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Dale E, Novak J, Dmytriiev D, Demeshko O, Habicht J. Resilience of Primary Health Care in Ukraine: Challenges of the Pandemic and War. Health Syst Reform 2024; 10:2352885. [PMID: 38875441 DOI: 10.1080/23288604.2024.2352885] [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: 03/18/2024] [Accepted: 05/04/2024] [Indexed: 06/16/2024] Open
Abstract
This commentary examines the resilience of primary health care in Ukraine amidst the ongoing war, drawing a few reflections relevant for other fragile and conflict-affected situations. Using personal observations and various published and unpublished reports, this article outlines five reflections on the strengths, challenges, and necessary adaptations of Primary Health Care (PHC) in Ukraine. It underscores the concerted efforts of the government to maintain public financing of PHC, thereby averting system collapse. The research also highlights the role of strategic adaptations during the COVID-19 pandemic in fostering resilience during the war, including the widespread use of digital communication and skills training. The commentary emphasizes the role of managerial and financial autonomy in facilitating quick and efficient organizational response to crisis. It also recognizes emerging challenges, including better access to PHC services among the internally displaced persons, shifting patient profiles and service needs, and challenges related to reliance on local government financing. Finally, the authors advocate for a coordinated approach in humanitarian response, recovery efforts, and development programs to ensure the sustainability and effectiveness of PHC in Ukraine.
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Affiliation(s)
- Elina Dale
- Global Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Julia Novak
- World Health Organization Country Office, Kyiv, Ukraine
| | | | - Olga Demeshko
- World Health Organization Country Office, Kyiv, Ukraine
| | - Jarno Habicht
- World Health Organization Country Office, Kyiv, Ukraine
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Farid AR, Hresko MT, Ghessese S, Linden GS, Wong S, Hedequist D, Birch C, Cook D, Flowers KM, Hogue GD. Validation of Examination Maneuvers for Adolescent Idiopathic Scoliosis in the Telehealth Setting. J Bone Joint Surg Am 2024:00004623-990000000-01229. [PMID: 39356742 DOI: 10.2106/jbjs.23.01146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
BACKGROUND Telehealth visits (THVs) have made it essential to adopt innovative ways to evaluate patients virtually. This study validates a novel THV approach that uses educational videos and an instructional datasheet, enabling parents to use smartphones to measure their child's scoliosis at home or in telehealth settings. METHODS We identified a prospective cohort of patients with adolescent idiopathic scoliosis (AIS) scheduled for follow-up care from March to July 2021. The angle of trunk rotation (ATR) was first measured at home by patients' guardians using instructional video guidance and a smartphone application with internal accelerometer software. The second measurement was made during a THV examination performed by caregivers with supervision by trained associates via a telehealth appointment. Lastly, the clinician measured the child's ATR during an in-person clinic visit. Intraclass correlation coefficients (ICCs) and interrater reliability were compared between in-person clinic measurements and (1) at-home and (2) THV measurements. Shoulder, lower back, and pelvic asymmetry were observed and quantified at home and virtually, and then were compared with in-person clinic evaluations using kappa values. Surveys were used to evaluate the experience of the patient/caregiver with the at-home and telehealth assessment tools. RESULTS Seventy-three patients were included (mean age, 14.1 years; 25% male). There was excellent agreement in the ATR measurements between THVs and in-person visits (ICC = 0.88; 95% confidence interval [CI] = 0.83 to 0.92). ATR agreement between at-home and in-person visits was also excellent, but slightly diminished (ICC = 0.76; 95% CI = 0.64 to 0.83). Agreement between THV and in-person measurements was significantly higher compared with that between at-home and in-person measurements (p = 0.04). There was poor agreement in lower back asymmetry between THV and in-person assessments (kappa = 0.37; 95% CI = 0.14 to 0.60); however, there was no significant agreement between at-home and in-person assessments (kappa = 0.06; 95% CI = -0.17 to 0.29). Patient/caregiver satisfaction surveys (n = 70) reported a median score of 4 ("good") for comfort with use of the technology, and a score of 3 ("neutral") for equivalence of THV and in-person evaluation. CONCLUSIONS There was a high level of agreement between telehealth and in-person spine measurements, suggesting that THVs may be reliably used to evaluate AIS, thus improving access to specialized care. LEVEL OF EVIDENCE Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alexander R Farid
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - M Timothy Hresko
- Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Semhal Ghessese
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gabriel S Linden
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Wong
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel Hedequist
- Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Craig Birch
- Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Danielle Cook
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kelsey Mikayla Flowers
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Grant D Hogue
- Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Cornelis J, Christiaens W, de Meester C, Mistiaen P. Remote patient monitoring in patients with COVID-19 at home: literature review. JMIR Nurs 2024. [PMID: 39287362 DOI: 10.2196/44580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND During the pandemic healthcare providers implemented remote patient monitoring (RPM) for patients suffering from COVID-19. RPM is an interaction between healthcare professionals and patients who are in different locations, in which a certain number of patient's functioning parameters is assessed and followed up for a certain duration of time. By implementing RPM for these patients they obtained to reduce the strain on hospitals and primary care. OBJECTIVE With this literature review we aim at describing the characteristics of the RPM interventions, reporting on the patients with COVID-19 included in RPM, and providing an overview of outcome variables such as length of stay (LOS), hospital (re)admissions, and mortality. METHODS A combination of different searches in several database types (traditional databases, trial registers, daily (google) searches and daily Pubmed alerts) were run daily from March 2020 till December 2021. A search update for randomized clinical trials (RCT's) was done in April 2022. RESULTS The initial search yielded more than 4448 articles (not including daily searches). After deduplication and assessment for eligibility, 241 articles were retained describing 164 telemonitoring studies from 160 centres. None of the 164 studies covering 248,431 included patients reported on the presence of a randomized control group. Studies described a 'prehosp' group (96 studies) with patients who had a suspected or confirmed COVID-19 diagnosis and for whom it was decided not to hospitalize them yet, but closely monitor them at home, or a 'posthosp' group (32 studies) with patients who were monitored at home after hospitalization for COVID-19; 34 studies described both groups, in 2 studies it was unclear. There is a large variety in number of emergency department (ED) visits (0-36% and 0-16%) and no convincing evidence that RPM leads to less or more ED-visits as well as hospital (re)admissions (0-30% and 0-22%) in prehosp and posthosp, respectively. Mortality was generally low, and there is weak to no evidence that RPM is associated with lower mortality. There is neither evidence that RPM shortens previous LOS. A literature update detected three small scale RCT's which could not demonstrate statistically significant differences in these outcomes. Most papers claim savings, however the scientific base for these claims is doubtful. The overall patient experiences with RPM were positive, as patients felt more reassured, although many patients declined RPM for several reasons (eg, technological embarrassment, digital literacy, etc.). CONCLUSIONS Based on these results, there is no convincing evidence that RPM in COVID-19 patients could avoid ED-visits or hospital (re)admissions, could shorten LOS or reduce mortality, but neither is there evidence that RPM has adverse outcomes. Further research should focus on developing, implementing, and evaluating an RPM framework. CLINICALTRIAL
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Affiliation(s)
- Justien Cornelis
- Belgian Health Care Knowledge Centre, Kruidtuinlaan 55, Brussels, BE
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Jones BS, DeWitt ME, Wenner JJ, Sanders JW. Lyme Disease Under-Ascertainment During the COVID-19 Pandemic in the United States: Retrospective Study. JMIR Public Health Surveill 2024; 10:e56571. [PMID: 39264291 PMCID: PMC11411844 DOI: 10.2196/56571] [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: 01/26/2024] [Revised: 08/10/2024] [Accepted: 08/12/2024] [Indexed: 09/13/2024] Open
Abstract
Background The COVID-19 pandemic resulted in a massive disruption in access to care and thus passive, hospital- and clinic-based surveillance programs. In 2020, the reported cases of Lyme disease were the lowest both across the United States and North Carolina in recent years. During this period, human contact patterns began to shift with higher rates of greenspace utilization and outdoor activities, putting more people into contact with potential vectors and associated vector-borne diseases. Lyme disease reporting relies on passive surveillance systems, which were likely disrupted by changes in health care-seeking behavior during the pandemic. Objective This study aimed to quantify the likely under-ascertainment of cases of Lyme disease during the COVID-19 pandemic in the United States and North Carolina. Methods We fitted publicly available, reported Lyme disease cases for both the United States and North Carolina prior to the year 2020 to predict the number of anticipated Lyme disease cases in the absence of the pandemic using a Bayesian modeling approach. We then compared the ratio of reported cases divided by the predicted cases to quantify the number of likely under-ascertained cases. We then fitted geospatial models to further quantify the spatial distribution of the likely under-ascertained cases and characterize spatial dynamics at local scales. Results Reported cases of Lyme Disease were lower in 2020 in both the United States and North Carolina than prior years. Our findings suggest that roughly 14,200 cases may have gone undetected given historical trends prior to the pandemic. Furthermore, we estimate that only 40% to 80% of Lyme diseases cases were detected in North Carolina between August 2020 and February 2021, the peak months of the COVID-19 pandemic in both the United States and North Carolina, with prior ascertainment rates returning to normal levels after this period. Our models suggest both strong temporal effects with higher numbers of cases reported in the summer months as well as strong geographic effects. Conclusions Ascertainment rates of Lyme disease were highly variable during the pandemic period both at national and subnational scales. Our findings suggest that there may have been a substantial number of unreported Lyme disease cases despite an apparent increase in greenspace utilization. The use of counterfactual modeling using spatial and historical trends can provide insight into the likely numbers of missed cases. Variable ascertainment of cases has implications for passive surveillance programs, especially in the trending of disease morbidity and outbreak detection, suggesting that other methods may be appropriate for outbreak detection during disturbances to these passive surveillance systems.
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Affiliation(s)
- Brie S Jones
- Section on Infectious Diseases, Department of Medicine, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC, 27159, United States, 1 336-422-7771
| | - Michael E DeWitt
- Section on Infectious Diseases, Department of Medicine, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC, 27159, United States, 1 336-422-7771
- Department of Biology, Wake Forest University, Winston Salem, NC, United States
- Center for the Study of Microbial Ecology and Emerging Diseases, Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - Jennifer J Wenner
- Section on Infectious Diseases, Department of Medicine, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC, 27159, United States, 1 336-422-7771
- Center for the Study of Microbial Ecology and Emerging Diseases, Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - John W Sanders
- Section on Infectious Diseases, Department of Medicine, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC, 27159, United States, 1 336-422-7771
- Center for the Study of Microbial Ecology and Emerging Diseases, Wake Forest University School of Medicine, Winston Salem, NC, United States
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Aalaei S, Tabesh H, Shahraki H, Rezaeitalab F, Amini M, Afsharisaleh L, Asadpour H, Eslami S. Remote monitoring system to support positive airway pressure therapy in patients with obstructive sleep apnea: a multi-center randomized controlled trial. Sleep Breath 2024:10.1007/s11325-024-03108-y. [PMID: 39196315 DOI: 10.1007/s11325-024-03108-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 05/29/2024] [Accepted: 07/12/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE To develop and evaluate an intervention tailored to patients' needs to increase the rate of positive airway pressure (PAP) adherence in patients afflicted with obstructive sleep apnea (OSA), who undergo PAP therapy. METHODS A multi-center, 3 parallel-arm, randomized, controlled trial was conducted. Participants with OSA who undergo a PAP therapy were randomized to one of three groups: control arm (usual care), educational booklet arm, and mobile-based application arm. PAP usage, the percentage of days using the device for more than 4 h, change in knowledge, risk perception, outcome expectancy, self-efficacy, and ESS were assessed before and one month after interventions in the three groups. Also, the application usage data were analyzed. RESULTS The result showed the change in average PAP usage, knowledge, risk perception, and self-efficacy in the application group was significantly higher than the control and booklet groups. Also, the change in use for more than 4 h in the application group was significantly higher than the control group. Comparing the actual and patients' self-report PAP use indicated patients' self-report about the use of the device is about 50 min (0.8 h) more than the actual amount of use. CONCLUSION The study results indicated that the improvement of primary and secondary outcomes in adherence to PAP was significantly higher in the application group than in other study groups. Given the increasingly penetrating influence of smartphone-based technologies, it seems that mobile-based applications could potentially be adopted in the population of patients with OSA. CLINICAL TRIALS REGISTRATION IRCT2017092236314N1; https://en.irct.ir/trial/27185.
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Affiliation(s)
- Shokoufeh Aalaei
- Department of Medical Informatics, School of Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, 91779-48564, Iran
| | - Hamed Tabesh
- Department of Medical Informatics, School of Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, 91779-48564, Iran
| | - Hadi Shahraki
- Department of Computer Engineering, Faculty of Industry and Mining, University of Sistan and Baluchestan, Zahedan, Iran
| | - Fariborz Rezaeitalab
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahnaz Amini
- Lung Diseases Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lahya Afsharisaleh
- Department of Occupational Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Asadpour
- Sleep Laboratory of Ibn-E-Sina Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeid Eslami
- Department of Medical Informatics, School of Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, 91779-48564, Iran.
- Department of Medical Informatics, University of Amsterdam, Amsterdam, the Netherlands.
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Amura CR, Medina R, Bean M, Centi S, Cook PF, Barton AJ, Jones J. Socio-Structural Intersect With Post-COVID-19 Telehealth Utilization for Hispanic/Latino Groups in Colorado: A Mixed Methods Study. J Transcult Nurs 2024:10436596241271301. [PMID: 39189347 DOI: 10.1177/10436596241271301] [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: 08/28/2024] Open
Abstract
INTRODUCTION We evaluated telehealth utilization among Colorado Hispanics/Latinos during the COVID-19 pandemic. METHODS A mixed methods design was used with urban and rural patients recruited through two Colorado Federally Qualified Health Centers (FQHCs) serving large Hispanic/Latino communities. Linguistically and culturally adapted Patient Attitudes Toward Telehealth (PATAT) surveys were collected electronically. Semi-structured interviews were conducted with a purposeful sample of Spanish-speaking Hispanics/Latinos. RESULTS Although the FQHCs serve a Hispanic/Latino population, only 40% of survey respondents (82/204) were Hispanic/Latinos, and they reported less telehealth utilization (p < .01). Trust in telehealth seemed driven by previous use, with no differences in PATAT scores by ethnicity or geolocation. Interviews with Spanish-speaking Hispanics/Latinos showed they highly preferred in-person care, and factors that influenced telehealth utilization were situated within the intersection of culture and trust with socio-structural determinants of health. DISCUSSION Resolving disparities in telehealth utilization requires patient-centric approaches and equitable transcultural care for underserved Hispanic/Latino populations.
