Consensus on Criteria for Good Practices in Video Consultation: A Delphi Study

Telediagnosis as an effective tool for assessment temporomandibular disorders

BACKGROUND

The use of communication technologies has allowed a substantial improvement in telediagnosis.

OBJECTIVES

To evaluate the feasibility and diagnostic agreement of synchronous teleconsultation compared to physical standard examination for temporomandibular disorders (TMD) and orofacial pain.

METHODS

Sixty-one patients (50 women, 11 men) with a mean age of 46.07 years referred to the Orofacial Pain Ambulatory Service (SAMDOF -UFPR) were evaluated remotely. They were then examined in person by another evaluator, blinded for the first evaluation. Data on the experience and level of satisfaction with the teleconsultation were also collected.

RESULTS

For each type and subtype of TMD, diagnostic agreement values, sensitivity, specificity, positive predictive values and negative predictive values were calculated with a 95% confidence interval. 'Almost perfect' agreement was found for Myalgia (k = 0.915), Arthralgia (k = 0.863), disc displacement without reduction without limited opening (k = 0.955) and no TMD (k = 1.00). 'Substantial' agreement for the subtypes headache attributed to TMD (k = 0.761), disc displacement without reduction with limited opening (k = 0.659) and subluxation (k = 7.82). The diagnoses of local myalgia (k = 0.573), myofascial pain with referral (k = 0.524) and disc displacement with reduction (k = 0.563) obtained 'moderate' agreement. Degenerative joint disease (k = 0.170) and disc displacement with reduction with intermittent locking (k = 0.000) obtained 'weak' and 'no agreement', respectively. More than 90% of the participants were satisfied and reported no discomfort during the assessment, agreeing to participate in another teleconsultation.

CONCLUSION

Synchronous teleconsultation proved to be feasible and presented adequate diagnostic agreement for the main painful TMDs, especially for the diagnosis of myalgia and arthralgia. This format was also well accepted among patients.

Selection of criteria for a telemedicine framework for designing, implementing, monitoring and evaluating telemedicine interventions: Validation using a modified Delphi process

Objectives

The call to scale up telemedicine services globally as part of the digital health transformation lacks an agreed-upon set of constructs to guide the implementation process. A lack of guidance hinders the development, consolidation, sustainability and optimisation of telemedicine services. The study aims to reach consensus among telemedicine experts on a set of implementation constructs to be developed into an evidence-based support tool.

Methods

A modified Delphi study was conducted to evaluate a set of evidence-informed telemedicine implementation constructs comprising cores, domains and items. The study evaluated the constructs consisting of five cores: Assessment of the Current Situation, Development of a Telemedicine Strategy, Development of Organisational Changes, Development of a Telemedicine Service, and Monitoring, Evaluation and Optimisation of Telemedicine Implementation; seven domains: Individual Readiness, Organisational Readiness, Clinical, Economic, Technological and Infrastructure, Regulation, and Monitoring, Evaluation and Optimisation; divided into 53 items. Global telemedicine specialists (n = 247) were invited to participate and evaluate 58 questions. Consensus was set at ≥70%.

Results

Forty-five experts completed the survey. Consensus was reached on 78% of the constructs evaluated. Regarding the core constructs, Monitoring, Evaluation and Optimisation of Telemedicine Implementation was determined to be the most important one, and Development of a Telemedicine Strategy the least. As for the domains, the Clinical one had the highest level of consensus, and the Economic one had the lowest.

Conclusions

This research advances the field of telemedicine, providing expert consensus on a set of implementation constructs. The findings also highlight considerable divergence in expert opinion on the constructs of reimbursement and incentive mechanisms, resistance to change, and telemedicine champions. The lack of agreement on these constructs warrants attention and may partly explain the barriers that telemedicine services continue to face in the implementation process.

Designing a video consultation area for hybrid care delivery: the Garden Room with a view

Introduction

Accelerated by the coronavirus pandemic, the healthcare landscape is rapidly evolving, with a shift towards hybrid care models combining in-person and online care. To support this shift, the Radboudumc, an academic hospital in the Netherlands, decided to redesign an existing space facilitating the conduction of video consultations.

Method

The design process involved participation of end-users to ensure that the physical space met their needs. The look and feel of the area was based on evidence-based design guidelines. Two prototype setups were built and tested, and the feedback informed the final design of the Garden Room.

Results

Identified end-user needs were divided into 3 major categories entailing consultation room setup, optimal use of technology and practical issues involving room availability. Combined with the look and feel of the hospital, final design requirements were developed. The Garden Room consists of 18 video consultation rooms, 4 shared workspaces, relaxation area with kitchen, and meeting rooms. Specific attention is given to the ergonomics, technology and privacy in the rooms to facilitate optimal video conversations between patients and healthcare providers. In the Garden Room, natural elements and an open design supports working in a healing environment.

