
- Clinical Resource Hub, Veterans Affairs Veterans Integrated Service Network 7, Atlanta, GA, United States
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
| | - Suephy Chen
- Department of Dermatology, Duke University School of Medicine, Durham, NC, United States
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, United States
- Clinical Resource Hub, Veterans Affairs Veterans Integrated Service Network 7, Atlanta, GA, United States
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[Translated article] Dermatology Care in Spanish Public Hospitals: A Mapping Study of Health Care Resources and Medical and Surgical Activity in Dermatology Departments in 2019. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2021.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Mapa asistencial dermatológico: descripción de los recursos estructurales y de la actividad médico-quirúrgica de los servicios de dermatología de los hospitales públicos españoles en 2019. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:467-480. [DOI: 10.1016/j.ad.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
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Teledermatology Addressing Disparities in Health Care Access: a Review. CURRENT DERMATOLOGY REPORTS 2021; 10:40-47. [PMID: 33747638 PMCID: PMC7953516 DOI: 10.1007/s13671-021-00329-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 11/09/2022]
Abstract
Purpose of Review Dermatologists have been at the forefront of researching telemedicine to expand access to care. The current COVID-19 pandemic has prompted even greater expansion and implementation of teledermatology. This review discusses the research examining the potential impact of teledermatology addressing disparities in care. Recent Findings Teledermatology appears to increase access to dermatology given expanded means to deliver care. Specifically, recent studies have found increased access among Medicaid-insured, resource-poor urban and rural, and elderly populations. Teledermatology implementation also facilitates education among providers at different levels of training. Still, as some patients have inconsistent access to the required technology, increased reliance on telemedicine may also potentially increase disparities for some populations. Summary Teledermatology may serve to reduce disparities in health care access in many underserved and marginalized communities. Future research should continue to study implementation, especially given the expansion during the COVID-19 pandemic. Ultimately, teledermatology may play an important role in ensuring equitable care access for all.
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Dovigi E, Kwok EYL, English JC. A Framework-Driven Systematic Review of the Barriers and Facilitators to Teledermatology Implementation. CURRENT DERMATOLOGY REPORTS 2020; 9:353-361. [PMID: 33200042 PMCID: PMC7658914 DOI: 10.1007/s13671-020-00323-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 01/07/2023]
Abstract
Purpose of Review Telemedicine use in dermatology, termed “teledermatology”, offers a cost-effective model to improve healthcare efficiency and access. Only a minority of dermatology practices has integrated teledermatology into their practice prior to COVID-19. A thorough understanding of the barriers and facilitators may promote teledermatology adoption. Implementation science frameworks offer theoretically driven ways to assess factors affecting teledermatology implementation. This review uses a comprehensive implementation science framework to summarize barriers and facilitators of teledermatology implementation and appraises the quality of existing research. Recent Findings Technological characteristics of teledermatology (e.g., user-friendliness) and factors within the outer setting (e.g., reimbursement and legal considerations) were the most commonly reported barriers. No existing studies use a comprehensive implementation framework to identify factors influencing teledermatology implementation. Many included studies have a risk of bias in at least two of the five study quality indices evaluated. Summary This systematic review is the first study to summarize the existing teledermatology implementation literature into well-defined constructs from a comprehensive implementation science framework. Findings suggest future studies would benefit from the use of an implementation framework to reduce study bias, improve result comprehensiveness, facilitate comparisons across studies, and produce evidence-based resolutions to implementation barriers. Tools, resources, and recommendations to facilitate the use of an implementation framework in future studies are provided. Supplementary Information The online version contains supplementary material available at 10.1007/s13671-020-00323-0.