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Curran V, Glynn R, Whitton C, Hollett A. An Approach to the Design and Development of an Accredited Continuing Professional Development e-Learning Module on Virtual Care. JMIR MEDICAL EDUCATION 2024; 10:e52906. [PMID: 39119741 PMCID: PMC11327639 DOI: 10.2196/52906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 08/10/2024]
Abstract
Unlabelled Virtual care appointments expanded rapidly during COVID-19 out of necessity and to enable access and continuity of care for many patients. While previous work has explored health care providers' experiences with telehealth usage on small-scale projects, the broad-level adoption of virtual care during the pandemic has expounded opportunities for a better understanding of how to enhance the integration of telehealth as a regular mode of health care services delivery. Training and education for health care providers on the effective use of virtual care technologies are factors that can help facilitate improved adoption and use. We describe our approach to designing and developing an accredited continuing professional development (CPD) program using e-learning technologies to foster better knowledge and comfort among health care providers with the use of virtual care technologies. First, we discuss our approach to undertaking a systematic needs assessment study using a survey questionnaire of providers, key informant interviews, and a patient focus group. Next, we describe our steps in consulting with key stakeholder groups in the health system and arranging committees to inform the design of the program and address accreditation requirements. The instructional design features and aspects of the e-learning module are then described in depth, and our plan for evaluating the program is shared as well. As a CPD modality, e-learning offers the opportunity to enhance access to timely continuing professional education for health care providers who may be geographically dispersed across rural and remote communities.
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Affiliation(s)
- Vernon Curran
- Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Robert Glynn
- Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Cindy Whitton
- Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Ann Hollett
- Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
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Nanda A, Lam LL, Lynch J, Soudy H. Experiences and Satisfaction With Telehealth During the COVID-19 Pandemic: The Perspectives of Patients With Cancer in Australia. JCO Glob Oncol 2024; 10:e2400081. [PMID: 39088779 DOI: 10.1200/go.24.00081] [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: 02/23/2024] [Revised: 04/15/2024] [Accepted: 05/30/2024] [Indexed: 08/03/2024] Open
Abstract
PURPOSE There has been a significant rise in telehealth consultations across Australia since COVID-19 was declared a worldwide pandemic. We aimed to obtain patient feedback on telehealth, identify key strengths and weaknesses, and assess the feasibility of telehealth beyond the pandemic. METHODS A survey was developed to obtain patient feedback on telehealth. Patients attending medical oncology clinics at St George Hospital and Sutherland Hospital from April 1, 2020, to May 31, 2020, were identified. Patients who were reviewed via phone or videoconference were included in this study. Eligible patients were texted or emailed a survey link within a week of their telehealth consultation. Surveys were anonymous and completion of the survey implied informed consent. Patients who did not have a mobile number or e-mail were excluded from this study. RESULTS One thousand fifty-nine patients were reviewed during the study period, of whom 644 (60%) were reviewed via telehealth. The survey response rate was 36.3% (230 patients responded of 634 surveys sent). Ten telehealth patients did not have a mobile number or email and were excluded. Sixty-seven percent of telehealth consults were for active surveillance, 31% for prechemotherapy/treatment reviews, 1.6% for best supportive care, and 0.5% for new consults. Seventy percent of patients were satisfied that their medical needs were met via telehealth. Ninety percent wanted another telehealth consult, and 73% wanted telehealth to continue post resolution of the pandemic. Minimizing risk of exposure to COVID-19 and patient convenience were identified as key strengths of telehealth while absence of physical examination was the main disadvantage. CONCLUSION Majority of the patients surveyed were satisfied that telehealth safely met their medical needs. There is a considerable demand for telehealth to continue beyond the pandemic.
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Affiliation(s)
- Arnav Nanda
- Department of Medical Oncology, St George Hospital, Sydney, Australia
- Western Cancer Centre, Dubbo Base Hospital, Dubbo, Australia
| | - Lyn Ley Lam
- Department of Medical Oncology, St George Hospital, Sydney, Australia
| | - Jodi Lynch
- Department of Medical Oncology, St George Hospital, Sydney, Australia
| | - Hussein Soudy
- Department of Medical Oncology, St George Hospital, Sydney, Australia
- Department of Medical Oncology, Sutherland Hospital, Caringbah, Australia
- Faculty of Medicine, Cairo University, Cairo, Egypt
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Wilhite JA, Phillips Z, Altshuler L, Fisher H, Gillespie C, Goldberg E, Wallach A, Hanley K, Zabar S. Does it get better? An ongoing exploration of physician experiences with and acceptance of telehealth utilization. J Telemed Telecare 2024; 30:1190-1201. [PMID: 36221982 DOI: 10.1177/1357633x221131220] [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: 11/17/2022]
Abstract
INTRODUCTION COVID-19 forced health systems to rapidly implement telehealth for routine practice, often without sufficient training or standards. We conducted a longitudinal survey of physicians to explore changes in their perceptions of the challenges and benefits of telehealth and identify recommendations for future practice. METHODS An anonymous online survey was distributed to a cohort of internal medicine physicians in May to June 2020 and March to June 2021. Changes in responses between 2020 and 2021 and by site (private vs. public) were described. These findings, along with those of a thematic analysis of open-ended responses to questions on telehealth experiences, informed a set of recommendations. RESULTS The survey response rate was 111/391 in 2021 compared to 122/378 in 2020. Fewer physicians reported that telehealth was more difficult than in person with regards to taking a history (49% in 2020, 33% in 2021, p= 0.015), maximizing patient adherence (33% in 2020, 19% in 2021, p = 0.028), and maintaining patient relationships (31%, 25%, p = 0.009) in 2021. Similar proportions of physicians reported continued challenges with building new patient relationships (75%, 77%, p = 0.075), educating patients (40%, 32%, p = 0.393), and working collaboratively with their team (38%, 41%, p = 0.794). Physicians reported increased satisfaction with tele-visits over in-person visits (13%, 27%, p = 0.006) and less worry over doing future tele-visits (45%, 31%, p = 0.027). Physicians' open-ended responses identified recommendations for further improving the design and use of telehealth. DISCUSSION Results suggest that physician experience with telehealth improved but opportunities for training and improved integration remain. Longitudinal assessment can deepen understanding of the evolution of telehealth care.
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Affiliation(s)
- Jeffrey A Wilhite
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Zoe Phillips
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Lisa Altshuler
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Harriet Fisher
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Colleen Gillespie
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | | | | | - Kathleen Hanley
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Sondra Zabar
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA
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Lu W, Caldwell B, Gao N, Oursler J, Wang K, Beninato J, Srijeyanthan J, Kumi C, Sawyer J, Giacobbe G, Chen Y, Lin KWR, Mueser KT. Healing Trauma While Staying at Home: Using Telehealth to Conduct a Brief Treatment Program for Posttraumatic Stress Disorder. J Psychosoc Nurs Ment Health Serv 2024; 62:36-46. [PMID: 38095851 DOI: 10.3928/02793695-20231205-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Studies suggest that a three-session brief treatment program (Brief Relaxation, Education, and Trauma Healing [BREATHE]) can help treat posttraumatic stress disorder (PTSD) and symptoms of trauma; however, the program has not been examined via telehealth. Thus, the current study evaluated the feasibility of BREATHE delivered via telehealth. The intervention included breathing retraining and psychoeducation about PTSD and trauma. Thirty participants from the community with confirmed PTSD diagnoses participated in this telehealth program. Treatment retention was high, and participants showed decreased PTSD symptoms, posttraumatic cognitions, depression, anxiety, overall psychiatric symptoms, and internalized stigma and increased resiliency at posttreatment and 3-month follow up. Results suggest that a telehealth brief treatment program for PTSD is feasible and effective for individuals with PTSD. [Journal of Psychosocial Nursing and Mental Health Services, 62(7), 36-46.].
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Narcisse MR, Andersen JA, Felix HC, Hayes CJ, Eswaran H, McElfish PA. Factors associated with telehealth use among adults in the United States: Findings from the 2020 National Health Interview Survey. J Telemed Telecare 2024; 30:993-1004. [PMID: 35892167 DOI: 10.1177/1357633x221113192] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION During the COVID-19 pandemic, health care shifted to virtual interactions with health professionals. The aim of this study was to examine the determinants of telehealth use in a nationally representative sample of the United States adult population. METHODS The study used data from the 2020 National Health Interview Survey of 17,582 respondents aged ≥18. Andersen's model of health services utilization was employed to examine predisposing, enabling, and needs factors associated with past-year telehealth use. Multivariable logistic regression was conducted to examine statistical associations. RESULTS 32.5% of adults (n = 6402; mean age 51.6, SE = 0.4) reported telehealth use. Predisposing factors: Women and married/partnered adults and those with higher levels of education had greater odds of using telehealth. Adults living in Midwest and South and adults living in medium-small and non-metropolitan areas had decreased odds of using telehealth. Enabling factors: Income and having a usual source of care were positively associated with telehealth use. A negative association was found for those with no insurance and telehealth use, whereas a positive association was found for military insurance. Needs factors: Odds of using telehealth were increased for adults who had well-visits and ER visits in the past 12 months. Mental health services quadrupled the odds of telehealth use. Odds of using telehealth increased with each additional chronic disease, including COVID-19. CONCLUSION There are disparities in telehealth use according to sex, education, rurality, access to care, and health needs. Tackling these disparities is pivotal to ensure barriers to telehealth use are not exacerbated post-pandemic.
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Affiliation(s)
- Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Corey J Hayes
- College of Medicine, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hari Eswaran
- Institute of Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
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Ware OD, Cano MT, Dalal Safa M, Garza N, Martinez S, Salloum I. Availability of substance use disorder treatment in Spanish: Associations with state-level proportions of Spanish speakers and treatment facility characteristics in the United States. Am J Addict 2024; 33:400-408. [PMID: 38264804 DOI: 10.1111/ajad.13520] [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: 07/28/2023] [Revised: 12/07/2023] [Accepted: 01/01/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Spanish is the second most spoken language in the United States. Not all substance use disorder (SUD) treatment facilities provide treatment in Spanish. This study examined factors associated with SUD treatment facilities having counselors that provide treatment in Spanish. METHODS State-level estimates of Spanish-speaking individuals were derived from the American Community Survey 2019. SUD treatment facility characteristics were captured from the National Survey of Substance Abuse Treatment Services 2020. We examined a sample of 15,246 facilities which included 12,798 outpatient, 3554 nonhospital residential, and 1106 with both outpatient and residential programs. Binary logistic regression models were used to observe state-level proportions of Spanish speakers and facility-level characteristics as factors associated with a facility having counselors that provide treatment in Spanish. RESULTS Approximately 23.3% of facilities had counselors able to provide treatment in Spanish. Among outpatient or nonhospital residential SUD facilities, those in a state with a larger proportion of Spanish-speaking individuals, facilities with pay assistance, facilities that accept Medicaid, and facilities that engage in community outreach had higher odds of having counselors that provide treatment in Spanish. CONCLUSIONS Considering that less than a quarter of facilities provide treatment in Spanish, increasing the availability of linguistically appropriate and culturally responsive services for SUD is imperative. SCIENTIFIC SIGNIFICANCE This national study is the first of its kind to examine associations between estimates of Spanish speakers and treatment facility characteristics associated with counselors that provide treatment in Spanish in outpatient and nonhospital residential SUD treatment.
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Affiliation(s)
- Orrin D Ware
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Monique T Cano
- Department of Psychological Science, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - M Dalal Safa
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Noe Garza
- Institute of Neuroscience, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Suky Martinez
- Division on Substance Use Disorders, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York, USA
| | - Ihsan Salloum
- Institute of Neuroscience, University of Texas Rio Grande Valley, Edinburg, Texas, USA
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Guillari A, Sansone V, Giordano V, Catone M, Rea T. Assessing digital health knowledge, attitudes and practices among nurses in Naples: a survey study protocol. BMJ Open 2024; 14:e081721. [PMID: 38925700 PMCID: PMC11208876 DOI: 10.1136/bmjopen-2023-081721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Digital competencies are essential for nurses to actively participate in the digitisation of healthcare systems. Therefore, it is important to assess their skill levels to identify strengths and areas for improvement. METHOD AND ANALYSIS This study aims to investigate nurses' knowledge, attitudes, behaviours, subjective norms and behavioural control regarding digital health. A knowledge-attitude-practice model guided the development of a structured questionnaire divided into six sections. A sample of 480 registered nurses of Naples will be involved in the study. After conducting a pretest, an invitation will be publicised through the institutional communication channels of Nurses Provincial Order of Naples. Nurses will respond via a unique link or quick response code sent through a PEC email system (a legally valid email system, which guarantees delivery and receipt). They will have 30 days to complete the survey, scheduled between May and July 2024. ETHICS AND DISSEMINATION No ethics committee approval was required, as the study does not involve minors, direct or indirect physical or physiological harm to participants, or clinical trials. Anonymity will be guaranteed at all data collection and processing levels. The results will be broadly distributed through conference presentations and peer-reviewed publications. The effective use of digital technologies by healthcare professionals can bring significant improvements to healthcare services and help improve the health of individuals and community health. The study's findings will serve as a foundation for developing and implementing educational programmes related to eHealth and telemedicine, promoting the harmonisation of such programmes.
