1
|
Raghavendra AS, Jennings K, Guerra G, Tripathy D, Karuturi MS. Patient-reported convenience and effectiveness of telehealth for breast cancer management. Oncologist 2024:oyae165. [PMID: 39017637 DOI: 10.1093/oncolo/oyae165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/09/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Before the coronavirus disease 2019 (COVID-19) pandemic, telehealth was rarely used for breast cancer management at tertiary care centers. We sought to examine patient satisfaction, experiences, preferences, and perceived effectiveness and technical quality of telehealth visits in follow-up patients receiving routine outpatient care in the breast medical oncology practice at The University of Texas MD Anderson Cancer Center. METHODS We administered a survey to 60 follow-up patients for a duration of 9 months (January 5, 2021 to October 27, 2021) who had at least one telehealth consultation during the COVID-19 pandemic, from April 10, 2020 to October 21, 2021. Descriptive statistics were then generated for each question, each domain, and overall survey scores. Subgroup comparisons within patient populations were done using the chi-square or t-test when appropriate. RESULTS Among the 60 participants, 49 (82%) were undergoing standard follow-up during active treatment for either early-stage or metastatic breast cancer. Telehealth and in-person office visits were considered equivalent in terms of quality of communication by 43 participants (72%). Most participants (n = 49, 82%) felt equally cared for during telehealth and in-person visits, and 40 participants (67%) reported feeling connected to their healthcare professional during both telehealth and in-person visits. In addition, 28 participants (47%) felt that the duration of telehealth visits was similar to in-person visits, 46 (77%) found both telehealth and in-person visits equally comfortable for discussing sensitive topics, 39 (65%) considered telehealth visits convenient, and 42 (70%) perceived the overall quality of care for telehealth to be similar to that of in-person visits. Participants expressed high satisfaction with telehealth appointments, with 42 (70%) rating their experience as very satisfying. Most participants (n = 44, 73%) expressed a strong likelihood of participating in telehealth appointments for breast cancer follow-up care in the future. CONCLUSIONS Our results indicate that telehealth can serve as an effective and satisfactory approach for delivering healthcare services to patients with breast cancer requiring follow-up care. The positive experiences and willingness to continue using telehealth indicate its potential for improving access to care and patient outcomes.
Collapse
Affiliation(s)
| | - Kristofer Jennings
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Gil Guerra
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Meghan S Karuturi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| |
Collapse
|
2
|
Hassan J, Saeed SM, Deka L, Uddin MJ, Das DB. Applications of Machine Learning (ML) and Mathematical Modeling (MM) in Healthcare with Special Focus on Cancer Prognosis and Anticancer Therapy: Current Status and Challenges. Pharmaceutics 2024; 16:260. [PMID: 38399314 PMCID: PMC10892549 DOI: 10.3390/pharmaceutics16020260] [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: 12/08/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
The use of data-driven high-throughput analytical techniques, which has given rise to computational oncology, is undisputed. The widespread use of machine learning (ML) and mathematical modeling (MM)-based techniques is widely acknowledged. These two approaches have fueled the advancement in cancer research and eventually led to the uptake of telemedicine in cancer care. For diagnostic, prognostic, and treatment purposes concerning different types of cancer research, vast databases of varied information with manifold dimensions are required, and indeed, all this information can only be managed by an automated system developed utilizing ML and MM. In addition, MM is being used to probe the relationship between the pharmacokinetics and pharmacodynamics (PK/PD interactions) of anti-cancer substances to improve cancer treatment, and also to refine the quality of existing treatment models by being incorporated at all steps of research and development related to cancer and in routine patient care. This review will serve as a consolidation of the advancement and benefits of ML and MM techniques with a special focus on the area of cancer prognosis and anticancer therapy, leading to the identification of challenges (data quantity, ethical consideration, and data privacy) which are yet to be fully addressed in current studies.
Collapse
Affiliation(s)
- Jasmin Hassan
- Drug Delivery & Therapeutics Lab, Dhaka 1212, Bangladesh; (J.H.); (S.M.S.)