Discussion

Next challenge will be optimizing the use of the Garden Room, which may be hindered by various barriers like resistance to change, existing work processes, and lack of skills training. To address these barriers and support use of the Garden Room, the hospital should focus on the implementation of education, changes in work processes, and the presence of advocates for telehealth.

Intention of healthcare providers to use video-communication in terminal care: a cross-sectional study

BACKGROUND

Interdisciplinary collaboration between healthcare providers with regard to consultation, transfer and advice in terminal care is both important and challenging. The use of video communication in terminal care is low while in first-line healthcare it has the potential to improve quality of care, as it allows healthcare providers to assess the clinical situation in real time and determine collectively what care is needed. The aim of the present study is to explore the intention to use video communication by healthcare providers in interprofessional terminal care and predictors herein.

METHODS

In this cross-sectional study, an online survey was used to explore the intention to use video communication. The survey was sent to first-line healthcare providers involved in terminal care (at home, in hospices and/ or nursing homes) and consisted of 39 questions regarding demographics, experience with video communication and constructs of intention to use (i.e. Outcome expectancy, Effort expectancy, Attitude, Social influence, Facilitating conditions, Anxiety, Self-efficacy and Personal innovativeness) based on the Unified Theory of Acceptance and Use of Technology and Diffusion of Innovation Theory. Descriptive statistics were used to analyze demographics and experiences with video communication. A multiple linear regression analysis was performed to give insight in the intention to use video communication and predictors herein.

RESULTS

90 respondents were included in the analysis.65 (72%) respondents had experience with video communication within their profession, although only 15 respondents (17%) used it in terminal care. In general, healthcare providers intended to use video communication in terminal care (Mean (M) = 3.6; Standard Deviation (SD) = .88). The regression model was significant (F = 9.809, p-value<.001) and explained 44% of the variance in intention to use video communication, with 'Outcome expectancy' (beta .420, p < .001) and 'Social influence' (beta .266, p = .004) as significant predictors.

CONCLUSIONS

Healthcare providers have in general the intention to use video communication in interprofessional terminal care. However, their actual use in terminal care is low. 'Outcome expectancy' and 'Social influence' seem to be important predictors for intention to use video communication. This implicates the importance of informing healthcare providers, and their colleagues and significant others, about the usefulness and efficiency of video communication.

Effects of Video-Based Patient Education and Consultation on Unplanned Health Care Utilization and Early Recovery After Coronary Artery Bypass Surgery (IMPROV-ED): Randomized Controlled Trial

BACKGROUND

Health care utilization after coronary artery bypass graft (CABG) surgery is high and is partly of an unplanned nature. eHealth applications have been proposed to reduce care consumption, which involve and assist patients in their recovery. In this way, health care expenses could be reduced and quality of care could be improved.

OBJECTIVE

The aim of this study was to evaluate if an eHealth program can reduce unplanned health care utilization and improve mental and physical health in the first 6 weeks after CABG surgery.

METHODS

A single-blind randomized controlled trial was performed, in which patients scheduled for nonacute CABG surgery were included from a single center in the Netherlands between February 2020 and October 2021. Participants in the intervention group had, alongside standard care, access to an eHealth program consisting of online education videos and video consultations developed in conjunction with the Dutch Heart Foundation. The control group received standard care. The primary outcome was the volume and costs of a composite of unplanned health care utilization, including emergency department visits, outpatient clinic visits, rehospitalization, patient-initiated telephone consultations, and visits to a general practitioner, measured using the Medical Technology Assessment Medical Consumption Questionnaire. Patient-reported anxiety and recovery were also assessed. Intention-to-treat and "users-only" analyses were used.

RESULTS

During the study period, 280 patients were enrolled and randomly allocated at a 1:1 ratio to the intervention or control group. The intention-to-treat analysis consisted of 136 and 135 patients in the intervention and control group, respectively. At 6 weeks, the primary endpoint had occurred in 43 of 136 (31.6%) patients in the intervention group and in 61 of 135 (45.2%) patients in the control group (hazard ratio 0.56, 95% CI 0.34-0.92). Recovery was faster in the intervention group, whereas anxiety was similar between study groups. "Users-only" analysis yielded similar results.

CONCLUSIONS

An eHealth strategy comprising educational videos and video consultations can reduce unplanned health care utilization and can aid in faster patient-reported recovery in patients following CABG surgery.

TRIAL REGISTRATION

Netherlands Trial Registry NL8510; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8510.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1007/s12471-020-01508-9.