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Affiliation(s)
- Assunta Guillari
- Public Health Department, Federico II University Hospital, Napoli, Campania, Italy
| | - Vincenza Sansone
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli School of Medicine and Surgery, Napoli, Campania, Italy
| | - Vincenza Giordano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
| | - Maria Catone
- Public Health Department, Federico II University Hospital, Napoli, Campania, Italy
| | - Teresa Rea
- Public Health Department, Federico II University Hospital, Napoli, Campania, Italy
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Oliveira CRA, Pires MC, Meira KC, de Jesus JC, Borges IN, Paixão MC, Mendes MS, Ribeiro LB, Marcolino MS, Alkmim MBM, Ribeiro ALP. Effect of a Structured Multilevel Telehealth Service on Hospital Admissions and Mortality During COVID-19 in a Resource-Limited Region in Brazil: Retrospective Cohort Study. J Med Internet Res 2024; 26:e48464. [PMID: 38857068 PMCID: PMC11196913 DOI: 10.2196/48464] [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: 04/25/2023] [Revised: 10/02/2023] [Accepted: 04/23/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic represented a great stimulus for the adoption of telehealth and many initiatives in this field have emerged worldwide. However, despite this massive growth, data addressing the effectiveness of telehealth with respect to clinical outcomes remain scarce. OBJECTIVE The aim of this study was to evaluate the impact of the adoption of a structured multilevel telehealth service on hospital admissions during the acute illness course and the mortality of adult patients with flu syndrome in the context of the COVID-19 pandemic. METHODS A retrospective cohort study was performed in two Brazilian cities where a public COVID-19 telehealth service (TeleCOVID-MG) was deployed. TeleCOVID-MG was a structured multilevel telehealth service, including (1) first response and risk stratification through a chatbot software or phone call center, (2) teleconsultations with nurses and medical doctors, and (3) a telemonitoring system. For this analysis, we included data of adult patients registered in the Flu Syndrome notification databases who were diagnosed with flu syndrome between June 1, 2020, and May 31, 2021. The exposed group comprised patients with flu syndrome who used TeleCOVID-MG at least once during the illness course and the control group comprised patients who did not use this telehealth service during the respiratory illness course. Sociodemographic characteristics, comorbidities, and clinical outcomes data were extracted from the Brazilian official databases for flu syndrome, Severe Acute Respiratory Syndrome (due to any respiratory virus), and mortality. Models for the clinical outcomes were estimated by logistic regression. RESULTS The final study population comprised 82,182 adult patients with a valid registry in the Flu Syndrome notification system. When compared to patients who did not use the service (n=67,689, 82.4%), patients supported by TeleCOVID-MG (n=14,493, 17.6%) had a lower chance of hospitalization during the acute respiratory illness course, even after adjusting for sociodemographic characteristics and underlying medical conditions (odds ratio [OR] 0.82, 95% CI 0.71-0.94; P=.005). No difference in mortality was observed between groups (OR 0.99, 95% CI 0.86-1.12; P=.83). CONCLUSIONS A telehealth service applied on a large scale in a limited-resource region to tackle COVID-19 was related to reduced hospitalizations without increasing the mortality rate. Quality health care using inexpensive and readily available telehealth and digital health tools may be delivered in areas with limited resources and should be considered as a potential and valuable health care strategy. The success of a telehealth initiative relies on a partnership between the involved stakeholders to define the roles and responsibilities; set an alignment between the different modalities and levels of health care; and address the usual drawbacks related to the implementation process, such as infrastructure and accessibility issues.
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Affiliation(s)
- Clara Rodrigues Alves Oliveira
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Magda Carvalho Pires
- Department of Statistics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Isabela Nascimento Borges
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Cristina Paixão
- Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mayara Santos Mendes
- Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Leonardo Bonisson Ribeiro
- Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Milena Soriano Marcolino
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Institute for Health Technology Assessment, Porto Alegre, Brazil
| | - Maria Beatriz Moreira Alkmim
- Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antonio Luiz Pinho Ribeiro
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Institute for Health Technology Assessment, Porto Alegre, Brazil
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15
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Li H, Naqvi IA, Strobino K, Malhotra S. Clinical Telepharmacy: Addressing Care Gaps in Diabetes Management for an Underserved Urban Population Using a Collaborative Care Model. Telemed J E Health 2024; 30:e1923-e1926. [PMID: 38621151 DOI: 10.1089/tmj.2023.0589] [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: 04/17/2024] Open
Abstract
Introduction: Optimal chronic care management is limited by low health care access and health literacy among underserved populations. We introduced clinical pharmacy services to enhance our patient-centered home model, which serves mostly Medicare/Medicaid-insured patients. Primary care providers (PCP) refer patients with uncontrolled diabetes to the pharmacist for chronic disease management between PCP appointments to bring A1c to goal under a collaborative agreement. This workflow existed before the COVID-19 pandemic and was primarily in-person visits. Our model transitioned to telehealth, where pharmacy services continued via audio/video visits to avoid disruption in care. Methods: A collaborative scope of practice within care guidelines was developed with PCPs. Established patients with uncontrolled diabetes were referred to the clinical pharmacist. The workflow remained consistent through January 1, 2019 to January 31, 2020 (pre-COVID), and April 1, 2020 to October 31, 2021 (post-COVID). February and March 2020 were excluded due to changing operational processes at the pandemic onset. The pharmacist independently saw patients for medication-related interventions and ordered associated labs within the scope of practice. The program was retrospectively evaluated via process metrics (visit volume and intervention types) and clinical outcome (A1c reduction). Results: A total of 105 patients were referred for diabetes management during the study period. These were in-person pre-COVID (95%) and shifted to entirely audio/video (100%) post-COVID. Impact of pharmacy services was sustained through the change in care model: an A1c reduction of more than 0.5% was observed in 65% (n = 20) and 69% (n = 49) of patients managed by the pharmacist, pre- and post-COVID, respectively. Pharmacy visit volumes were 86 versus 308, respectively. Conclusion: Pharmacy referral and visit volumes increased over the pandemic, made possible via telehealth. The goal attainment rate observed pre-COVID was amplified even with the growth in services over time. Clinical pharmacy services delivered through audio/video telehealth visits may be equally effective compared to face-to-face services.
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Affiliation(s)
- Hanlin Li
- Department of Pharmacy, New York-Presbyterian Hospital, New York, New York, USA
| | - Imama A Naqvi
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Kevin Strobino
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Sujata Malhotra
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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Kirby RL, Smith C, Osmond D, Moore SA, Theriault CJ, Sandila N. A Remote-Learning Course can improve the subjective wheelchair-skills performance and confidence of wheelchair service providers: an observational cohort study. Disabil Rehabil Assist Technol 2024; 19:1729-1738. [PMID: 37384537 DOI: 10.1080/17483107.2023.2230259] [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: 04/06/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE To test the hypothesis that a Remote-Learning Course improves the subjective wheelchair-skills performance and confidence of wheelchair service providers, and to determine the participants' views on the Course. METHODS This was an observational cohort study, with pre-post comparisons. To meet the objectives of the six-week Course, the curriculum included self-study and weekly one-hour remote meetings. Participants submitted their Wheelchair Skills Test Questionnaire (WST-Q) (Version 5.3.1) "performance" and "confidence" scores before and after the Course. Participants also completed a Course Evaluation Form after the Course. RESULTS The 121 participants were almost all from the rehabilitation professions, with a median of 6 years of experience. The mean (SD) WST-Q performance scores rose from 53.4% (17.8) pre-Course to 69.2% (13.8) post-Course, a 29.6% relative improvement (p < 0.0001). The mean (SD) WST-Q confidence scores rose from 53.5% (17.9) to 69.5% (14.3), a 29.9% relative improvement (p < 0.0001). Correlations between performance and confidence were highly significant (p < 0.0001). The Course Evaluation indicated that most participants found the Course useful, relevant, understandable, enjoyable, "just right" in duration, and most stated that they would recommend the Course to others. CONCLUSIONS Although there is room for improvement, a Remote-Learning Course improves the subjective wheelchair-skills performance and confidence scores of wheelchair service providers by almost 30%, and participants were generally positive about the Course.
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Affiliation(s)
- R Lee Kirby
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Cher Smith
- Department of Occupational Therapy, Nova Scotia Health, Halifax, NS, Canada
| | - Dee Osmond
- Department of Occupational Therapy, Nova Scotia Health, Halifax, NS, Canada
| | - Sarah A Moore
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Navjot Sandila
- Research Methods Unit, Nova Scotia Health, Halifax, NS, Canada
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Fukuzawa F, Yanagita Y, Yokokawa D, Uchida S, Yamashita S, Li Y, Shikino K, Tsukamoto T, Noda K, Uehara T, Ikusaka M. Importance of Patient History in Artificial Intelligence-Assisted Medical Diagnosis: Comparison Study. JMIR MEDICAL EDUCATION 2024; 10:e52674. [PMID: 38602313 PMCID: PMC11024399 DOI: 10.2196/52674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/31/2024] [Accepted: 02/15/2024] [Indexed: 04/12/2024]
Abstract
Background Medical history contributes approximately 80% to a diagnosis, although physical examinations and laboratory investigations increase a physician's confidence in the medical diagnosis. The concept of artificial intelligence (AI) was first proposed more than 70 years ago. Recently, its role in various fields of medicine has grown remarkably. However, no studies have evaluated the importance of patient history in AI-assisted medical diagnosis. Objective This study explored the contribution of patient history to AI-assisted medical diagnoses and assessed the accuracy of ChatGPT in reaching a clinical diagnosis based on the medical history provided. Methods Using clinical vignettes of 30 cases identified in The BMJ, we evaluated the accuracy of diagnoses generated by ChatGPT. We compared the diagnoses made by ChatGPT based solely on medical history with the correct diagnoses. We also compared the diagnoses made by ChatGPT after incorporating additional physical examination findings and laboratory data alongside history with the correct diagnoses. Results ChatGPT accurately diagnosed 76.6% (23/30) of the cases with only the medical history, consistent with previous research targeting physicians. We also found that this rate was 93.3% (28/30) when additional information was included. Conclusions Although adding additional information improves diagnostic accuracy, patient history remains a significant factor in AI-assisted medical diagnosis. Thus, when using AI in medical diagnosis, it is crucial to include pertinent and correct patient histories for an accurate diagnosis. Our findings emphasize the continued significance of patient history in clinical diagnoses in this age and highlight the need for its integration into AI-assisted medical diagnosis systems.
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Affiliation(s)
- Fumitoshi Fukuzawa
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
| | - Yasutaka Yanagita
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
| | - Daiki Yokokawa
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
| | - Shun Uchida
- Uchida Internal Medicine Clinic, Saitama-shi, Japan
| | - Shiho Yamashita
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
| | - Yu Li
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
| | - Tomoko Tsukamoto
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
| | - Kazutaka Noda
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
| | - Takanori Uehara
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Chiba-shi, Japan
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Murphy DR, Kadiyala H, Wei L, Singh H. An electronic trigger to detect telemedicine-related diagnostic errors. J Telemed Telecare 2024:1357633X241236570. [PMID: 38557263 DOI: 10.1177/1357633x241236570] [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: 04/04/2024]
Abstract
INTRODUCTION The COVID-19 pandemic advanced the use of telehealth-facilitated care. However, little is known about how to measure safety of clinical diagnosis made through telehealth-facilitated primary care. METHODS We used the seven-step Safer Dx Trigger Tool framework to develop an electronic trigger (e-trigger) tool to identify potential missed opportunities for more timely diagnosis during primary care telehealth visits at a large Department of Veterans Affairs facility. We then applied the e-trigger algorithm to electronic health record data related to primary care visits during a 1-year period (1 April 2020-31 March 2021). The algorithm identified patients with unexpected visits within 10 days of an index telemedicine visit and classified such records as e-trigger positive. We then validated the e-trigger's ability to detect missed opportunities in diagnosis using chart reviews based on a structured data collection instrument (the Revised Safer Dx instrument). RESULTS We identified 128,761 telehealth visits (32,459 unique patients), of which 434 visits led to subsequent unplanned emergency department (ED), hospital, or primary care visits within 10 days of the index visit. Of these, 116 were excluded for clinical reasons (trauma, injury, or childbirth), leaving 318 visits (240 unique patients) needing further evaluation. From these, 100 records were randomly selected for review, of which four were falsely flagged due to invalid data (visits by non-providers or those incorrectly flagged as completed telehealth visits). Eleven patients had a missed opportunity in diagnosis, yielding a positive predictive value of 11%. DISCUSSION Electronic triggers that identify missed opportunities for additional evaluation could help advance the understanding of safety of clinical diagnosis made in telehealth-enabled care. Better measurement can help determine which patients can safely be cared for via telemedicine versus traditional in-person visits.
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Affiliation(s)
- Daniel R Murphy
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Baylor College of Medicine, Department of Medicine, Houston, TX, USA
| | - Himabindu Kadiyala
- Baylor College of Medicine, Department of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Li Wei
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Baylor College of Medicine, Department of Medicine, Houston, TX, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Baylor College of Medicine, Department of Medicine, Houston, TX, USA
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De La Torre A, Diaz P, Perdomo R. Analysis of the virtual healthcare model in Latin America: a systematic review of current challenges and barriers. Mhealth 2024; 10:20. [PMID: 38689618 PMCID: PMC11058594 DOI: 10.21037/mhealth-23-47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/03/2023] [Indexed: 05/02/2024] Open
Abstract
Background The virtual care model can be used in all aspects of healthcare, such as prevention, diagnosis, treatment, and follow-up of most medical and surgical conditions. The objective of this study was to identify the current barriers to implementing and consolidating the virtual healthcare model, of "telemedicine", in Latin American countries. Methods A systematic review was conducted through four databases: PubMed, Scopus, Web of Science, and Virtual Health, including articles in Spanish, Portuguese, and English. A combination of Boolean operators was used with the terms "telemedicine", "telehealth", "telecare", "home care services", "remote care" and the name of each Latin American country. Articles published from January 2020 to January 2023 that reported on the barriers and challenges of using the virtual care model were included. Results Nineteen articles were included. Brazil (n=5) and Argentina (n=4) were the countries where there was the greatest interest to explore barriers to virtual care. The barriers identified were categorized into five main themes: (I) technological and technical issues; (II) absence of a physical examination; (III) patient's negative perceptions; (IV) negative perceptions among healthcare professionals; and (V) structural obstacles and those associated with the healthcare system. The main obstacles reported were connectivity problems, lack of a complete physical examination, issues of privacy, high risk of medical malpractice, and absence of local regulation. Conclusions The virtual care model is a safe and cost-effective alternative for the delivery of health services, with multiple benefits for patients and their families. The indication for the use of virtual care should be based on a risk model for patient prioritization. Likewise, the analysis of the main barriers and benefits is fundamental to consolidating this model of care and ensuring its expansion in the region.
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Yeboah I, Dwomoh D, Ndejjo R, Kabwama SN, Ohemeng F, Takyi SA, Issah I, Bawuah SA, Wanyenze RK, Fobil J. Maintaining essential health services during COVID-19 in Ghana: a qualitative study. BMJ Glob Health 2024; 8:e013284. [PMID: 38490688 PMCID: PMC11148662 DOI: 10.1136/bmjgh-2023-013284] [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: 06/30/2023] [Accepted: 02/11/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Evidence suggests that non-pharmaceutical interventions such as lockdown policies, restriction of movement and physical distancing to control the novel COVID-19 contributed to the decline in utilisation of essential health services. We explored healthcare providers' and policy-makers' experiences of the barriers, interventions and response actions that contributed to ensuring the continuity of essential health services during the COVID-19 pandemic in Ghana to help inform future practice and policy. METHODS We used a qualitative study approach. Data were analysed using thematic analysis. Thirty Four participants composed of 20 healthcare providers and 14 policy-makers who worked across regions with low and high recorded COVID-19 cases in Ghana during the COVID-19 pandemic were involved in this study. RESULTS Participants reported that essential health services including maternal, reproductive and child health services, communicable and non-communicable disease care, and elective surgeries were disrupted during the COVID-19 pandemic. Barriers to the utilisation of essential services were constructed into three subthemes: (1) fear, (2) poor quality of care at the facility and (3) financial limitation. These barriers were mitigated with population-based interventions underpinned by the socioecological model at the individual and interpersonal level (including psychosocial care for families and home visits), institutional and community levels (such as allocation of funds, training of health workers, public education, triage stations, provision of logistics, appointment scheduling, telemedicine and redeployment of health workers) and public policy level (tax relief packages, transportation arrangements and provision of incentives), which helped in maintaining essential health services during COVID-19. CONCLUSION Disruption of essential health services during COVID-19 in Ghana instigated population-based interventions which aided in expanding the populations' continuous access to essential health services and strengthened health service delivery.