| | | | - Lipika Deka
- Faculty of Computing, Engineering and Media, De Montfort University, Leicester LE1 9BH, UK;
| | - Md Jasim Uddin
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Diganta B. Das
- Department of Chemical Engineering, Loughborough University, Loughborough LE11 3TU, UK
| |
Collapse
|
3
|
Shi Y, Gao Y, Huai Q, Du Z, Yang L. Experiences of financial toxicity among caregivers of cancer patients: a meta-synthesis of qualitative studies. Support Care Cancer 2024; 32:146. [PMID: 38326575 DOI: 10.1007/s00520-024-08349-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: 07/23/2023] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES The purpose of this study was to explore the experience of financial toxicity among caregivers of cancer patients and to provide recommendations for subsequent intervention strategies. METHODS Computer searches of PubMed, EmBase, The Cochrane Library, Web of Science, CINAHL (EBSCO), CNKI, Wanfang database, and SinoMed for qualitative studies experience of financial toxicity among caregivers cancer patients. The search time frame was from the establishment of the database to May 2023. The quality of included studies was assessed using the Qualitative Research Checklist from the Joanna Briggs Institute (JBI) Reviewer's Manual. The meta-synthesis was integrated following the meta-aggregation method proposed by the Joanna Briggs Institute (JBI) and reported following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. RESULTS A total of nine studies were included, distilling 25 qualitative findings into nine new categories and synthesizing three synthesized findings: caregivers have strong negative experiences that affect their family relationships, daily work and life; caregivers use different strategies to cope with financial toxicity; needs and expectations of caregivers coping with financial toxicity. CONCLUSIONS Financial toxicity among caregivers of cancer patients affects their daily lives. Receiving timely recognition of this financial burden and providing assistance to enhance their coping skills are crucial in mitigating its impact. Healthcare professionals should focus on the financial toxicity experienced by caregivers of people with cancer, address their supportive needs, and develop a comprehensive support system to improve caregivers' coping abilities and quality of life.
Collapse
Affiliation(s)
- Yanan Shi
- School of Nursing, Weifang Medical University, 7166 Baotong West Street, Weifang, 261053, China
| | - Ying Gao
- School of Nursing, Weifang Medical University, 7166 Baotong West Street, Weifang, 261053, China
| | - Qiyang Huai
- School of Nursing, Weifang Medical University, 7166 Baotong West Street, Weifang, 261053, China
| | - Zhongyan Du
- School of Nursing and Rehabilitation, Shandong University, 44 West Culture Road, Jinan, 250000, China
| | - Lijuan Yang
- Department of Nursing, Shandong Provincial Hospital, Jingwuweiqi Road, Jinan, 250000, China.
| |
Collapse
|
4
|
Dev V, Mittal A, Joshi V, Meena JK, Dhanesh Goel A, Didel S, Pareek P, Misra S, Singh K. Cost analysis of telemedicine use in paediatric nephrology-the LMIC perspective. Pediatr Nephrol 2024; 39:193-201. [PMID: 37488241 DOI: 10.1007/s00467-023-06062-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The overall cost of managing chronic diseases is a significant barrier to accessing complete and timely healthcare, especially in rural and geographically isolated areas. This cost disparity becomes more pronounced in the case of children and more so in under-resourced regions of the world. In the era of COVID-19, as the need for physical distancing increased, there was a transition in approach to healthcare provision to telemedicine consultations. This study evaluates the cost saving using teleconsultations in a paediatric nephrology clinic. METHODS This prospective cohort study was conducted at AIIMS Jodhpur, a tertiary care centre in western Rajasthan from March 2021 to October 2022. All consecutive paediatric (29 days-18 years) patients attending telemedicine services for kidney-related illness were enrolled. Basic demographic details were collected. Cost analysis was done after 6 months, regarding perceived cost savings for the patient and family by using telehealth for follow-up during 6 months starting from enrolment. RESULTS A total of 112 patients were enrolled; 266 teleconsultations attended; 109 patients who could be followed up saved INR 457,900 during 6 months of follow-up. The average cost saving was INR - 1577/patient/visit. Patients saved 4.99% of the family income (median 2.16% (IQR 0.66-5.5)). The highest expenditure per visit was incurred for food and transport. The median distance from the residence to the clinic was 122.5 km (IQR 30-250). Over the 6-month study period, patients saved a travel distance of 83,274 km (743 km/patient). CONCLUSIONS The use of telemedicine as a follow-up method helps save significant costs and distances travelled by patients. A higher-resolution version of the Graphical abstract is available as Supplementary information.