Patient Care via Video Consultations: Piloting and S.W.O.T. Analysis of a Family Medicine Digitally Synchronous Seminar for Medical Students

Background: There is a need to familiarize medical students with the specifics of video consultations. This paper presents the concept and tests of a digitally synchronous distance seminar in which medical students practice video consultations as an aid to a family physician’s activity in a patient-oriented manner. The aim of the evaluation was to analyze the strengths, weaknesses, opportunities, and threats (S.W.O.T.) of the teaching concept. Methods: A total of 12 students carried out video consultations independently and under medical supervision. The seminar included two elements: (A) All students and teachers were video consulted in a family practice; (B) A small group performed a video consultation in a patient´s home environment. The students’ evaluation was conducted with two questionnaires (pre/post), which were analyzed with descriptive statistics and qualitative content analysis. The S.W.O.T. analysis was elaborated by the author team based on the results of the questionnaires and the interviews with the teachers. Results: Students learned the limits and possibilities of teleconsultations and deepened their family medical knowledge. Strengths: Among others; increase interest in video consultations, patient contact, focused work. Weaknesses: Among others; technical difficulties and the time it requires. Opportunities: Among others; involve students with multiple workloads in patient teaching. Risks: Among others; no integration into the curriculum yet, few personnel resources. Conclusions: The learning model familiarizes medical students with competences in family medical patient care using video communication. The results of S.W.O.T. analyses can be weighted differently. Project groups can decide individually if they want to integrate the learning concept into their curriculum and which further improvements are necessary.

Health and social care frontline leaders’ perceptions of competence management in telemedicine in Finland: An interview study

AIM

This work aims to describe competence management in telemedicine from the perspective of health and social care frontline leaders.

BACKGROUND

The increasing use of services in health and social care is a challenging aspect of modern telemedicine; it requires staff to develop relevant professional competence and good telemedicine practices.

METHODS

The study was conducted using thematic interviews of frontline leaders from primary health care, specialized medical care and social care (n = 10) in the spring of 2021. The data were analysed by inductive content analysis.

RESULTS

The following main categories were identified: Activities of frontline leaders while managing competence in telemedicine, promotion of community learning, competence management in determining telemedicine content, and recognizing health and social care professionals' competence in telemedicine.

CONCLUSIONS

Achieving the goals set for telemedicine requires ensuring that knowledge from leaders is widely disseminated and shared and that staff are adequately trained. The results can be utilized in the practical work of other telemedicine and in the development of their operations.

IMPLICATIONS FOR NURSING MANAGEMENT

Managing competence in telemedicine requires from the leaders an encouraging attitude and improved personal interactions in the work community.

Evaluation of the performance of a collaborative proposal of multiple access in cognitive radio networks

Cognitive radio networks (CRN) allow for an increase in spectral efficiency and performance of today's wireless networks. Currently, multiple proposals exist in the area of spectral decision-making and mobility; however, very few evaluate the impact of collaboration between secondary users and the performance of spectrum access by many secondary users. Unlike existing works, this article provides a comprehensive quantitative analysis of the performance of CRN taking into account access to the spectrum simultaneously by multiple users and decision making based on collaboration through the exchange of information between nearby secondary users. This proposal is developed through the implementation of four modules: Input Module, Multi-user Module, Collaborative module and Decision-making module, where the results are evaluated comparatively through the handoff rate generated with two multicriteria techniques: Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) and Multi-Criteria Optimization and Compromise Solution (VIKOR). The evaluation is carried out taking into account three levels of collaboration, three multi-user access scenarios, and two multi-criteria techniques for a total of 18 simulation scenarios. The results obtained show the importance of implementing collaboration strategies, as for multi-user access, the number of handoffs increases as the number of serial users increases. TOPSIS presented the best results in 76 % of the analyzed cases where VIKOR generated a smaller number of handoffs; TOPSIS maintained good performance with differences not exceeding 90 handoffs.

Delphi methodology in healthcare research: How to decide its appropriateness

The Delphi technique is a systematic process of forecasting using the collective opinion of panel members. The structured method of developing consensus among panel members using Delphi methodology has gained acceptance in diverse fields of medicine. The Delphi methods assumed a pivotal role in the last few decades to develop best practice guidance using collective intelligence where research is limited, ethically/logistically difficult or evidence is conflicting. However, the attempts to assess the quality standard of Delphi studies have reported significant variance, and details of the process followed are usually unclear. We recommend systematic quality tools for evaluation of Delphi methodology; identification of problem area of research, selection of panel, anonymity of panelists, controlled feedback, iterative Delphi rounds, consensus criteria, analysis of consensus, closing criteria, and stability of the results. Based on these nine qualitative evaluation points, we assessed the quality of Delphi studies in the medical field related to coronavirus disease 2019. There was inconsistency in reporting vital elements of Delphi methods such as identification of panel members, defining consensus, closing criteria for rounds, and presenting the results. We propose our evaluation points for researchers, medical journal editorial boards, and reviewers to evaluate the quality of the Delphi methods in healthcare research.