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Affiliation(s)
- Isaac Yeboah
- Employment and Society, University of Professional Studies, Legon, Ghana
| | - Duah Dwomoh
- Department of Biostatistics, University of Ghana, Legon, Ghana
| | - Rawlance Ndejjo
- Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Sylvia Akpene Takyi
- Department of Biological, Environmental, and Occupational Health, University of Ghana, Legon, Ghana
| | - Ibrahim Issah
- Department of Biological, Environmental, and Occupational Health, University of Ghana, Legon, Ghana
| | - Serwaa Akoto Bawuah
- Department of Biological, Environmental, and Occupational Health, University of Ghana, Legon, Ghana
| | | | - Julius Fobil
- Department of Biological, Environmental, and Occupational Health, University of Ghana, Legon, Ghana
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Amura CR, Thorne J, Bean M, Avery LK, Sylla LN, Liss HK, Cook PF. Evolution of HIV Health Care Workforce Needs in the U.S. Mountain West During the COVID-19 Pandemic: A Mixed Method Study. J Assoc Nurses AIDS Care 2024; 35:78-90. [PMID: 38949905 PMCID: PMC11217585 DOI: 10.1097/jnc.0000000000000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
ABSTRACT The COVID-19 pandemic drastically affected health care delivery for vulnerable populations. Many facilities shifted services to telemedicine, and people with HIV or at risk of acquiring HIV experienced interruptions in care. Simultaneously, traditional training approaches to help providers adapt were disrupted. Using a mixed method approach to examine changes over time, we integrated data on trainee needs collected by the Mountain West AIDS Education and Training Center (AETC): a 10-state needs assessment survey in 2020; feedback from a 2020 community of practice; aggregate training data from 2000 to 2022; and a second survey in 2022. HIV care providers' training needs evolved from wanting support on telemedicine and COVID-19 patient care issues, to a later focus on mental health and substance use, social determinants of health, and care coordination. This integrative analysis demonstrates the vital role that AETCs can play in addressing evolving and emergent public health challenges for the HIV workforce.
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Affiliation(s)
- Claudia R Amura
- Claudia R. Amura, PhD, MPH, is an Assistant Professor of Research, University of Colorado College of Nursing, and is a Director of the Latino Health Certificate, Latino Research of Policy Center, Colorado School of Public University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. Julia Thorne, is an MPH Graduate, Colorado School of Public Health, Aurora, Colorado, USA. Meagan Bean, is a Latino Health Certificate and MPH Candidate, Colorado School of Public Health, Aurora, Colorado, USA. Lisa Krug Avery, MSW, is a Professional Research Assistant, Department of Behavioral, Family and Population Health, College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. Laurie N. Sylla, MHSA, is the Director, Mountain West AIDS Training Education Center, Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, Washington, USA. Hillary K. Liss, MD, is a Clinical Associate Professor, Division of General Internal Medicine, University of Washington, Seattle, Washington, USA. Paul F. Cook, PhD, is a Professor and Chair, Department of Behavioral, Family and Population Health, College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Donnelly MR, Barie PS, Schubl SD. Impact of the Coronavirus Disease 2019 Pandemic on Utilization of Emergency Medical Services in New York City. Surg Infect (Larchmt) 2024; 25:95-100. [PMID: 38294840 DOI: 10.1089/sur.2023.357] [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: 02/01/2024] Open
Abstract
Background: This study evaluates trends in the utilization of emergency medical services (EMS) in New York City, the "epicenter" of the first "wave" of the coronavirus pandemic. We hypothesize that EMS call volumes decreased overall in New York City during the first year of the pandemic, specifically with respect to trauma/injury calls. Contrarily, we posit that calls for "sick" events increased given pervasive fear of virus transmission. Materials and Methods: Retrospective New York City EMS calls data (January 1, 2019 to December 31, 2020) were obtained from the NYC Open Data/EMS Incident Dispatch database. Total EMS calls, trauma/injury calls, and "sick" event calls were collected for New York City and for all five boroughs. Census data for each borough were used to weigh daily EMS calls per 100,000 individuals. Mann-Whitney U tests were used to compare pre-pandemic (2019 to March 2020) versus pandemic (April 2020 to December 2020) EMS call volumes, p = 0.05. Results: Median daily EMS calls per 100,000 individuals decreased 21.6% at the start of the pandemic across New York City (pre-pandemic, 3,262 calls; pandemic, 2,556 calls; p < 0.001) and similarly decreased when stratified by borough (all, p < 0.001). Median daily trauma/injury and sick event calls per 100,000 also decreased in New York City and the five boroughs from pre-pandemic to pandemic time periods (all, p < 0.001). Discussion and Conclusions: These data reflect an unprecedented window into EMS utilization during an infectious disease pandemic. As decreased EMS utilization for multiple conditions likely reflects delayed or impeded access to care, utilization data have important implications for provision of acute care services during possible future disruptions related to the pandemic.
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Affiliation(s)
- Megan R Donnelly
- Department of Surgery, UC Irvine Health, Orange, California, USA
| | - Philip S Barie
- Department of Surgery, Weill Cornell Medicine, New York, New York, USA
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Cunha AS, Pedro AR, V Cordeiro J. Challenges of Using Telemedicine in Hospital Specialty Consultations during the COVID-19 Pandemic in Portugal According to a Panel of Experts. ACTA MEDICA PORT 2024; 37:198-206. [PMID: 38430471 DOI: 10.20344/amp.19931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/12/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION The COVID-19 pandemic has accelerated the adoption of telemedicine as a means of reducing face-to-face contact and protecting professionals and patients. In Portugal, the number of hospital telemedicine consultations has significantly increased. However, the rapid implementation of telemedicine has also led to disparities in access to these services, resulting in inequalities in healthcare delivery. The aim of this study was to identify the main challenges to accessing hospital medical specialty consultations through telemedicine in Portugal during the COVID-19 pandemic. Additionally, this study aimed to establish a consensus on possible solutions for the challenges which were identified. METHODS This study used the nominal group technique, which involved a panel of 10 experts. The panel generated a total of 71 ideas, which were then categorized into three groups: A) challenges relating to patients, which impact access to hospital-based medical specialty consultations through telemedicine; B) challenges relating to professionals, institutions and health systems, which impact access to hospital medical specialty consultations through telemedicine; C) recommendations to overcome the challenges faced in adopting telemedicine solutions. Each of the ideas was assessed, scored and ranked based on its relevance considering the study objectives. RESULTS This study identified several significant challenges that impacted the adoption of telemedicine in Portugal during the COVID-19 pandemic. The challenges that related to patients (A) that were deemed the most relevant were low digital literacy, lack of information about telemedicine processes, low familiarity with technologies and distrust about the quality of services; the challenges that impacted healthcare professionals, institutions, and health systems (B) and were deemed the most relevant were the lack of integration of telemedicine in the patient's journey, low motivation to adopt telemedicine solutions, poor interoperability between systems, and the absence of the necessary technological equipment. The most relevant recommendations (C) included investing in healthcare institutions, developing clear guidelines for the safety and quality of telemedicine practices, and incorporating telemedicine into the curricula of health professions. CONCLUSION This study identified several challenges that impacted the adoption and implementation of telemedicine services for hospital care in Portugal during the pandemic period. These challenges were related to digital health literacy, technological and operational conditions, and reluctance in technological adoption. To overcome these challenges, training programs for healthcare professionals and patients may be necessary, along with investment in technological infrastructures, interoperability between systems, effective communication strategies and the strengthening of specific regulations.
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Affiliation(s)
- Ana Soraia Cunha
- Public Health Research Centre. NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon. Portugal
| | - Ana Rita Pedro
- Public Health Research Centre. NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon; Public Health Research Centre. Comprehensive Health Research Center (CHRC). NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon. Portugal
| | - João V Cordeiro
- Public Health Research Centre. NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon; Public Health Research Centre. Comprehensive Health Research Center (CHRC). NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisbon; Interdisciplinary Center of Social Sciences. Universidade NOVA de Lisboa. Lisbon. Portugal
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Naamanka E, Salakka I, Parkkila M, Hotti J, Poutiainen E. Effectiveness of teleneuropsychological rehabilitation: Systematic review of randomized controlled trials. J Int Neuropsychol Soc 2024; 30:295-312. [PMID: 37746802 DOI: 10.1017/s1355617723000565] [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] [Indexed: 09/26/2023]
Abstract
OBJECTIVE The effectiveness of neuropsychological rehabilitation is supported by the evidence found in previous reviews, but there is a lack of research regarding the effectiveness of remotely conducted neuropsychological rehabilitation. This review aimed to identify and evaluate the results of studies investigating the effectiveness of teleneuropsychological rehabilitation. METHODS Relevant articles were extracted from electronic databases and filtered to include studies published in 2016 or later to focus on recent practices. Data were synthesized narratively. RESULTS A total of 14 randomized controlled studies were included in the synthesis (9 for children/adolescents, 5 for adults). The most common type of intervention was computerized cognitive training with regular remote contact with the therapist (seven studies). Regarding children and adolescents, the evidence for the effectiveness was found only for these types of interventions with improvements in cognitive outcomes. The results regarding the family-centered interventions were mixed with improvements only found in psychosocial outcomes. No support was found for the effectiveness of interventions combining cognitive and motor training. Regarding adults, all included studies offered support for the effectiveness, at least to some extent. There were improvements particularly in trained cognitive functions. Long-term effects of the interventions with generalization to global functioning remained somewhat unclear. CONCLUSION Remote interventions focused on computerized cognitive training are promising methods within teleneuropsychological rehabilitation. However, their impact on long-term meaningful, everyday functioning remained unclear. More research is needed to reliably assess the effectiveness of teleneuropsychological interventions, especially with more comprehensive approaches.
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Affiliation(s)
| | - Ilja Salakka
- Rehabilitation Foundation, Helsinki, Finland
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Joona Hotti
- Rehabilitation Foundation, Helsinki, Finland
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Onseng P, Jiraporncharoen W, Moonkayaow S, Veerasirikul P, Wiwatkunupakarn N, Angkurawaranon C, Pinyopornpanish K. Expectation, Attitude, and Barriers to Receiving Telehomecare Among Caregivers of Homebound or Bedridden Older Adults: Qualitative Study. JMIR Aging 2024; 7:e48132. [PMID: 38324373 PMCID: PMC10882467 DOI: 10.2196/48132] [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: 04/13/2023] [Revised: 09/26/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND In recent years, telehomecare has become an increasingly important option for health care providers to deliver continuous care to their patients. OBJECTIVE This study aims to explore the expectations, attitudes, and barriers to telehomecare among caregivers of homebound or bedridden older adults. METHODS This qualitative study used semistructured interviews to explore caregivers' perspectives on telehomecare for homebound or bedridden older adults. The study adhered to the SRQR (Standards for Reporting Qualitative Research) guidelines. Participants were selected using convenience sampling from caregivers of homebound or bedridden older adults with experience in both in-person home visits and telehomecare services provided by the Department of Family Medicine at Chiang Mai University, in an urban area of Chiang Mai Province in Northern Thailand. Semistructured interviews were conducted. The interviews were audio recorded with participant consent and transcribed verbatim. The framework method was used, involving multiple readings of transcripts to facilitate familiarization and accuracy checking. The study used the technology acceptance model and comprehensive geriatric assessment as the analytical framework. RESULTS The study included 20 caregivers of older adult patients. The patients were predominantly female (15/20, 75%), with an average age of 86.2 years. Of these patients, 40% (n=8) of patients were bedridden, and 60% (n=12) of patients were homebound. Caregivers expressed generally positive attitudes toward telehomecare. They considered it valuable for overall health assessment, despite recognizing certain limitations, particularly in physical assessments. Psychological assessments were perceived as equally effective. While in-person visits offered more extensive environmental assessments, caregivers found ways to make telehomecare effective. Telehomecare facilitated multidisciplinary care, enabling communication with specialists. Caregivers play a key role in care planning and adherence. Challenges included communication issues due to low volume, patient inattention, and faulty devices and internet signals. Some caregivers helped overcome these barriers. The loss of information was mitigated by modifying signaling equipment. Technology use was a challenge for some older adult caregivers. Despite these challenges, telehomecare offered advantages in remote communication and resolving scheduling conflicts. Caregivers varied in their preferences. Some preferred in-person visits for a broader view, while others favored telehomecare for its convenience. Some had no strong preference, appreciating both methods, while others considered the situation and patient conditions when choosing between them. Increased experience with telehomecare led to more confidence in its use. CONCLUSIONS Caregivers have positive attitudes and high expectations for telehomecare services. Although there may be barriers to receiving care through this mode, caregivers have demonstrated the ability to overcome these challenges, which has strengthened their confidence in telehomecare. However, it is important to enhance the skills of caregivers and health care teams to overcome barriers and optimize the use of telehomecare.