Collapse
Affiliation(s)
- Vishnu Dev
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Aliza Mittal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Vibha Joshi
- Resource Center HTA, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Jitendra K Meena
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Akhil Dhanesh Goel
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Siyaram Didel
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Puneet Pareek
- Department of Radiotherapy, All India Institute of Medical Sciences, Jodhpur, India
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India
| | - Kuldeep Singh
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| |
Collapse
|
5
|
Trankle SA, Reath J. Afterhours telehealth in Australian residential aged care facilities: a mixed methods evaluation. BMC Health Serv Res 2023; 23:1263. [PMID: 37968685 PMCID: PMC10652444 DOI: 10.1186/s12913-023-10257-5] [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: 01/22/2023] [Accepted: 10/31/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The aged care system in Australia is under pressure. Residential aged care facilities (RACFs) and general practitioners (GPs) have difficulty providing the care needed by their residents, particularly after hours. Many residents are given ambulance support and transferred to hospital emergency departments (EDs) for care that could be provided at RACFs. The MyEmergencyDoctor (MED) service was commissioned in a 12-month program (February 2020-February 2021) using ED physicians to provide afterhours telehealth care in six RACFs. METHODS Using the NASSS framework, we synthesised descriptive analyses of statistical data from the MED service, RACFs and the ambulance service and a thematic analysis of interview data collected from GPs, RACF and MED service staff, and family members of residents. RESULTS Most calls to MED (179/209) were resolved with in-house treatment thereby reducing ambulance usage and hospital admissions. Interviews further revealed that MED enabled timely care for residents who were unwell but did not need hospital transfer. Technology, training, and rapid access to MED assisted RACF staff and complemented usual GP care. MED potentially reduced GP burnout. Refresher training was considered important especially in RACFs with high staff turnover, as was greater afterhours access to medications. CONCLUSIONS The afterhours telehealth model provided in-house care and reduced ambulance transfers, and GPs and RACF staff generally felt supported. The service was easy to use and fostered good communications with GPs and RACF staff. Some GPs preferred to provide their own care, commenting on the need for a good understanding of patient and family needs and of the local context. Other stakeholders suggested this model could be extended to palliative care settings and to normal business hours when GPs were unavailable. The reduced ambulance and hospital use suggested benefits to wider health systems, however policies and funding that remunerate GPs, support community-based care and provide additional staffing in RACFs are needed to sustain afterhours telehealth in RACFs. Use of the NASSS (non-adoption, abandonment, scale-up, spread, and sustainability) Framework provided a valuable explanatory lens for our analyses.
Collapse
Affiliation(s)
- Steven A Trankle
- Department of General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Jennifer Reath
- Department of General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| |
Collapse
|
6
|
Nadkarni A, Garg A, Agrawal R, Sambari S, Mirchandani K, Velleman R, Gupta D, Bhatia U, Fernandes G, D’souza E, Amonkar A, Rane A. Acceptability and feasibility of assisted telepsychiatry in routine healthcare settings in India: a qualitative study. OXFORD OPEN DIGITAL HEALTH 2023; 1:oqad016. [PMID: 38025140 PMCID: PMC10668329 DOI: 10.1093/oodh/oqad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/16/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023]
Abstract
Technology-enabled interventions are often recommended to overcome geographical barriers to access and inequitable distribution of mental healthcare workers. The aim of this study was to examine the acceptability and feasibility of an assisted telepsychiatry model implemented in primary care settings in India. In-depth interviews were conducted with patients who received telepsychiatry consultations. Data were collected about domains such as experience with communicating with psychiatrists over a video call and feasibility of accessing services. Data were analysed using a thematic analysis approach. Patients recognized that technology enabled them to access treatment and appreciated its contribution to the improvement in their mental health condition. They reported that the telepsychiatry experience was comparable to face-to-face consultations. They had a positive experience of facilitation by counsellors and found treatment delivery in primary care non-stigmatizing. While some adapted easily to the technology platform because of increased access to technology in their daily lives, others struggled to communicate over a screen. For some, availability of care closer to their homes was convenient; for others, even the little travel involved posed a financial burden. In some cases, the internet connectivity was poor and interfered with the video calls. Patients believed that scale could be achieved through adoption of this model by the public sector, collaboration with civil society, enhanced demand generation strategies and leveraging platforms beyond health systems. Assisted telepsychiatry integrated in routine healthcare settings has the potential to make scarce specialist mental health services accessible in low resource settings by overcoming geographical and logistical barriers.