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Affiliation(s)
- Edwin Dovigi
- Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612 USA
| | | | - Joseph C. English
- Department of Dermatology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA USA
- Center for Teledermatology, UPMC North Hills Dermatology, 9000, Brooktree Rd Suite 200, Wexford, PA 15044 USA
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Holmes AN, Chansky PB, Simpson CL. Teledermatology Consultation Can Optimize Treatment of Cutaneous Disease by Nondermatologists in Under-Resourced Clinics. Telemed J E Health 2019; 26:1284-1290. [PMID: 31800369 DOI: 10.1089/tmj.2019.0217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Access to dermatologists is limited for disadvantaged patients, who may receive suboptimal dermatologic care from nonspecialists. We assessed if teledermatology could improve primary care provider (PCP)-delivered care for cutaneous disease at a clinic serving uninsured patients. Materials and Methods: Utilizing the American Academy of Dermatology's free AccessDerm program, we offered store-and-forward teledermatology to PCPs, who initiated consultations at will during clinical care independent of the study. We retrospectively analyzed all consultations from 2013 to 2017 and collected patient age/sex, teledermatologist diagnosis, time to teledermatologist reply, time to next dermatology appointment, as well as PCP- and teledermatologist-proposed care plans. Results: Retrospective analysis of 131 consults revealed a 37-h mean teledermatology response-time versus a 14-day appointment wait (p < 0.00001). Teledermatologists provided a definitive care plan without in-person evaluation for 82 (65%) of completed consults and recommended interim treatments while awaiting appointments in 15 cases, thus accelerating care plan delivery in 97 cases (76%). The triage decision rate differed among diagnostic categories; deferral to in-person evaluation was more frequent for neoplasms (p < 0.0001). When PCPs specified preconsult treatment plans, 82% differed from teledermatologist-advised management. Following teledermatologist recommendations would have changed the clinical course in 70% of cases, potentially avoiding suboptimal care, including inappropriate corticosteroids, antimicrobials, and emergency room referrals. Conclusions: We found teledermatology can effectively guide PCPs in resource-limited settings by accelerating delivery of dermatologist-recommended care plans for uninsured patients. Expanding teledermatology for PCPs in under-resourced clinics has the potential to improve treatment of cutaneous disease by nonspecialists and to mitigate suboptimal care for disadvantaged patients.
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Affiliation(s)
- Alexis N Holmes
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter B Chansky
- Department of Dermatology, New York University, New York, New York, USA
| | - Cory L Simpson
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wang RF, Trinidad J, Lawrence J, Pootrakul L, Forrest LA, Goist K, Levine E, Nair S, Rizer M, Thomas A, Wexler R, Kaffenberger BH. Improved patient access and outcomes with the integration of an eConsult program (teledermatology) within a large academic medical center. J Am Acad Dermatol 2019; 83:1633-1638. [PMID: 31678336 DOI: 10.1016/j.jaad.2019.10.053] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 10/13/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Insurance, racial, and socioeconomic health disparities continue to pose significant challenges for access to dermatologic care. Studies applying teledermatology to increase access to underinsured individuals and ethnic minorities are limited. OBJECTIVE To determine how the implementation of a teledermatology program affects access to health care and patient outcomes. METHODS A cross-sectional evaluation was performed of all ambulatory dermatology referrals and electronic dermatology consultations (eConsults) at Ohio State University within a 25-month period. RESULTS Compared with ambulatory referrals, eConsults served more nonwhite patients (612 of 1698 [36.0%] vs 4040 of 16,073 [25.1%]; P < .001) and more Medicaid enrollees (459 of 1698 patients [27.0%] vs 3266 of 16,073 [20.3%]; P < .001). In addition, ambulatory referral patients were significantly less likely to attend their scheduled appointment compared with eConsult patients, as either "no-shows" (246 of 2526 [9.7%] vs 3 of 62 [4.8%]) or cancellations (742 of 2526 [29.4%] vs 8 of 62 [12.9%]; P = .003). There were fewer median days to extirpation for eConsult patients compared with ambulatory referral patients (interquartile range; 80.7 ± 79.8 vs 116.9 ± 86.6 days; P = .004). CONCLUSION Integrating dermatologic care through a telemedicine system can result in improved access for underserved patients through improved efficiency outcomes.
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Affiliation(s)
- Rebecca F Wang
- Division of Dermatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John Trinidad
- Division of Dermatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey Lawrence
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Llana Pootrakul
- Division of Dermatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - L Arick Forrest
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kevin Goist
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Edward Levine
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Shalina Nair
- Department of Family Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Milisa Rizer
- Department of Family Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Andrew Thomas
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Randell Wexler
- Department of Family Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Benjamin H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio.