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Affiliation(s)
- Pansiree Onseng
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Nutchar Wiwatkunupakarn
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
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Punzalan JK, Guingona M, Gregorio E, Ferraren J, Sta Elena MA, Valaquio M, Arnuco FD, Punzalan MG, Arciaga R, Woolley T, Kunting A, Miravite DA, Cristobal F. Telehealth program for symptomatic COVID-19 patients in Mindanao, Philippines: a whole-of-system, pragmatic interventional study on patient monitoring from isolation facilities to community reintegration. Int J Equity Health 2024; 23:20. [PMID: 38310299 PMCID: PMC10838445 DOI: 10.1186/s12939-024-02115-5] [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: 09/04/2023] [Accepted: 01/19/2024] [Indexed: 02/05/2024] Open
Abstract
The COVID-19 pandemic is impacting individuals and society's physical and mental health. Despite the lack of any definite and effective therapeutic regimen, public health measures such as quarantine and isolation have been instituted to contain this pandemic. However, these mitigating measures have also raised issues regarding isolated patients' mental and psychological well-being. Several stakeholders were engaged in this approach, including the university, the local health office, the tertiary hospital, and the local communities. This intervention addresses concerns regarding the health status of isolated individuals due to COVID-19 infection, making the program available to anyone who agrees to participate. This was done through telehealth services delivered via phone calls and SMS. The university provided technical support and telehealth manpower through medical students. The local health unit manages the isolation facilities, while the referral hospital offers specialty care for isolated patients through teleconsultation. Finally, the local community is the one that reintegrates discharged patients into their communities. Three hundred forty-four (344) participants were provided seven sessions on telehealth education and tracking of their COVID-19 prescribed practices and mental health. The mean age of the patients was 37 years; half were females, and 15% had comorbidities. Regarding their mental health status, the level of depression dropped from 6% to 1% (p<0.0001), the level of anxiety dropped from 12% to 2% (p<0.0001), and the level of stress dropped from 3% to 0% (p<0.0001) from the first day of admission to 2 weeks after discharge. Moreover, a general trend of statistically significant increase in various practices was noted: wearing face masks, physical distancing, disinfecting frequently held objects, hand hygiene, and self-monitoring for COVID-19 symptoms. Those with progressing symptoms of COVID-19 were referred immediately to the referral hospital. There were also no reports of complications of co-morbidities during their stay in the isolation facilities or social isolation upon community reintegration. The study concludes that telehealth services have the potential to address many challenges in providing continuous healthcare services to isolated patients until they are reintegrated into their community. Furthermore, a whole-of-society approach is necessary to provide holistic care to patients affected by the pandemic.
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Affiliation(s)
- Jaime Kristoffer Punzalan
- Ateneo de Zamboanga University, Zamboanga City, Philippines.
- Zamboanga City Medical Center, Zamboanga City, Philippines.
| | | | - Elgie Gregorio
- Zamboanga City Medical Center, Zamboanga City, Philippines
| | | | | | | | | | - Mary Germeyn Punzalan
- Ateneo de Zamboanga University, Zamboanga City, Philippines
- Zamboanga City Medical Center, Zamboanga City, Philippines
| | | | | | - Afdal Kunting
- Zamboanga City Medical Center, Zamboanga City, Philippines
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Fatani M, Shamayleh A, Alshraideh H. Assessing the Disruption Impact on Healthcare Delivery. J Prim Care Community Health 2024; 15:21501319241260351. [PMID: 38907592 PMCID: PMC11193933 DOI: 10.1177/21501319241260351] [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: 03/23/2023] [Revised: 05/04/2024] [Accepted: 05/21/2024] [Indexed: 06/24/2024] Open
Abstract
Health emergency outbreaks such as the COVID-19 pandemic make it challenging for healthcare systems to ration medical resources and patient care. Such disastrous events have been increasing over the past years and are becoming inevitable, necessitating the need for healthcare to be well-prepared and resilient to unpredictable rises in demand. Quantitative and qualitative based decision support systems increase the effectiveness of planning, alleviating uncertainties associated with the crisis. This study aims to understand how the COVID-19 pandemic has affected the performance of healthcare systems in different areas and to address the associated disruption. A cross-sectional online survey was conducted in the Kingdom of Saudi Arabia and the United Arab Emirates among healthcare workers who worked during the pandemic. The pandemic-related disruption and its psychometric properties were assessed using Structural Equations Modeling (SEM) with 5 latent factors: Staff Mental Health, Communication Level, Planning and Readiness, Healthcare Supply Chain, and Telehealth. Responses from highly qualified participants with many years of experience in hospital settings were collected and analyzed. Results show that the model satisfactorily fits the data with a CLI of 0.91 and TLI of 0.88. The model indicates that enhancing supply chain management, planning, telehealth usage, and communication level across the healthcare system can mitigate the disruption. However, the lack of mental health management for healthcare workers can significantly disrupt the quality of delivered care. Staff mental health and healthcare supply chain, respectively, are the highest contributors to varying degrees of disruption in healthcare delivery. This study provides a direction for more research focusing on determinants of healthcare efficiency. It also provides decision-makers insights into the main factors leading to disruptions in healthcare systems, allowing them to shape their outbreak response and better prepare for future health emergencies.
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Affiliation(s)
- Maymunah Fatani
- Biomedical Engineering Graduate Program, American University of Sharjah, Sharjah UAE
- Engineering Systems Management, American University of Sharjah, Sharjah UAE
- Department of Industrial Engineering, American University of Sharjah, Sharjah UAE
| | - Abdulrahim Shamayleh
- Biomedical Engineering Graduate Program, American University of Sharjah, Sharjah UAE
- Engineering Systems Management, American University of Sharjah, Sharjah UAE
- Department of Industrial Engineering, American University of Sharjah, Sharjah UAE
| | - Hussam Alshraideh
- Biomedical Engineering Graduate Program, American University of Sharjah, Sharjah UAE
- Engineering Systems Management, American University of Sharjah, Sharjah UAE
- Department of Industrial Engineering, American University of Sharjah, Sharjah UAE
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Theis RP, Dorbu JI, Mavrodieva ME, Guerrero RA, Wright SE, Donahoo WT, Modave F, Carrasquillo O, Shenkman EA. Telehealth Implementation Response to COVID-19 in the OneFlorida+ Clinical Research Network: Perspectives of Clinicians and Health Systems Leaders. Telemed J E Health 2024; 30:268-277. [PMID: 37358611 PMCID: PMC10794842 DOI: 10.1089/tmj.2023.0029] [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: 01/27/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 06/27/2023] Open
Abstract
Introduction: The COVID-19 pandemic forced health systems worldwide to make rapid adjustments to patient care. Nationwide stay-at-home mandates and public health concerns increased demand for telehealth to maintain patients' continuity of care. These circumstances permitted observation of telehealth implementation in real-world settings at a large scale. This study aimed to understand clinician and health system leader (HSL) experiences in expanding, implementing, and sustaining telehealth during COVID-19 in the OneFlorida+ clinical research network. Methods: We conducted semistructured videoconference interviews with 5 primary care providers, 7 specialist providers, and 12 HSLs across 7 OneFlorida+ health systems and settings. Interviews were audiorecorded, transcribed, and summarized using deductive team-based template coding. We then used matrix analysis to organize the qualitative data and identify inductive themes. Results: Rapid telehealth implementation occurred even among sites with low readiness, facilitated by responsive planning, shifts in resource allocation, and training. Common hurdles in routine telehealth use, including technical and reimbursement issues, were also barriers to telehealth implementation. Acceptability of telehealth was influenced by benefits such as the providers' ability to view a patient's home environment and the availability of tools to enhance patient education. Lower acceptability stemmed from the inability to conduct physical examinations during the shutdown. Conclusions: This study identified a broad range of barriers, facilitators, and strategies for implementing telehealth within large clinical research networks. The findings can contribute to optimizing the effectiveness of telehealth implementation in similar settings, and point toward promising directions for telehealth provider training to improve acceptability and promote sustainability.
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Affiliation(s)
- Ryan P. Theis
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Joshua I. Dorbu
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Maria E. Mavrodieva
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Richard A. Guerrero
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Stacy E. Wright
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - William T. Donahoo
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - François Modave
- Department of Anesthesiology, University of Florida, Gainesville, Florida, USA
| | - Olveen Carrasquillo
- Miller School of Medicine, Division of General Internal Medicine, University of Miami, Miami, Florida, USA
| | - Elizabeth A. Shenkman
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
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Cronin E, McCallion M, Monaghan K. "The best of a bad situation?" A mixed methods survey exploring patients' perspectives on physiotherapy-led online group exercise programmes. Ir J Med Sci 2023; 192:2595-2606. [PMID: 37154996 PMCID: PMC10165280 DOI: 10.1007/s11845-023-03386-7] [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: 12/07/2022] [Accepted: 04/20/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION The COVID-19 pandemic saw the migration of many physiotherapy-led group exercise programmes towards online platforms. This online survey aimed to ascertain the patients' views of online group exercise programmes (OGEP), including their satisfaction with various aspects of these programmes, the advantages and disadvantages and usefulness beyond the pandemic. METHODS A mixed-methods design was utilised with a cross-sectional national online survey of patients who had previously attended a physiotherapy-led OGEP in Ireland. The survey collected both qualitative and quantitative data. Descriptive statistics were used to summarise the ordinal and continuous data and conventional content analysis was used to analyse the free-text responses. RESULTS In total, 94 patients completed the surveys. Fifty percent of patients questioned would prefer in-person classes. Despite only a quarter of patient respondents preferring online classes going forward, satisfaction with the OGEPs was high with nearly 95% of respondents somewhat or extremely satisfied. Decreased travel and convenience were cited as the main benefits of OGEPs. Decreased social interaction and decreased direct observation by the physiotherapist were the main disadvantages cited. CONCLUSION Patients expressed high satisfaction rates overall with online classes, but would value more opportunities for social interaction. Although 50% of respondents would choose in-person classes in the future, offering both online and in-person classes beyond the pandemic may help to suit the needs of all patients and improve attendance and adherence.
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Affiliation(s)
- Eimear Cronin
- Atlantic Technological University, Neuroplasticity Research Group (NRG), Health & Biomedical Research Centre (HEAL), Sligo, Ash Lane, Ballytivnan, Sligo, Ireland.
- Physiotherapy Department, St. John's Hospital, Sligo, Ireland.
| | - Maire McCallion
- Atlantic Technological University, Neuroplasticity Research Group (NRG), Health & Biomedical Research Centre (HEAL), Sligo, Ash Lane, Ballytivnan, Sligo, Ireland
| | - Kenneth Monaghan
- Atlantic Technological University, Neuroplasticity Research Group (NRG), Health & Biomedical Research Centre (HEAL), Sligo, Ash Lane, Ballytivnan, Sligo, Ireland
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KURNIAWAN ARIF, GAMELIA ELVIERA, ANANDARI DIAN. The theory behind and factors influencing the use of telemedicine during the COVID-19 pandemic: A systematic review. J Public Health Afr 2023; 14:2592. [PMID: 38162328 PMCID: PMC10755515 DOI: 10.4081/jphia.2023.2592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/09/2023] [Indexed: 01/03/2024] Open
Abstract
A paradigm change in patient health care toward telemedicine services was necessary in 2020 due to the COVID-19 pandemic, which broke out at the end of 2019. Theories used in determining the determinants of telemedicine utilization are various theories. Research conducted on the use of telemedicine still has doubts about the basic theory used in analyzing the factors that influence telemedicine, especially during the Covid-19 pandemic. The goal of this study is to outline the fundamental principles of telemedicine utilization during the Covid-19 outbreak and the variables that affect it. This Literature Review uses the scoping review method with the tool procedure, namely PRISMA. Based on the conducted literature review, there are 12 scholarly papers addressing the variables that affect the utilization of telemedicine services. During the Covid 19 epidemic, more individuals in many nations used telemedicine services. Anderson's theory of health care use and the idea of technology adoption or acceptance serve as the foundational theories for forecasting the variables that affect the use of telemedicine. The utilization of telemedicine is influenced by 29 different factors that come from different theories. The desire for health, exposure to COVID 19, co-morbidities, social media usage, avoiding contamination, time efficiency, ease of use of services, social impact, and hedonic incentive are among the factors associated to the COVID 19 pandemic.
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Affiliation(s)
- ARIF KURNIAWAN
- Public Health Department, Faculty of Health Sciences, University of Jenderal Soedirman, Indonesia
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Zhang M, Zhang H, Zhu R, Yang H, Chen M, Wang X, Li Z, Xiong Z. Factors affecting the willingness of patients with type 2 diabetes to use digital disease management applications: a cross-sectional study. Front Public Health 2023; 11:1259158. [PMID: 37937072 PMCID: PMC10626484 DOI: 10.3389/fpubh.2023.1259158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/29/2023] [Indexed: 11/09/2023] Open
Abstract
Background The global burden of type 2 diabetes has significantly increased, leading to a considerable impact on healthcare systems worldwide. While the advent of mobile healthcare has provided some relief by addressing the shortage of certain medical resources, its adoption among the Chinese population remains relatively low. To extend the benefits of mHealth to a greater number of Chinese diabetic patients, it is essential to investigate the factors that influence their willingness to utilize it and implement targeted interventions based on these influencing factors. The Technology Acceptance Model (TAM) is widely employed to examine users' ultimate usage behaviors, and previous studies have indicated the potential relevance of the Perceived Risk (PR) theory and the eHealth Literacy Theory to users' usage behaviors. Objective Our objective was to investigate the determinants that affect the willingness of Chinese patients diagnosed with type 2 diabetes patients to utilize digital disease management applications (DDMAs). Methods We conducted a cross-sectional study of patients with type 2 diabetes in three tertiary general hospitals in Chengdu using questionnaires designed by the investigators. Participants were sampled using a convenience sampling method. The questionnaire comprised three sections: socio-demographic profile and medical history; current awareness and willingness to use digital disease management applications; and the current level of e-health literacy. Structural equation modeling was employed to assess the impact of patient awareness of DDMAs and e-health literacy on the willingness to use such DDMAs. Results (1) Patients' attitudes toward using DDMAs were significantly influenced by perceived ease of use (β = 0.380, P < 0.001) and perceived usefulness (β = 0.546, P < 0.001); (2) Electronic health literacy exerted a significant impact on patients' perceived usefulness (β = 0.115, P = 0.018) and perceived ease of use (β = 0.659, P < 0.001); (3) Patients' willingness to use was significantly influenced by perceived usefulness (β = 0.137, P < 0.001) and use attitude (β = 0.825, P < 0.001). Conclusions The present research findings hold both theoretical and practical significance, and can serve as a guide for healthcare practitioners and researchers to gain a deeper comprehension of the acceptance of digital disease management applications (DDMAs) among type 2 diabetes patients.