Collapse
Affiliation(s)
- Abhijit Nadkarni
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Ankur Garg
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Ravindra Agrawal
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Seema Sambari
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Kedar Mirchandani
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Richard Velleman
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
- Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY, UK
| | - Devika Gupta
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Urvita Bhatia
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Godwin Fernandes
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Ethel D’souza
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Akshada Amonkar
- Addictions and Related Research Group, Sangath, Porvorim, Goa 403501, India
| | - Anil Rane
- Institute of Psychiatry & Human Behaviour , Bambolim, Goa 403108, India
| |
Collapse
|
7
|
Williams TD, Kaur A, Warner T, Aslam M, Clark V, Walker R, Ngo DTM, Sverdlov AL. Cardiovascular outcomes of cancer patients in rural Australia. Front Cardiovasc Med 2023; 10:1144240. [PMID: 37180785 PMCID: PMC10167273 DOI: 10.3389/fcvm.2023.1144240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
Background Cancer and heart disease are the two most common health conditions in the world, associated with high morbidity and mortality, with even worse outcomes in regional areas. Cardiovascular disease is the leading cause of death in cancer survivors. We aimed to evaluate the cardiovascular outcomes of patients receiving cancer treatment (CT) in a regional hospital. Methods This was an observational retrospective cohort study in a single rural hospital over a ten-year period (17th February 2010 to 19th March 2019). Outcomes of all patients receiving CT during this period were compared to those who were admitted to the hospital without a cancer diagnosis. Results 268 patients received CT during the study period. High rates of cardiovascular risk factors: hypertension (52.2%), smoking (54.9%), and dyslipidaemia (38.4%) were observed in the CT group. Patients who had CT were more likely to be readmitted with ACS (5.9% vs. 2.8% p = 0.005) and AF (8.2% vs. 4.5% p = 0.006) when compared to the general admission cohort. There was a statistically significant difference observed for all cause cardiac readmission, with a higher rate observed in the CT group (17.1% vs. 13.2% p = 0.042). Patients undergoing CT had a higher rate of mortality (49.5% vs. 10.2%, p ≤ 0.001) and shorter time (days) from first admission to death (401.06 vs. 994.91, p ≤ 0.001) when compared to the general admission cohort, acknowledging this reduction in survival may be driven at least in part by the cancer itself. Conclusion There is an increased incidence of adverse cardiovascular outcomes, including higher readmission rate, higher mortality rate and shorter survival in people undergoing cancer treatment in rural environments. Rural cancer patients demonstrated a high burden of cardiovascular risk factors.
Collapse
Affiliation(s)
- Trent D. Williams
- Hunter New England Local Health District, New Lambton, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Nursing and Midwifery, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Nursing and Midwifery Centre: Hunter New England Local Health District, New Lambton, NSW, Australia
- Newcastle Centre of Excellence in Cardio-Oncology, New Lambton Heights, NSW, Australia
| | - Amandeep Kaur
- Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Thomas Warner
- Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Maria Aslam
- Hunter New England Local Health District, New Lambton, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Vanessa Clark
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Nursing and Midwifery, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute Asthma and Breathing Research Program, Newcastle, NSW, Australia
| | - Rhonda Walker
- Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Doan T. M. Ngo
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- Newcastle Centre of Excellence in Cardio-Oncology, New Lambton Heights, NSW, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Aaron L. Sverdlov
- Hunter New England Local Health District, New Lambton, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- Newcastle Centre of Excellence in Cardio-Oncology, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| |
Collapse
|
8
|
Lindsay D, Bates N, Callander E, Johnston K, Carlisle K, Smith D, Evans R, Larkins S. Evaluating the quality and safety of the BreastScreen remote radiology assessment model of service delivery in Australia. J Telemed Telecare 2023; 29:203-210. [PMID: 33283606 DOI: 10.1177/1357633x20975653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Breast cancer is the most commonly diagnosed cancer in Australian women. Given the diverse geography and populations within Australia, the ability to offer a telemedicine-supported breast screening and assessment service may increase access. The aim of this study was to assess clinical outcomes of a telemedicine-based remote radiology assessment service delivery model for detecting breast cancer in regional Australian women compared to the traditional radiologist onsite model. METHODS This study was a pre-post intervention study using de-identified administrative data. Data were collected from seven sites across three health jurisdictions within Australia. There were a total of 21,117 assessment visits, with 10,508 (49.8%) pre- and 10,609 (50.2%) post-remote model implementation. Of the 10,609 post-remote model visits, 3,904 (36.8%) were under the remote model. The main outcome was cancer detection, split into any cancer, any invasive cancer or any small invasive cancer. Timeliness of assessment was also examined. RESULTS After adjusting for multiple factors, there were no statistically significant differences in cancer detection rates between the remote and onsite models (adjusted odds ratio (AOR) = 1.02, 95% CI 0.86-1.19, n.s.). Implementing the remote assessment model had statistically significant positive effects on the timeliness of assessment (AOR = 0.68, 95% CI 0.59-0.77, p < 0.001). DISCUSSION This study found the remote model delivers safe and high-quality assessment services, with equivalent rates of cancer detection and improved timeliness of assessment when compared to the traditional onsite model. Careful monitoring and ongoing evaluation of any health-service model is important for ongoing safety, efficiency and acceptability.