Delphi methodology in healthcare research: How to decide its appropriateness

The Delphi technique is a systematic process of forecasting using the collective opinion of panel members. The structured method of developing consensus among panel members using Delphi methodology has gained acceptance in diverse fields of medicine. The Delphi methods assumed a pivotal role in the last few decades to develop best practice guidance using collective intelligence where research is limited, ethically/logistically difficult or evidence is conflicting. However, the attempts to assess the quality standard of Delphi studies have reported significant variance, and details of the process followed are usually unclear. We recommend systematic quality tools for evaluation of Delphi methodology; identification of problem area of research, selection of panel, anonymity of panelists, controlled feedback, iterative Delphi rounds, consensus criteria, analysis of consensus, closing criteria, and stability of the results. Based on these nine qualitative evaluation points, we assessed the quality of Delphi studies in the medical field related to coronavirus disease 2019. There was inconsistency in reporting vital elements of Delphi methods such as identification of panel members, defining consensus, closing criteria for rounds, and presenting the results. We propose our evaluation points for researchers, medical journal editorial boards, and reviewers to evaluate the quality of the Delphi methods in healthcare research.

Best Practices for Using Telehealth in Hospice and Palliative Care

Hospice and palliative care providers throughout the United States have continued to provide compassionate patient- and family-centered care during the COVID-19 (coronavirus disease 2019) pandemic while adapting to the need for scrupulous infection control measures and the accelerated use of telehealth. Prior to the pandemic, hospice and palliative care adopted telehealth slowly compared with other specialties, but its rapidly increasing utilization during the COVID-19 pandemic has long-term implications for access to primary and specialty palliative care, particularly for patients in rural communities and populations experiencing inequitable access to services. Telehealth also shows great promise for leveraging technology to provide care more effectively and efficiently. As more provider organizations become equipped with telehealth infrastructure, and as advocacy for broader reimbursement of these services grows, telehealth services for hospice and palliative care are expected to continue. This article highlights the work of expert clinicians from multiple hospice and palliative care organizations to develop best practices for conducting telehealth visits in inpatient and community settings. The authors propose that best practices be compiled and considered to ensure quality-driven, evidence-based clinical practice guidelines with interprofessional applicability.

Is Tele-Dentistry an Effective Approach for Patient Follow-up in Maxillofacial Surgery

PURPOSE

To explore the feasibility and diagnostic accuracy of the tele-dentistry for the follow-up of different diagnostic groups of Turkish patients in maxillofacial surgery.

MATERIALS AND METHODS

In this study, follow-up patients were allocated to four groups as dental implant, minor surgical procedure, infection-medication-related osteonecrosis of the jaws (MRONJ) and temporomandibular joint disorder (TMD). In all groups, remote examination via video call and subsequently face-to-face clinic examination were performed. The quality and accuracy of the video call were scored by the same investigator. Also, patient satisfaction regarding the video call was evaluated with a questionnaire.

RESULTS

Twenty-one patients (12 females, 9 males) between 18 and 71 years (38.90 ± 17.88) participated in the study. A strong preference of 71% and 95% toward video call by patients was seen in the questionnaires performed after video call and face-to-face examination, respectively. Regarding the rating of the clinician, no significant differences were found between groups in terms of the quality and accuracy of video call (p ≥ 0.05).

CONCLUSION

Remote follow up of diagnostic groups which can benefit from tele-dentistry pose a promising remedy that is reliable as in-person visits and also can reduce the clinical visits in routine clinical practice.

Telemedicine Chronic Viral Hepatitis C Treatment during the Lockdown Period in Romania: A Pilot Study

The COVID-19 pandemic is currently delaying the process of chronic hepatitis C (HCV) eradication, since most of the chronic diseases are neglected. Thus, there is a need for alternative programs for HCV therapy implementation and disease monitoring. Our aim was to provide a multidisciplinary approach, so that HCV-infected patients from distant locations may benefit from HCV antivirals during the COVID-19 outbreak and within the lockdown period in Romania. Previously diagnosed HCV patients willing to participate in this telemedicine pilot study were included. Patient characteristics and medical adherence were assessed and compared to the year preceding the pandemic. We proposed a multidisciplinary approach by using a telemedicine program for HCV therapy monitoring. Patients also received a satisfaction questionnaire after delivering the sustained virologic response (SVR) result. A total of 41 patients agreed to participate in this study. The medication adherence was 100% for patients included in the telemedicine group, with a statistically significant difference from the medication adherence of the patients treated in 2019. The satisfaction item score was 4.92 out of 5 and our results (r = −0.94, p < 0.0001) suggested that older patients embraced the telemedicine program less, but with the same success in terms of SVR (100%) and medication adherence (100%). Our pilot study offers the first example of a telemedicine program in Romania for HCV therapeutic management. During the lockdown period, telemedicine has served as a reliable tool and novel alternative for conventional monitoring of patients treated with direct antiviral agents and should be further considered even following the pandemic.