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Affiliation(s)
- Mingjiao Zhang
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
- West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hao Zhang
- West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rong Zhu
- The 3rd Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu, Sichuan, China
| | - Huiqi Yang
- Nanbu Country People's Hospital, Nanchong, Sichuan, China
| | - Mengjie Chen
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Xiaoxia Wang
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Zhe Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, Sichuan, China
| | - Zhenzhen Xiong
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
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Antonacci G, Benevento E, Bonavitacola S, Cannavacciuolo L, Foglia E, Fusi G, Garagiola E, Ponsiglione C, Stefanini A. Healthcare professional and manager perceptions on drivers, benefits, and challenges of telemedicine: results from a cross-sectional survey in the Italian NHS. BMC Health Serv Res 2023; 23:1115. [PMID: 37853448 PMCID: PMC10585875 DOI: 10.1186/s12913-023-10100-x] [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: 11/29/2022] [Accepted: 10/01/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The Covid-19 pandemic provided new challenges and opportunities for patients and healthcare providers while accelerating the trend of digital healthcare transformation. This study explores the perspectives of healthcare professionals and managers on (i) drivers to the implementation of telemedicine services and (ii) perceived benefits and challenges related to the use of telemedicine across the Italian National Health Service. METHODS An online cross-sectional survey was distributed to professionals working within 308 healthcare organisations in different Italian regions. Quantitative and qualitative data were collected through a self-administered questionnaire (June-September 2021). Responses were analysed using summary statistics and thematic analysis. RESULTS Key factors driving the adoption of telemedicine have been grouped into (i) organisational drivers (reduce the virus spread-80%; enhance care quality and efficiency-61%), (ii) technological drivers (ease of use-82%; efficacy and reliability-64%; compliance with data governance regulations-64%) and (iii) regulatory drivers (regulations' semplification-84%). Nearly all respondents perceive telemedicine as useful in improving patient care (96%). The main benefits reported by respondents are shorter waiting lists, reduced Emergency Department attendance, decreased patient and clinician travel, and more frequent patient-doctor interactions. However, only 7% of respondents believe that telemedicine services are more effective than traditional care and 66% of the healthcare professionals believe that telemedicine can't completely substitute in-person visits due to challenges with physical examination and patient-doctor relationships. Other reported challenges include poor quality and interoperability of telemedicine platforms and scarce integration of telemedicine with traditional care services. Moreover, healthcare professionals believe that some groups of patients experience difficulties in accessing and using the technologies due to socio-cultural factors, technological and linguistic challenges and the absence of caregivers. CONCLUSIONS Respondents believe that telemedicine can be useful to complement and augment traditional care. However, many challenges still need to be overcome to fully consider telemedicine a standard of care. Strategies that could help address these challenges include additional regulations on data governance and reimbursements, evidence-based guidelines for the use of telemedicine, greater integration of tools and processes, patient-centred training for clinicians, patient-facing material to assist patients in navigating virtual sessions, different language options, and greater involvement of caregivers in the care process.
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Affiliation(s)
- Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK.
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK.
| | - Elisabetta Benevento
- Department of Energy, Systems, Territory and Construction Engineering, University of Pisa, Pisa, Italy
| | | | | | - Emanuela Foglia
- Healthcare Datascience LAB, LIUC- Carlo Cattaneo University, Castellanza, VA, Italy
| | - Giulia Fusi
- LIUC- Cattaneo University, Castellanza, VA, Italy
| | - Elisabetta Garagiola
- Healthcare Datascience LAB, LIUC- Carlo Cattaneo University, Castellanza, VA, Italy
| | - Cristina Ponsiglione
- Department of Industrial Engineering, University of Naples Federico II, Naples, Italy
| | - Alessandro Stefanini
- Department of Energy, Systems, Territory and Construction Engineering, University of Pisa, Pisa, Italy
- School of Economics and Business, Kaunas University of Technology, Kaunas, Lithuania
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Johnson EE, Kruis R, Verdin R, Wells E, Ford DW, Sterba KR. Development of an Implementation Science Telehealth Toolkit to Promote Research Capacity in Evaluation of Telehealth Programs. TELEMEDICINE REPORTS 2023; 4:286-291. [PMID: 37817872 PMCID: PMC10561742 DOI: 10.1089/tmr.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 10/12/2023]
Abstract
Background The field of telehealth is rapidly growing and expanding access to quality health care, although there have been varied implementation outcomes in telehealth modalities. Dissemination and implementation (D&I) research can provide a systematic approach to identifying barriers and facilitators to telehealth implementation processes and outcomes. Methods An interdisciplinary research and clinical team developed an implementation science telehealth toolkit to guide D&I evaluations of new and existing telehealth innovations. Results The toolkit includes a separate section to correspond to each step in the D&I evaluation process. Each section includes resources to guide evaluation steps, telehealth specific considerations, and case study examples based on three completed telehealth evaluations. Discussion The field of telehealth is forecasted to continue to expand, with potential to increase health care access to populations in need. This toolkit can help guide health care stakeholders to develop and carry out evaluations to improve understanding of telehealth processes and outcomes to maximize implementation and sustainability of these valuable innovations.
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Affiliation(s)
- Emily E. Johnson
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ryan Kruis
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rebecca Verdin
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elana Wells
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dee W. Ford
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katherine R. Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Del Risco A, Cherches A, Smith SL, Riska KM. Guideline Adherence to Benign Paroxysmal Positional Vertigo Treatment and Management in Primary Care. Otolaryngol Head Neck Surg 2023; 169:865-874. [PMID: 36884006 PMCID: PMC10782547 DOI: 10.1002/ohn.315] [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: 11/03/2022] [Revised: 02/01/2023] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To determine adherence to the 2017 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines for the management and treatment of benign paroxysmal positional vertigo (BPPV) in primary care (PC) and compare whether key recommendations differed by sex, race, or insurance status. STUDY DESIGN Retrospective chart review. SETTING Twenty-six clinic locations within a single healthcare system. METHODS Charts of 458 patients diagnosed with BPPV in PC between 2018 and 2022 were reviewed. Encounters where the diagnosis of BPPV was made were identified. From the clinical encounter note, demographics, symptomatology, management, and treatment were extracted. Nonparametric analyses were used to identify whether AAO-HNS guidelines differed regarding sex, race, or insurance status. RESULTS Of 458 patients, 249 (54.4%) did not receive a diagnostic exam, and only 4 (0.9%) patients received imaging. Regarding treatment, only 51 (11.1%) received the Epley maneuver, with 263 (57.4%) receiving vestibular suppressant medication and 12.4% receiving a referral to a specialist. In regard to sex, race, or insurance status, there was no significant difference in receiving a Dix-Hallpike diagnostic maneuver, Epley maneuver, vestibular suppressant medication, imaging, or referral to a specialist. CONCLUSION Our data suggest that there continue to be gaps in the adherence to AAO-HNS guidelines; however, these gaps did not differ by sex, race, or insurance status. Care should be taken to increase the use of diagnostic and treatment maneuvers but decrease the use of vestibular-suppressant medications for the treatment of BPPV in PC.
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Affiliation(s)
| | - Alex Cherches
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Sherri L Smith
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kristal M Riska
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA
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Mahdavi A, Atlasi R, Ebrahimi M, Azimian E, Naemi R. Human resource management (HRM) strategies of medical staff during the COVID-19 pandemic. Heliyon 2023; 9:e20355. [PMID: 37771528 PMCID: PMC10522956 DOI: 10.1016/j.heliyon.2023.e20355] [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: 07/18/2022] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
Healthcare workers are at the forefront of fight against COVID-19 and the managers of medical centers should develop coping strategies for the challenges caused by COVID-19, especially for health human resources in order to improve the performance of healthcare organizations. Hence, the purpose of this study is to investigate the human resource management strategies of medical staff during the COVID-19 to help them cope with the new strains of COVID-19 or epidemics of viral diseases that may occur in the future. In this study, a search was performed in the international Web of Science electronic database, using keywords such as human resource management and COVID-19. As a result, a total of 1884 articles published between January 1st, 2020 and October 22nd, 2021 were extracted. After screening the articles based on inclusion and exclusion criteria, 24 articles were selected to enter the study. Then, a scientometric analysis was performed on the content of selected articles and the results were presented in the form of tables and conceptual models. In total, 9 strategies were extracted from the selected articles including development of organizational culture, staff screening, policy-making, infection control training and monitoring the implementation of learned materials, patient management, human resource management, psychological and motivational support, communication and coordination, and digital health services. Employing comprehensive strategies to maintain the health of healthcare workers during the COVID-19 can play an effective role in reducing burnout, improving productivity and employee satisfaction, and in increasing the resilience of healthcare workers. It also has a positive effect on the patient's safety. Revision and reengineering of human resource management strategies in health and treatment organizations according to different cultures and contexts require research and investment in creative and innovative strategies.
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Affiliation(s)
- Abdullah Mahdavi
- Department of Health Information Management, School of Paramedical Sciences, Ardabil University of Medical Sciences, Iran
| | - Rasha Atlasi
- Information and Scientometrics Center at Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Iran
| | - Maryam Ebrahimi
- Department of Health Information Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Ehsanollah Azimian
- Department of Linguistics and Foreign Languages, Payame Noor University, Tehran, Iran
| | - Roya Naemi
- Department of Health Information Management, School of Paramedical Sciences, Ardabil University of Medical Sciences, Iran
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Cheung KW, Au TST, Wai JKO, Seto MTY. Perceptions and Challenges of Telehealth Obstetric Clinics Among Pregnant Women in Hong Kong: Cross-Sectional Questionnaire Study. J Med Internet Res 2023; 25:e46663. [PMID: 37725425 PMCID: PMC10548321 DOI: 10.2196/46663] [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: 02/21/2023] [Revised: 08/05/2023] [Accepted: 08/27/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Integrating telehealth in an obstetric care model is important to prepare for possible infection outbreaks that require social distancing and limit in-person consultations. To ensure the successful implementation of obstetric telehealth in Hong Kong, it is essential to understand and address pregnant women's concerns. OBJECTIVE This study aimed to assess pregnant women's attitudes, concerns, and perceptions regarding telehealth obstetric clinic services in Hong Kong. METHODS We conducted a prospective cross-sectional questionnaire study at Queen Mary Hospital between November 2021 and August 2022. Utilizing a 5-point rating scale, the questionnaire aimed to capture pregnant women's preferences, expectations, feasibility perceptions, and privacy concerns related to telehealth clinic services. We used statistical analyses, including chi-square tests and multinomial logistic regression, to compare questionnaire responses and investigate the association between advancing gestation and attitudes toward telehealth clinics. RESULTS The study included 664 participants distributed across different pregnancy stages: 269 (40.5%) before 18 gestational weeks, 198 (29.8%) between 24 and 31 weeks, and 197 (29.7%) after delivery. Among them, 49.8% (329/664) favored face-to-face consultations over telehealth clinics, and only 7.3% (48/664) believed the opposite. Additionally, 24.2% (161/664) agreed that telehealth clinics should be launched for obstetric services. However, the overall preference for telehealth clinics was <20% for routine prenatal checkups (81/664, 12.2%) and addressing pregnancy-related concerns, such as vaginal bleeding (76/664, 11.5%), vaginal discharge (128/664, 19.4%), reduced fetal movement (64/664, 9.7%), uterine contractions (62/664, 9.4%), and suspected leakage of amniotic fluid (54/664, 8.2%). Conversely, 76.4% (507/664) preferred telehealth clinics to in-person visits for prenatal education talks, prenatal and postpartum exercise, and addressing breastfeeding problems. Participants were more comfortable with telehealth clinic tasks for tasks like explaining pregnancy exam results (418/664, 63.1%), self-administering urinary dipsticks at home (373/664, 56.4%), medical history-taking (341/664, 51.5%), and self-monitoring blood pressure using an electronic machine (282/664, 42.8%). %). During the postpartum period, compared to before 18 weeks of gestation, significantly more participants agreed that telehealth clinics could be an option for assessing physical symptoms such as vaginal bleeding (aOR 2.105, 95% CI 1.448-3.059), reduced fetal movement (aOR 1.575, 95% CI 1.058-2.345), uterine contractions (aOR 2.906, 95% CI 1.945-4.342), suspected leakage of amniotic fluid (aOR 2.609, 95% CI 1.721-3.954), fever (aOR 1.526, 95% CI 1.109-2.100), and flu-like symptoms (aOR 1.412, 95% CI 1.030-1.936). They were also more confident with measuring the symphysis-fundal height, arranging further investigations, and making diagnoses with the doctor via the telehealth clinic. The main perceived public health advantage of telehealth clinics was the shorter traveling and waiting time (526/664, 79.2%), while the main concern was legal issues from wrong diagnosis and treatment (511/664, 77.4%). CONCLUSIONS Face-to-face consultation remained the preferred mode of consultation among the participants. However, telehealth clinics could be an alternative for services that do not require physical examination or contact. An increased acceptance of and confidence in telehealth was found with advancing gestation and after delivery. Enforcing stricter laws and guidelines could facilitate the implementation of telehealth clinics and increase confidence in their use among pregnant women for obstetric care.
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Affiliation(s)
- Ka Wang Cheung
- Department of Obstetrics & Gynaecology, Queen Mary Hospital, Hong Kong, China (Hong Kong)
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Tiffany Sin-Tung Au
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Joan Kar On Wai
- Department of Obstetrics & Gynaecology, Queen Mary Hospital, Hong Kong, China (Hong Kong)
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Mimi Tin-Yan Seto
- Department of Obstetrics & Gynaecology, Queen Mary Hospital, Hong Kong, China (Hong Kong)
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Hong Kong, China (Hong Kong)
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Sudati IP, Monteiro RFL, Nasser AB, Rocha NACF, de Campos AC. Telehealth in paediatric physical therapy education: Strategies and perceptions of interns and caregivers of children with disabilities in Brazil. CLINICAL TEACHER 2023:e13653. [PMID: 37679054 DOI: 10.1111/tct.13653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023]
Abstract
AIMS To describe the implementation of paediatric rehabilitation telehealth at a physical therapy (PT) unit in Brazil during the COVID-19 pandemic and to describe the perception about this modality by two groups: (1) undergraduate PT students using telehealth during their clinical rotations in this unit and (2) the caregivers of children with disabilities receiving the services. METHODS Twenty-one PT interns (19 females; 25 ± 2 years of age) and seven caregivers (seven females; 40 ± 6 years of age) of seven children with disabilities (five females; 10 ± 4 years of age; five children diagnosed with cerebral palsy) responded to an online questionnaire about their experience with the telehealth programme. Participant attendance and frequency of objective responses were reported descriptively; open-ended responses were analysed qualitatively and grouped according to broad themes. RESULTS 71.4% of interns rated telehealth as an excellent or good experience, and 28.6% did not appreciate it. In addition, 28.6% of them thought that telehealth should be part of the mandatory internship. Regarding caregivers, 85.8% judged the telehealth programme as excellent or good. Both interns and caregivers cited pros and cons related to technology, professional resources, communication skills and caregiver-related aspects, among others. CONCLUSIONS Specific teaching strategies had to be utilised for implementation of telehealth. Despite being a novel modality for interns and caregivers, telehealth was well accepted.