Collapse
Affiliation(s)
- Daniel Lindsay
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Australia.,Menzies School of Health Research, Charles Darwin University, Australia
| | - Nicole Bates
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Australia
| | - Emily Callander
- School of Public Health and Preventive Medicine, Monash University, Australia
| | - Karen Johnston
- College of Medicine and Dentistry, James Cook University, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry, James Cook University, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Australia
| | - Deb Smith
- College of Medicine and Dentistry, James Cook University, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Australia
| | - Rebecca Evans
- College of Medicine and Dentistry, James Cook University, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Australia
| |
Collapse
|
9
|
Nguyen OT, Mason A, Khanna N, Charles D, Naso C, Hong YR, Sprow O, Alishahi Tabriz A, Turner K, Spiess P, Patel KB. Patient and caregiver experience with telehealth for surgical cancer care: A qualitative study. J Surg Oncol 2023; 127:1203-1211. [PMID: 36883752 DOI: 10.1002/jso.27228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/18/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION The COVID-19 pandemic led to telemedicine adoption for many medical specialties, including surgical cancer care. To date, the evidence for patient experience of telemedicine among patients with cancer undergoing surgery is limited to quantitative surveys. Thus, this study qualitatively assessed the patient and caregiver experience of telehealth visits for surgical cancer care. METHODS We conducted semistructured interviews with 25 patients with cancer and three caregivers who had completed a telehealth visit for preanesthesia or postoperative visits. Interviews covered visit descriptions, overall satisfaction, system experience, visit quality, what roles caregivers had, and thoughts on what types of surgery-related visits would be appropriate through telehealth versus in-person. RESULTS Telehealth delivery for surgical cancer care was generally viewed positively. Multiple factors influenced the patient experience, including prior experience with telemedicine, ease of scheduling visits, smooth connection experiences, having access to technical support, high communication quality, and visit thoroughness. Participants identified use cases on telehealth for surgical cancer care, including postoperative visits for uncomplicated surgical procedures and educational visits. CONCLUSIONS Patient experiences with telehealth for surgical care are influenced by smooth system experiences, high-quality patient-clinician communications, and a patient-centered focus. Interventions are needed to optimize telehealth delivery (e.g., improve telemedicine platform usability).
Collapse
Affiliation(s)
- Oliver T Nguyen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Arianna Mason
- Research, Interventions, and Measurement Core, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Neel Khanna
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Dannelle Charles
- Research, Interventions, and Measurement Core, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Cristina Naso
- Virtual Health Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Young-Rock Hong
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida, USA
| | - Olivia Sprow
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.,Department of Oncologic Science, University of South Florida, Tampa, Florida, USA.,Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.,Department of Oncologic Science, University of South Florida, Tampa, Florida, USA.,Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Philippe Spiess
- Virtual Health Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.,Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Krupal B Patel
- Department of Head and Neck Endocrine Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| |
Collapse
|
10
|
Zhong W, Fu C, Xu L, Sun X, Wang S, He C, Wei Q. Effects of home-based cardiac telerehabilitation programs in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. BMC Cardiovasc Disord 2023; 23:101. [PMID: 36814188 PMCID: PMC9945630 DOI: 10.1186/s12872-023-03120-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Recent advances in telecommunications technology have raised the possibility of telehealth intervention delivering cardiac telerehabilitation, which may provide the efficacy of health services in patients after percutaneous coronary intervention (PCI). This study aimed to investigate the effects of home-based cardiac telerehabilitation (HBCTR) in patients undergoing PCI. METHODS We performed a comprehensive search of the following electronic databases: PubMed, Cochrane Central, Web of Science, Embase, CNKI, and WANFANG. For the prespecified outcomes, the primary outcomes were results of physical function (the six-minute walking test, 6MWT) and quality of life (QoL) of the participants. The secondary outcomes were results of (1) blood pressure; (2) full lipid profile (3) reliable assessment of anxiety and depression in patients. RESULTS All studies were conducted between 2013 and 2022, and a total of 5 articles could be included in the quantitative meta-analysis. The results showed that there was a statistically significant difference between the HBCTR intervention group and the control group in 6WMT (MD 16.59, 95%CI 7.13 to 26.06, P = 0.0006), but there was no difference in QoL (SMD - 0.25, 95%CI - 1.63 to 1.13, P = 0.73). According to the fixed effects model, there was a statistically significant difference between the HBCTR group versus the control group (MD - 2.88, 95%CI - 5.19 to - 0.57, P = 0.01), but not in diastolic blood pressure. Likewise, significant improvements of triglycerides and in low-density lipoprotein cholesterol were observed in HBTCR groups, but no significant differences were observed regarding total cholesterol and high-density lipoprotein cholesterol. CONCLUSION This systematic review and meta-analysis have proven that the HBCTR is one of the promisingly effective cardiac rehabilitation strategies that improve cardiorespiratory fitness and reduce cardiovascular disease risk factors. With the continuous improvement of the telerehabilitation network, it is expected to serve in clinical.