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O'Hoski S, Butler S, Dubois-Webster J, Brooks D, Goldstein R. Use of telemedicine in the assessment of patients referred for pulmonary rehabilitation. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2018. [DOI: 10.1080/24745332.2017.1391055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sachi O'Hoski
- School of Rehabilitation Science, McMaster University and West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Stacey Butler
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | | | - Dina Brooks
- Department of Physical Therapy, University of Toronto and West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Roger Goldstein
- Departments of Medicine and Physical Therapy, University of Toronto and Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
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Coates SJ, Kvedar J, Granstein RD. Teledermatology: from historical perspective to emerging techniques of the modern era: part I: History, rationale, and current practice. J Am Acad Dermatol 2015; 72:563-74; quiz 575-6. [PMID: 25773407 DOI: 10.1016/j.jaad.2014.07.061] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/21/2014] [Accepted: 07/27/2014] [Indexed: 11/30/2022]
Abstract
Telemedicine is the use of telecommunications technology to support health care at a distance. Technological advances have progressively increased the ability of clinicians to care for diverse patient populations in need of skin expertise. Dermatology relies on visual cues that are easily captured by imaging technologies, making it ideally suited for this care model. Moreover, there is a shortage of medical dermatologists in the United States, where skin disorders account for 1 in 8 primary care visits and specialists tend to congregate in urban areas. Even in regions where dermatologic expertise is readily accessible, teledermatology may serve as an alternative that streamlines health care delivery by triaging chief complaints and reducing unnecessary in-person visits. In addition, many patients in the developing world have no access to dermatologic expertise, rendering it possible for teledermatologists to make a significant contribution to patient health outcomes. Teledermatology also affords educational benefits to primary care providers and dermatologists, and enables patients to play a more active role in the health care process by promoting direct communication with dermatologists.
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Affiliation(s)
- Sarah J Coates
- Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Joseph Kvedar
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Richard D Granstein
- Department of Dermatology, Weill Cornell Medical College, New York, New York.
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Teledermatology: Key factors associated with reducing face-to-face dermatology visits. J Am Acad Dermatol 2014; 71:570-6. [DOI: 10.1016/j.jaad.2014.02.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 02/15/2014] [Accepted: 02/18/2014] [Indexed: 11/24/2022]
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Canzi Lanzini R, Fallen RS, Wismer J, Lima HC. Impact of the Number of Dermatologists on Dermatology Biomedical Research: A Canadian Study. J Cutan Med Surg 2012; 16:174-9. [DOI: 10.1177/120347541201600307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Fewer dermatologists than other clinical specialists are entering and being retained as physicians in the Canadian medical workforce. Studies suggest that dermatologist numbers may influence skin disease outcomes. No study has questioned whether the number of clinical dermatologists can influence academic productivity. Objective: To quantify the correlation of the number of dermatologists with biomedical scientific production in this field from 1996 to 2008 in Canada. Methods: Canadian dermatology biomedical scientific production from SCImago Journal & Country Rank (SJR) were merged with Canadian Medical Association (CMA) dermatologist demographic data. Linear regression analyses were used to model the relationships. Results: The low growth of dermatologist numbers by 8.16% in Canada from 1996 to 2008 correlates with a small increase in articles by 7.59% published in this subject area during this period. This has reduced the scientific importance of Canadian dermatology in the world. Conclusion: The number of dermatologists was a significant predictor of biomedical research production in the field of dermatology. This suggests that specialist availability may be one factor influencing dermatology research and publications.
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Terschüren C, Mensing M, Mekel OCL. Is telemonitoring an option against shortage of physicians in rural regions? Attitude towards telemedical devices in the North Rhine-Westphalian health survey, Germany. BMC Health Serv Res 2012; 12:95. [PMID: 22507694 PMCID: PMC3386008 DOI: 10.1186/1472-6963-12-95] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 04/16/2012] [Indexed: 05/04/2023] Open
Abstract
Background General practitioners (GP) in rural areas of Germany are struggling to find successors for their private practices. Telemonitoring at home offers an option to support remaining GPs and specialists in ambulatory care. Methods We assessed the knowledge and attitude towards telemedicine in the population of North Rhine-Westphalia (NRW), Germany, in a population-based telephone survey. Results Out of 2,006 participants, 734 (36.6%) reported an awareness of telemedical devices. Only 37 participants (1.8%) have experience in using them. The majority of participants were in favour of using them in case of illness (72.2%). However, this approval declined with age. These findings were similar in rural and urban areas. Participants who were in favour of telemedicine (n = 1,480) strongly agreed that they would have to see their doctor less often, and that the doctor would recognize earlier relevant changes in their vital status. Participants who disliked to be monitored by telemedical devices preferred to receive immediate feedback from their physician. Especially, the elderly fear the loss of personal contact with their physician. They need the direct patient-physician communication. Conclusions The fear of being left alone with the technique needs to be compensated for today's elderly patients to enhance acceptance of home telemonitoring as support for remaining doctors either in the rural areas or cities.
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