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Affiliation(s)
| | | | - Ana Beatriz Nasser
- Department of Physical Therapy, Federal University of São Carlos, São Paulo, Brazil
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Tukur M, Saad G, AlShagathrh FM, Househ M, Agus M. Telehealth interventions during COVID-19 pandemic: a scoping review of applications, challenges, privacy and security issues. BMJ Health Care Inform 2023; 30:e100676. [PMID: 37541739 PMCID: PMC10407386 DOI: 10.1136/bmjhci-2022-100676] [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: 10/03/2022] [Accepted: 07/25/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND The COVID-19, caused by the SARS-CoV-2 virus, proliferated worldwide, leading to a pandemic. Many governmental and non-governmental organisations and research institutes are contributing to the COVID-19 fight to control the pandemic. MOTIVATION Numerous telehealth applications have been proposed and adopted during the pandemic to combat the spread of the disease. To this end, powerful tools such as artificial intelligence (AI)/robotic technologies, tracking, monitoring, consultation apps and other telehealth interventions have been extensively used. However, there are several issues and challenges that are currently facing this technology. OBJECTIVE The purpose of this scoping review is to analyse the primary goal of these techniques; document their contribution to tackling COVID-19; identify and categorise their main challenges and future direction in fighting against the COVID-19 or future pandemic outbreaks. METHODS Four digital libraries (ACM, IEEE, Scopus and Google Scholar) were searched to identify relevant sources. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was used as a guideline procedure to develop a comprehensive scoping review. General telehealth features were extracted from the studies reviewed and analysed in the context of the intervention type, technology used, contributions, challenges, issues and limitations. RESULTS A collection of 27 studies were analysed. The reported telehealth interventions were classified into two main categories: AI-based and non-AI-based interventions; their main contributions to tackling COVID-19 are in the aspects of disease detection and diagnosis, pathogenesis and virology, vaccine and drug development, transmission and epidemic predictions, online patient consultation, tracing, and observation; 28 telehealth intervention challenges/issues have been reported and categorised into technical (14), non-technical (10), and privacy, and policy issues (4). The most critical technical challenges are: network issues, system reliability issues, performance, accuracy and compatibility issues. Moreover, the most critical non-technical issues are: the skills required, hardware/software cost, inability to entirely replace physical treatment and people's uncertainty about using the technology. Stringent laws/regulations, ethical issues are some of the policy and privacy issues affecting the development of the telehealth interventions reported in the literature. CONCLUSION This study provides medical and scientific scholars with a comprehensive overview of telehealth technologies' current and future applications in the fight against COVID-19 to motivate researchers to continue to maximise the benefits of these techniques in the fight against pandemics. Lastly, we recommend that the identified challenges, privacy, and security issues and solutions be considered when designing and developing future telehealth applications.
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Affiliation(s)
- Muhammad Tukur
- ICT, Hamad Bin Khalifa University College of Science and Engineering, Doha, Qatar
- Computer Science, Gombe State University, Gombe, Nigeria
| | - Ghassan Saad
- ICT, Hamad Bin Khalifa University College of Science and Engineering, Doha, Qatar
| | - Fahad M AlShagathrh
- ICT, Hamad Bin Khalifa University College of Science and Engineering, Doha, Qatar
| | - Mowafa Househ
- ICT, Hamad Bin Khalifa University College of Science and Engineering, Doha, Qatar
| | - Marco Agus
- ICT, Hamad Bin Khalifa University College of Science and Engineering, Doha, Qatar
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Phillips Z, Wong L, Crotty K, Horlick M, Johnston R, Altshuler L, Zabar S, Jay M, Dembitzer A. Implementing an Experiential Telehealth Training and Needs Assessment for Residents and Faculty at a Veterans Affairs Primary Care Clinic. J Grad Med Educ 2023; 15:456-462. [PMID: 37637347 PMCID: PMC10449358 DOI: 10.4300/jgme-d-22-00868.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/03/2023] [Accepted: 04/18/2023] [Indexed: 08/29/2023] Open
Abstract
Background The transition to telehealth during the COVID-19 pandemic revealed a lack of preexisting telehealth training for clinicians. As a workplace-based simulation methodology designed to improve virtual clinical skills, announced standardized patients (ASPs) may help meet evolving educational needs to sustain quality telehealth care. Objective We describe the development and implementation of an ASP program to assess and provide feedback to resident and faculty clinicians in virtual practice, and report on performance, feasibility, and acceptability. Methods From June 2021 to April 2022, resident and faculty clinicians at a VA primary care clinic participated in a video visit in which an ASP portrayed either a 70-year-old man with hearing loss and hypertension or a 60-year-old man with hypertension and financial stress. Following the visit, ASPs provided verbal feedback and completed a behaviorally anchored checklist to rate telehealth and communication skills, chronic disease management, and use of resources. Domain summary scores were calculated as the mean percentage of "well done" items. Participants completed a feedback survey on their experience. Results Seventy-six televisits (60 primary care residents [postgraduate year 1-3], 16 internal medicine faculty) were conducted from August 2021 to April 2022. Clinicians performed well in communication skills: information gathering (79%, 60 of 76, well done), relationship development (67%, 51 of 76), education and counseling (71%, 54 of 76), and patient satisfaction (86%, 65 of 76). They performed less well in telemedicine skills (38%, 29 of 76). Participants agreed that the experience was a good use of their time (88%, 67 of 76). Conclusions An ASP-facilitated training for resident and faculty clinicians assessed telehealth skills and clinical practice and identified areas for intervention. Clinicians responded well to the training and feedback.
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Affiliation(s)
- Zoe Phillips
- Zoe Phillips, BA, is Research Data Associate, New York University Grossman School of Medicine
| | - Laura Wong
- Laura Wong, BA, is Program Manager, New York Harbor Veterans Health Affairs, and New York University Grossman School of Medicine
| | - Kelly Crotty
- Kelly Crotty, MD, is Assistant Professor of Medicine, New York Harbor Veterans Health Affairs and New York University Grossman School of Medicine
| | - Margaret Horlick
- Margaret Horlick, MD, is Associate Professor of Medicine, New York Harbor Veterans Health Affairs and New York University Grossman School of Medicine
| | - Rhonda Johnston
- Rhonda Johnston, PhD, is Director, Veterans Health Administration Office of Connected Care
| | - Lisa Altshuler
- Lisa Altshuler, PhD, is Assistant Professor, New York University Grossman School of Medicine
| | - Sondra Zabar
- Sondra Zabar, MD, is Professor of Medicine, New York University Grossman School of Medicine
| | - Melanie Jay
- Melanie Jay, MD, is Clinician Investigator and Staff Physician, New York Harbor Veterans Health Affairs, and Associate Professor of Medicine and Population Health, New York University Grossman School of Medicine; and
| | - Anne Dembitzer
- Anne Dembitzer, MD, is Staff Physician, New York Harbor Veterans Health Affairs, and Assistant Professor, New York University Grossman School of Medicine
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Palmar-Santos AM, Pedraz Marcos A, Rubio-Casado LA, Pulido-Fuentes M, García-Perea ME, Navarta-Sanchez MV. Resilience among primary care professionals in a time of pandemic: a qualitative study in the Spanish context. BMJ Open 2023; 13:e069606. [PMID: 37399436 DOI: 10.1136/bmjopen-2022-069606] [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] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVES This study explores the impact of the COVID-19 pandemic on the Spanish primary care structure and services and the mechanisms implemented by the primary care workforce to restore and reinforce their reference care model. DESIGN An exploratory, qualitative study with semistructured interviews and a focus group discussion conducted during the fall semester of 2020. SETTING Primary health centres in Madrid (Spain), chosen based on factors such as infection rates during the earliest stages of the pandemic and demographic and socioeconomic aspects. PARTICIPANTS A total of 19 primary health and social care professionals were purposively selected. Criteria for inclusion were gender (male/female), at least 5 years of experience in their current position, category (health/social/administrative worker), and whether they worked in a rural or urban healthcare setting. RESULTS Two main themes were identified: (1) reflecting on a model in crisis-particularly the reopening of centres to users and the proactive, participative strategies implemented by primary care professionals to reach their community; and (2) regaining a sense of purpose-how healthcare professionals implemented strategies to sustain their vision of their reference model. The COVID-19 pandemic exposed leadership deficiencies that, together with the initial unavailability of resources and difficulties maintaining face-to-face contact with users, triggered a sense of loss of professional identity. On the other hand, the analysis revealed potential strategies to restore and reinforce the traditional model, such as the adoption of digital technologies and reliance on community networks. CONCLUSION This study highlights the importance of a solid reference framework and enhances the strengths and skills of the workforce to reinforce the community-based service provision model.
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Affiliation(s)
- Ana María Palmar-Santos
- Deparment of Nursing, Autonomous University of Madrid, Madrid, Spain
- Nursing and Health Care Research Group, Puerta de Hierro-Segovia Arana Health Research Institute, Madrid, Spain
| | | | | | | | | | - Maria Victoria Navarta-Sanchez
- Deparment of Nursing, Autonomous University of Madrid, Madrid, Spain
- Nursing and Health Care Research Group, Puerta de Hierro-Segovia Arana Health Research Institute, Madrid, Spain
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James M, Koshkina N, Froese T. From tech to tact: emotion dysregulation in online communication during the COVID-19 pandemic. PHENOMENOLOGY AND THE COGNITIVE SCIENCES 2023:1-32. [PMID: 37363715 PMCID: PMC10233186 DOI: 10.1007/s11097-023-09916-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/28/2023]
Abstract
Recent theorizing argues that online communication technologies provide powerful, although precarious, means of emotional regulation. We develop this understanding further. Drawing on subjective reports collected during periods of imposed social restrictions under COVID-19, we focus on how this precarity is a source of emotional dysregulation. We make our case by organizing responses into five distinct but intersecting dimensions wherein the precarity of this regulation is most relevant: infrastructure, functional use, mindful design (individual and social), and digital tact. Analyzing these reports, along with examples of mediating technologies (i.e., self-view) and common interactive dynamics (e.g., gaze coordination), we tease out how breakdowns along these dimensions are sources of affective dysregulation. We argue that the adequacy of available technological resources and competencies of various kinds matter greatly to the types of emotional experiences one is likely to have online. Further research into online communication technologies as modulators of both our individual and collective well-being is urgently needed, especially as the echoes of the digital push that COVID-19 initiated are set to continue reverberating into the future.
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Affiliation(s)
- Mark James
- Embodied Cognitive Science Unit, Okinawa Institute of Science and Technology Graduate University, 1919-1 Tancha, Okinawa, 904-0495 Japan
| | - Natalia Koshkina
- Embodied Cognitive Science Unit, Okinawa Institute of Science and Technology Graduate University, 1919-1 Tancha, Okinawa, 904-0495 Japan
| | - Tom Froese
- Embodied Cognitive Science Unit, Okinawa Institute of Science and Technology Graduate University, 1919-1 Tancha, Okinawa, 904-0495 Japan
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Montross M, Douthit S, Learn L, Dombrowski SK, Hanna C, Gruver B. Impact of interdisciplinary case management and pharmacist transitions of care interventions on 30-day readmissions. Res Social Adm Pharm 2023:S1551-7411(23)00254-1. [PMID: 37198058 DOI: 10.1016/j.sapharm.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/14/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Pharmacists and case managers positively impact patient health outcomes during the transition of care from the hospital to the home. However, the combination of both specialties completing post-discharge telephone calls has not been clearly studied. OBJECTIVES The primary outcome of this research was to identify the combined impact of post-discharge telephone calls from both pharmacists and case managers on all cause 30-day hospital readmissions when compared to a call from either group alone. Secondary outcomes included 30-day emergency department visits and types of medication therapy problems identified by pharmacists during the call. METHODS This retrospective study included high risk patients eligible for a post-discharge telephone call from both pharmacy and case management from January 1, 2021 to September 1, 2021. Patients were excluded if they did not complete a telephone call from either group or were deceased within 30 days of discharge. Results were analyzed using descriptive and chi square analyses. RESULTS Eighty-five hospital discharges were included in the study, with 24 patients receiving post-discharge telephone calls from both case management and pharmacy, and 61 patients receiving a call from either group alone. Thirty-day all cause readmissions occurred in 13% of the combined group versus 26% in either group alone (p = 0.171). Thirty-day all cause emergency department visits were 8% in the combined group versus 11% in either group alone (p = 0.617). Of the 38 post-discharge encounters completed by pharmacists, 120 medication therapy problems were identified, averaging over 3 medication issues per patient. CONCLUSIONS Collaboration amongst pharmacists and case managers has the potential to positively impact patient outcomes upon discharge from the hospital. Health systems should work to integrate transitions of care services performed across disciplines.
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Affiliation(s)
- MeiLing Montross
- Geisinger/Prime Med, 790 Northern Blvd. Suite L, Clarks Summit, PA, 18411, USA.
| | - Sabra Douthit
- Geisinger Medical Center, 100 N Academy Avenue, Danville, PA, 17822, USA.
| | - Leonard Learn
- Geisinger Telepharmacy, 58-60 Public Square, Wilkes-Barre, PA, 18701, USA.
| | | | - Christina Hanna
- Wilkes University Nesbitt School of Pharmacy, 84 West South Street, Wilkes-Barre, PA, 18766, USA.
| | - Brenda Gruver
- Wilkes University Nesbitt School of Pharmacy, 84 West South Street, Wilkes-Barre, PA, 18766, USA.
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Akter F, Haq A, Godman B, Chowdhury K, Kumar S, Haque M. Impact of Lockdown Measures on Health Outcomes of Adults with Type 2 Diabetes Mellitus in Bangladesh. Healthcare (Basel) 2023; 11:healthcare11081191. [PMID: 37108025 PMCID: PMC10137871 DOI: 10.3390/healthcare11081191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
COVID-19 lockdown measures appreciably affected patients' lifestyles, negatively impacting on their health. This includes patients with Type 2 Diabetes Mellitus (T2DM). Care of these patients was also negatively impacted due to a priority to treat patients with COVID-19, certainly initially, within hospitals and clinics in Bangladesh, combined with a lack of access to clinics and physicians due to lockdown and other measures. This is a concern in Bangladesh with growing rates of T2DM and subsequent complications. Consequently, we sought to critically analyze the situation among patients with T2DM in Bangladesh during the initial stages of the pandemic to address this information gap and provide future direction. Overall, 731 patients were recruited by a simple random sampling method among patients attending hospitals in Bangladesh, with data collected over 3 timescales: before lockdown, during the pandemic, and after lockdown. Data extracted from patients' notes included current prescribed medicines and key parameters, including blood sugar levels, blood pressure, and comorbidities. In addition, the extent of record keeping. The glycemic status of patients deteriorated during lockdown, and comorbidities as well as complications related to T2DM increased during this period. Overall, a significant proportion of key datasets were not recorded in patients' notes by their physician before and during lockdown. This started to change after lockdown measures eased. In conclusion, lockdown measures critically affected the management of patients with T2DM in Bangladesh, building on previous concerns. Extending internet coverage for telemedicine, introduction of structured guidelines, and appreciably increasing data recording during consultations is of the utmost priority to improve the care of T2DM patients in Bangladesh.