Collapse
Affiliation(s)
- Wen Zhong
- Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Chenying Fu
- State Key Laboratory of Biotherapy and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Aging and Geriatric Mechanism Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Lin Xu
- Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Xin Sun
- Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Shiqi Wang
- Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Chengqi He
- Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Quan Wei
- Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China. .,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China.
| |
Collapse
|
11
|
Totten AM, Womack DM, Griffin JC, McDonagh MS, Davis-O'Reilly C, Blazina I, Grusing S, Elder N. Telehealth-guided provider-to-provider communication to improve rural health: A systematic review. J Telemed Telecare 2022:1357633X221139892. [PMID: 36567431 DOI: 10.1177/1357633x221139892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Telehealth may address healthcare disparities for rural populations. This systematic review assesses the use, effectiveness, and implementation of telehealth-supported provider-to-provider collaboration to improve rural healthcare. METHODS We searched Ovid MEDLINE®, CINAHL®, EMBASE, and Cochrane CENTRAL from 1 January 2010 to 12 October 2021 for trials and observational studies of rural provider-to-provider telehealth. Abstracts and full text were dual-reviewed. We assessed the risk of bias for individual studies and strength of evidence for studies with similar outcomes. RESULTS Seven studies of rural uptake of provider-to-provider telehealth documented increases over time but variability across geographic regions. In 97 effectiveness studies, outcomes were similar with rural provider-to-provider telehealth versus without for inpatient consultations, neonatal care, outpatient depression and diabetes, and emergency care. Better or similar results were reported for changes in rural clinician behavior, knowledge, confidence, and self-efficacy. Evidence was insufficient for other clinical uses and outcomes. Sixty-seven (67) evaluation and qualitative studies identified barriers and facilitators to implementing rural provider-to-provider telehealth. Success was linked to well-functioning technology, sufficient resources, and adequate payment. Barriers included lack of understanding of rural context and resources. Methodologic weaknesses of studies included less rigorous study designs and small samples. DISCUSSION Rural provider-to-provider telehealth produces similar or better results versus care without telehealth. Barriers to rural provider-to-provider telehealth implementation are common to practice change but include some specific to rural adaptation and adoption. Evidence gaps are partially due to studies that do not address differences in the groups compared or do not include sufficient sample sizes.
Collapse
Affiliation(s)
| | - Dana M Womack
- Oregon Health & Science University, Portland, OR, USA
| | | | | | | | - Ian Blazina
- Oregon Health & Science University, Portland, OR, USA
| | - Sara Grusing
- Oregon Health & Science University, Portland, OR, USA
| | - Nancy Elder
- Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
12
|
Uemoto Y, Yamanaka T, Kataoka Y, Wada Y, Aoyama Y, Kizawa R, Yamaguchi T, Kikawa Y, Mukai H, Taira N. Efficacy of Telemedicine Using Videoconferencing Systems in Outpatient Care for Patients With Cancer: A Systematic Review and Meta-Analysis. JCO Clin Cancer Inform 2022; 6:e2200084. [PMID: 36417685 DOI: 10.1200/cci.22.00084] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This systematic review aimed to investigate the efficacy of telemedicine (TM) using videoconferencing systems in outpatient care for patients with cancer. METHODS We searched six electronic databases (CENTRAL, MEDLINE, EMBASE, CINAHL, ICTRP, and ClinicalTrials.gov) through June 2021 to identify randomized controlled trials that evaluated the use of TM using videoconferencing systems compared with usual face-to-face care in outpatient care for patients with cancer. We assessed the certainty of evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation. RESULTS From the 2,400 articles screened, six randomized controlled trials were eligible for this study. Two studies evaluated the use of TM in cancer follow-up and four investigated psychotherapy for cancer. TM using videoconferencing systems may result in no differences in primary outcomes such as patient satisfaction (standardized mean difference, 0.11; 95% CI, -0.18 to 0.40) and outpatient attendance complete proportion (risk difference, 0.02%; 95% CI, -0.04 to 0.09), and secondary outcomes such as medical professional satisfaction, time devoted to outpatient care, and depression score. The certainty of evidence for these outcomes was low. Although the average money spent on outpatient visit was a primary outcome, the level of evidence was uncertain. CONCLUSION Our results suggest that TM using videoconferencing systems in outpatient care for patients with cancer may be as effective as usual face-to-face care. Use of TM more frequently may be considered for patients with cancer who are expected to obtain benefit from TM using videoconference systems.
Collapse
Affiliation(s)
- Yasuaki Uemoto
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Taro Yamanaka
- Department of Medical Oncology, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Sakyo-ku, Kyoto, Japan.,Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan.,Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan.,Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Yoshitaka Wada
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan
| | - Yosuke Aoyama
- Department of Medical Oncology, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Rika Kizawa
- Department of Medical Oncology, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Takeshi Yamaguchi
- Department of Medical Oncology, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Yuichiro Kikawa
- Department of Breast Surgery, Kansai Medical University Hospital, Hirakata, Japan
| | - Hirofumi Mukai
- Division of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Naruto Taira
- Department of Breast and Thyroid Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| |
Collapse
|
13
|
Williams E, Gawaya M, Terrill D. Rapid evaluation of COVID-19 related service and practice changes in health and human services using tailored methods. FRONTIERS IN SOCIOLOGY 2022; 7:959095. [PMID: 36311185 PMCID: PMC9612829 DOI: 10.3389/fsoc.2022.959095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic required substantive delivery and practice changes for government services under tight timeframes and high public scrutiny. These urgently implemented service changes provided the opportunity for evaluators to support decision-makers to understand the impact of adaptations for those delivering and receiving health and human services. Tailored rapid evaluation methods (REM) provide a pragmatic approach to generating timely information for evidence-based policy and decision-making under these conditions. Drawing from features of a range of existing rapid evaluation models, as well as developmental and utilization-focussed evaluation theory, this article outlines the design and implementation of a novel REM approach and considers the benefits of both tailoring and standardizing rapid evaluation approaches to meet end-user needs. The tailored REM approach and mixed methods are contextualized and compared to other documented rapid evaluation models to demonstrate the purpose and value of customization. This article builds on previous descriptions of the implementation of a novel REM approach to provide a comparative account of tailored rapid evaluation methods. The article outlines the drivers that led to the selected tailoring of the REM approach, and shares lessons learned in the context of the COVID-19 pandemic by a large internal government evaluation unit (Department of Health and Human Services) in Victoria, Australia. The customized features of REM ensure that it can consider the experiences of those delivering and receiving services, and inform near-term decision-making on programme and policy design in emergency and fast-paced contexts. The article shares a case study of a rapid evaluation of telehealth in pediatric care to demonstrate insights from tailoring the REM approach in practice. The REM method was utilized with the aim of delivering findings in a time-sensitive manner to rapidly inform decision making for policy-makers. Key enablers for the tailored REM protocol include the use of multi-disciplinary teams, flexible evaluation design, and a participatory approach that facilitates stakeholder involvement throughout delivery. Insights from the case study and methods presented seek to inform practice for evaluators who intend to or may want to tailor their own rapid evaluation model in resource and time-limited settings.
Collapse
Affiliation(s)
- Eleanor Williams
- Victorian Department of Health, Melbourne, VIC, Australia
- School of Political Science and International Studies, University of Queensland, Brisbane, QLD, Australia
| | - Milbert Gawaya
- Victorian Department of Health, Melbourne, VIC, Australia
| | - Desiree Terrill
- Victorian Department of Health, Melbourne, VIC, Australia
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| |
Collapse
|
14
|
Telemedicine and cancer care in India: promises, opportunities and caveats. Future Sci OA 2022; 8:FSO821. [PMID: 36788987 PMCID: PMC9912275 DOI: 10.2144/fsoa-2022-0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023] Open
Abstract
Telemedicine has revolutionized areas of medical practice and care. It has a potential in field of continuum of cancer care in India. SARS-CoV-2 has highlighted the potential use of this tool effectively. Scope of newer applications of telemedicine in field of cancer is reviewed in current paper enlisting benefits to patient, healthcare providers and centers in a developing country like India. Each of them is supported by appropriate evidence and examples. An analysis of strengths and opportunities when compared with weakness and threats brings out how telemedicine can redistribute oncology work force in a rational way and minimize disruption caused by the pandemic. Telemedicine can be utilized in cancer management starting from prevention, screening, diagnosis, treatment and rehabilitation to palliative care.
Collapse
|
15
|
Vanzella LM, Ghisi GLDM, Colella TJF, Larkin J, Vanderlei LCM, Marzolini S, Thomas S, Oh P. Physical Activity Level and Perspectives of Participants Transitioning from Onsite to Virtual Cardiac Rehabilitation during the Early COVID-19 Pandemic: A Mixed-Method Study. J Clin Med 2022; 11:jcm11164838. [PMID: 36013076 PMCID: PMC9409687 DOI: 10.3390/jcm11164838] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
This mixed-method study aimed to compare physical activity (PA) patterns of a cross-over cardiac rehabilitation (CR) cohort with a center-based CR cohort and to explore barriers and facilitators of participants transitioning and engaging in virtual CR. It included the retrospective self-reported PA of a cross-over CR cohort (n = 75) and a matched center-based CR cohort (n = 75). Some of the participants included in the cross-over cohort (n = 12) attended semi-structured focus group sessions and results were interpreted in the context of the PRECEDE-PROCEED model. Differences between groups were not observed (p > 0.05). The center-based CR cohort increased exercise frequency (p = 0.002), duration (p = 0.007), and MET/minutes (p = 0.007) over time. The cross-over cohort increased exercise duration (p = 0.04) with no significant change in any other parameters. Analysis from focus groups revealed six overarching themes classified under predisposing factors (knowledge), enabling factors (external support, COVID-19 restrictions, mental health, personal reasons/preferences), and reinforcing factors (recommendations). These findings suggest an improvement of the PA levels of center-based CR cohort participants pre-pandemic and mitigated improvement in those who transitioned to a virtual CR early in the pandemic. Improving patients’ exercise-related knowledge, provider endorsements, and the implementation of group videoconferencing sessions could help overcome barriers to participation in virtual CR.