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Affiliation(s)
- Farhana Akter
- Department of Endocrinology, Chittagong Medical College Hospital, Chattogram 4203, Bangladesh
| | - Ahsanul Haq
- Infectious Diseases Division, icddr, b, Mohakhali, Dhaka 1212, Bangladesh
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
| | - Kona Chowdhury
- Department of Pediatrics, Gonoshasthaya Samaj Vittik Medical College, Dhaka 1344, Bangladesh
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, Gandhinagar 382422, Gujarat, India
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur 57000, Malaysia
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Anastasio AT, Tabarestani TQ, Bagheri K, Bethell MA, Prado I, Taylor JR, Adams SB. A New Trend in Social Media and Medicine: The Poor Quality of Videos Related to Ankle Sprain Exercises on TikTok. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231171117. [PMID: 37151477 PMCID: PMC10161314 DOI: 10.1177/24730114231171117] [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: 05/09/2023] Open
Abstract
Background Social media platforms, like TikTok, have become popular options for the distribution of health care information. Because of the lack of scientific oversight, the quality of health care-related videos has become a focus of the current literature. However, orthopaedic surgery has lagged behind other fields in acknowledging the widespread utilization of TikTok videos for medical information consumption. This study aims to assess the quality and educational benefits of ankle sprain-related TikTok videos. Methods TikTok was queried using the hashtag "#anklesprainexercises." One hundred videos were included after applying the exclusion criteria. The number of views, likes, shares, comments, and favorites was recorded. The content was graded using DISCERN (a well-validated informational analysis tool) and ASEES (a self-designed tool for exercise evaluation). We hypothesized that information on TikTok related to ankle sprain exercises would be poor in quality. Results The total number of views of the 100 videos was 6 483 412, with a median of 5377.5 (IQR = 1074-20 275). The videos collectively received 385 847 likes, 3642 comments, 55 574 favorites, and 14 918 shares with a median of 267.5 (IQR = 41.5-1678.0), 4.0 (IQR = 0.0-23.0), 42.0 (IQR = 4.8-264.5), and 13.0 (IQR = 1.8-67.8), respectively. General users had a higher percentage of their videos graded as "very poor" (61.8%) in comparison to the number of videos uploaded by health care professionals deemed "very poor" (34.4%). Neither general user nor health care professionals had videos graded as "good" or "excellent." There were significant differences between the 2 groups for DISCERN 1, 3, and ASSES scores. Conclusion Although TikTok is a powerful tool for information distribution, the educational value of the videos related to ankle sprain injury exercises was poor. With only 2% of videos receiving a grade of "fair," and no videos reaching a score of "good" or "excellent," health care professionals should be aware of the low-quality content easily accessible on TikTok. Level of Evidence Level III, cross-sectional study.
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Affiliation(s)
- Albert T. Anastasio
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
- Albert T. Anastasio, MD, Department of Orthopedic Surgery, Duke University Hospital, 200 Trent Drive, Durham, NC 27710, USA.
| | | | - Kian Bagheri
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | | | - Isabel Prado
- Duke University School of Medicine, Durham, NC, USA
| | | | - Samuel B. Adams
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
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Construction and Validation of an Image Discrimination Algorithm to Discriminate Necrosis from Wounds in Pressure Ulcers. J Clin Med 2023; 12:jcm12062194. [PMID: 36983198 PMCID: PMC10057569 DOI: 10.3390/jcm12062194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/04/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
Artificial intelligence (AI) in medical care can raise diagnosis accuracy and improve its uniformity. This study developed a diagnostic imaging system for chronic wounds that can be used in medically underpopulated areas. The image identification algorithm searches for patterns and makes decisions based on information obtained from pixels rather than images. Images of 50 patients with pressure sores treated at Kobe University Hospital were examined. The algorithm determined the presence of necrosis with a significant difference (p = 3.39 × 10−5). A threshold value was created with a luminance difference of 50 for the group with necrosis of 5% or more black pixels. In the no-necrosis group with less than 5% black pixels, the threshold value was created with a brightness difference of 100. The “shallow wounds” were distributed below 100, whereas the “deep wounds” were distributed above 100. When the algorithm was applied to 24 images of 23 new cases, there was 100% agreement between the specialist and the algorithm regarding the presence of necrotic tissue and wound depth evaluation. The algorithm identifies the necrotic tissue and wound depth without requiring a large amount of data, making it suitable for application to future AI diagnosis systems for chronic wounds.
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Sumarsono A, Case M, Kassa S, Moran B. Telehealth as a Tool to Improve Access and Reduce No-Show Rates in a Large Safety-Net Population in the USA. J Urban Health 2023; 100:398-407. [PMID: 36884183 PMCID: PMC9994401 DOI: 10.1007/s11524-023-00721-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 03/09/2023]
Abstract
Low-income populations are at higher risk of missing appointments, resulting in fragmented care and worsening disparities. Compared to face-to-face encounters, telehealth visits are more convenient and could improve access for low-income populations. All outpatient encounters at the Parkland Health between March 2020 and June 2022 were included. No-show rates were compared across encounter types (face-to-face vs telehealth). Generalized estimating equations were used to evaluate the association of encounter type and no-show encounters, clustering by individual patient and adjusting for demographics, comorbidities, and social vulnerability. Interaction analyses were performed. There were 355,976 unique patients with 2,639,284 scheduled outpatient encounters included in this dataset. 59.9% of patients were of Hispanic ethnicity, while 27.0% were of Black race. In a fully adjusted model, telehealth visits were associated with a 29% reduction in odds of no-show (aOR 0.71, 95% CI: 0.70-0.72). Telehealth visits were associated with significantly greater reductions in probability of no-show among patients of Black race and among those who resided in the most socially vulnerable areas. Telehealth encounters were more effective in reducing no-shows in primary care and internal medicine subspecialties than surgical specialties or other non-surgical specialties. These data suggest that telehealth may serve as a tool to improve access to care in socially complex patient populations.
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Affiliation(s)
- Andrew Sumarsono
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,Division of Hospital Medicine, Parkland Health, Dallas, TX, USA.
| | - Molly Case
- Virtual Care Department, Parkland Health, Dallas, TX, USA
| | | | - Brett Moran
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Clinical Informatics Department, Parkland Health, Dallas, TX, USA
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Cordero Romero SM, Gormley MA, Siddle J, Wampler WR, Roth P, Moschella P. Using Community Paramedicine to Treat Hepatitis C Virus in Upstate South Carolina. South Med J 2023; 116:321-325. [PMID: 36863056 PMCID: PMC9973429 DOI: 10.14423/smj.0000000000001521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVES Hepatitis C virus (HCV) is an infection of the liver that can lead to significant liver damage and hepatocellular carcinoma. Individuals born between 1945 and 1965 and individuals with intravenous drug use represent the largest HCV demographics and often experience barriers to treatment. In this case series, we discuss a novel partnership between community paramedics (CPs), HCV care coordinators, and an infectious disease physician to provide HCV treatment to individuals with barriers accessing care. METHODS Three patients tested positive for HCV within a large hospital system in the upstate region of South Carolina. All of the patients were contacted to discuss their results and scheduled for treatment by the hospital's HCV care coordination team. Patients who expressed barriers to attending in-person appointments or were lost to follow-up were offered a telehealth appointment facilitated by CPs performing a home visit with the added ability to draw blood and perform a physical assessment guided by the infectious disease physician. All of the patients were eligible for and prescribed treatment. The CPs assisted with follow-up visits, blood draws, and other patient needs. RESULTS Two of the three patients connected to care had an undetectable HCV viral load following 4 weeks of treatment, whereas the third was undetectable after 8 weeks. Only one patient reported a mild headache that was potentially linked to the medication, whereas the others did not report any adverse effects. CONCLUSIONS This case series highlights the barriers experienced by some HCV-positive patients and a distinctive plan to address impediments to access for HCV treatment.
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Affiliation(s)
| | - Mirinda Ann Gormley
- From the Department of Emergency Medicine,the University of South Carolina School of Medicine, Greenville,the Clemson University School of Health Research, Clemson
| | - Jennica Siddle
- From the Department of Emergency Medicine,the University of South Carolina School of Medicine, Greenville
| | | | - Prerana Roth
- the Clemson University School of Health Research, Clemson,the Department of Internal Medicine, Prisma Health Upstate, Greenville, South Carolina
| | - Phillip Moschella
- From the Department of Emergency Medicine,the University of South Carolina School of Medicine, Greenville,the Clemson University School of Health Research, Clemson
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Family Engagement in Services During COVID-19: A Mixed-Methods Study of Caregiver and Staff Perspectives. J Pediatr Health Care 2023; 37:142-152. [PMID: 36372630 PMCID: PMC9554331 DOI: 10.1016/j.pedhc.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/10/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION We examined changes in family engagement before versus during the pandemic in pediatric and family services and perceived facilitators and barriers to family engagement. METHOD We employed a mixed-methods assessment of staff and caregiver perspectives related to pediatric and family medicine clinics and family resource centers in rural northern New England. We used narrative synthesis to analyze qualitative interviews (n = 29) and descriptive statistics for quantitative surveys (n = 108). RESULTS Staff felt they were not doing as well at engaging families during versus prepandemic, identifying numerous facilitators and barriers. We found differences in resources used by families before versus during the pandemic. We identified discordant perspectives between caregivers and staff regarding how well clinics and centers identified and responded to family needs. DISCUSSION Leaders in pediatrics, advanced practice nursing, and related fields can draw on our findings to decide what services and modalities they provide for postpandemic.
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Curran VR, Hollett A, Peddle E. Virtual care and COVID-19: A survey study of adoption, satisfaction and continuing education preferences of healthcare providers in Newfoundland and Labrador, Canada. Front Digit Health 2023; 4:970112. [PMID: 36761449 PMCID: PMC9905429 DOI: 10.3389/fdgth.2022.970112] [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: 06/15/2022] [Accepted: 11/30/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction Virtual care has expanded during COVID-19 and enabled continued access to healthcare services. For many healthcare providers, the adoption of virtual care has been a new experience in the provision of healthcare services. The purpose of this survey study was to explore healthcare providers' experiences with virtual care during COVID-19. Methods A web-based survey-questionnaire was developed by applying Rogers' theory of diffusion of innovation and distributed to healthcare providers (physicians, nurses and allied health professionals) in Newfoundland and Labrador, Canada to explore virtual care experiences, satisfaction and continuing professional development (CPD) needs. Analyses included descriptive statistics and thematic analysis of survey responses. Results Fifty-one percent of respondents (n = 432) indicated they were currently offering virtual care and a majority (68.9%) reported it has improved their work experience. Telephone appointments were preferred over videoconferencing by respondents, with key challenges including the inability to conduct a physical exam, patients' cell phone services being unreliable and patients knowing how to use videoconferencing. Majority of respondents (57.5%) reported quality of care by telephone was lower than in-person, whereas quality of care by videoconferencing was equivalent to in-person. Main benefits of virtual care included increased patient access, ability to work from home, and reduction in no-show appointments. Key supports for adopting virtual care included in-house organizational supports (e.g., technical support staff), local colleague support, and technology training. Important topics for virtual care CPD included complying with regulatory standards/rules, understanding privacy or ethical boundaries, and developing competency and digital professionalism while engaging in virtual care. Discussion Beyond the COVID-19 pandemic, virtual care will have a continuing role in enhancing continuity of care through access that is more convenient. Survey findings reveal a number of opportunities for supporting healthcare providers in use of virtual care, including CPD, guidelines and resources to support adaptation to virtual care provision (e.g., virtual examinations/assessments), as well as patient educational support.
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Sanchez T, Mavragani A, Cerqueira-Silva T, Carreiro R, Pinheiro A, Coutinho A, Barral Netto M. Syndromic Surveillance Using Structured Telehealth Data: Case Study of the First Wave of COVID-19 in Brazil. JMIR Public Health Surveill 2023; 9:e40036. [PMID: 36692925 PMCID: PMC9875555 DOI: 10.2196/40036] [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: 06/02/2022] [Revised: 11/24/2022] [Accepted: 12/27/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Telehealth has been widely used for new case detection and telemonitoring during the COVID-19 pandemic. It safely provides access to health care services and expands assistance to remote, rural areas and underserved communities in situations of shortage of specialized health professionals. Qualified data are systematically collected by health care workers containing information on suspected cases and can be used as a proxy of disease spread for surveillance purposes. However, the use of this approach for syndromic surveillance has yet to be explored. Besides, the mathematical modeling of epidemics is a well-established field that has been successfully used for tracking the spread of SARS-CoV-2 infection, supporting the decision-making process on diverse aspects of public health response to the COVID-19 pandemic. The response of the current models depends on the quality of input data, particularly the transmission rate, initial conditions, and other parameters present in compartmental models. Telehealth systems may feed numerical models developed to model virus spread in a specific region. OBJECTIVE Herein, we evaluated whether a high-quality data set obtained from a state-based telehealth service could be used to forecast the geographical spread of new cases of COVID-19 and to feed computational models of disease spread. METHODS We analyzed structured data obtained from a statewide toll-free telehealth service during 4 months following the first notification of COVID-19 in the Bahia state, Brazil. Structured data were collected during teletriage by a health team of medical students supervised by physicians. Data were registered in a responsive web application for planning and surveillance purposes. The data set was designed to quickly identify users, city, residence neighborhood, date, sex, age, and COVID-19-like symptoms. We performed a temporal-spatial comparison of calls reporting COVID-19-like symptoms and notification of COVID-19 cases. The number of calls was used as a proxy of exposed individuals to feed a mathematical model called "susceptible, exposed, infected, recovered, deceased." RESULTS For 181 (43%) out of 417 municipalities of Bahia, the first call to the telehealth service reporting COVID-19-like symptoms preceded the first notification of the disease. The calls preceded, on average, 30 days of the notification of COVID-19 in the municipalities of the state of Bahia, Brazil. Additionally, data obtained by the telehealth service were used to effectively reproduce the spread of COVID-19 in Salvador, the capital of the state, using the "susceptible, exposed, infected, recovered, deceased" model to simulate the spatiotemporal spread of the disease. CONCLUSIONS Data from telehealth services confer high effectiveness in anticipating new waves of COVID-19 and may help understand the epidemic dynamics.
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Affiliation(s)
| | | | - Thiago Cerqueira-Silva
- Faculdade de Medicina, Federal University of Bahia, Salvador, Brazil.,Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Roberto Carreiro
- Centre for Data and Knowledge Integration for Health, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Adélia Pinheiro
- Departamento de Ciências da Saúde, Universidade Estadual de Santa Cruz, Salvador, Brazil
| | - Alvaro Coutinho
- Department of Civil Engineering, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Manoel Barral Netto
- Faculdade de Medicina, Federal University of Bahia, Salvador, Brazil.,Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
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