Collapse
Affiliation(s)
- Lais Manata Vanzella
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 2V6, Canada
| | | | - Tracey Jacqueline Fitchett Colella
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 2V6, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Jillian Larkin
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5G 2W6, Canada
| | | | - Susan Marzolini
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 2V6, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5G 2W6, Canada
| | - Scott Thomas
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5G 2W6, Canada
| | - Paul Oh
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 2V6, Canada
- Correspondence: ; Tel.: +1-(416)-597-3422
| |
Collapse
|
16
|
Improving Access to Cancer Treatment Services in Australia’s Northern Territory—History and Progress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137705. [PMID: 35805361 PMCID: PMC9265828 DOI: 10.3390/ijerph19137705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 12/28/2022]
Abstract
Cancer is the leading cause of death in the Northern Territory (NT), Australia’s most sparsely populated jurisdiction with the highest proportion of Aboriginal people. Providing cancer care to the NT’s diverse population has significant challenges, particularly related to large distances, limited resources and cultural differences. This paper describes the developments to improve cancer treatment services, screening and end-of-life care in the NT over the past two decades, with a particular focus on what this means for the NT’s Indigenous peoples. This overview of NT cancer services was collated from peer-reviewed literature, government reports, cabinet papers and personal communication with health service providers. The establishment of the Alan Walker Cancer Care Centre (AWCCC), which provides radiotherapy, chemotherapy and other specialist cancer services at Royal Darwin Hospital, and recent investment in a PET Scanner have reduced patients’ need to travel interstate for cancer diagnosis and treatment. The new chemotherapy day units at Alice Springs Hospital and Katherine Hospital and the rapid expansion of tele-oncology have also reduced patient travel within the NT. Access to palliative care facilities has also improved, with end-of-life care now available in Darwin, Alice Springs and Katherine. However, future efforts in the NT should focus on increasing and improving travel assistance and support and increasing the availability of appropriate accommodation; ongoing implementation of strategies to improve recruitment and retention of health professionals working in cancer care, particularly Indigenous health professionals; and expanding the use of telehealth as a means of delivering cancer care and treatment.
Collapse
|
17
|
Collins A, McLachlan SA, Pasanen L, Wawryk O, Philip J. Perceptions of telehealth in real-world oncological care: An exploration of matched patient- and clinician-reported acceptability data from an Australian cancer centre. Cancer Med 2022; 11:3342-3351. [PMID: 35373512 PMCID: PMC9468437 DOI: 10.1002/cam4.4700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 02/04/2022] [Accepted: 02/20/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Prior to 2020, the use of telehealth in cancer care was limited, but COVID-19 necessitated its rapid and widespread adoption into routine care delivery. This study aimed to evaluate perceptions of telehealth through a dyadic exploration of matched cancer patient- and clinician-reported acceptability data and to explore factors that may predict greater suitability for telehealth. METHODS A prospective, cross-sectional, exploratory survey study assessed (matched) patient- and clinician-reported perceptions of telehealth consultations occurring at a metropolitan, tertiary-based cancer centre in Victoria, Australia. RESULTS One-hundred and fifty-five matched patient- and clinician-reported data were included. High rates of acceptability with telehealth were reported by patients (93%) and clinicians (91%), who mostly shared concordant views (86%). Factors significantly associated with increased acceptability for telehealth, included, for clinicians, greater familiarity with the patient (OR 8.20, 95% CI: 1.50-45.06, p = 0.02), and younger patient age (OR 1.06, 95% CI: 0.99-1.13, p = 0.05), and for patients was earlier stage disease (≤stage III) (OR 5.29, 95% CI: 1.08-25.82, p = 0.04). Lower acceptability for telehealth according to clinicians was associated with poorer patient performance status (OR 0.04, 95% CI 1.00-1.08, p = 0.04) and for patients with the need for an interpreter (0R 0.06, 95% CI: 0.008-0.51, p = 0.009). CONCLUSION While overall telehealth is acceptable in cancer care, our findings raise important implications for future service development, notably that it may be less optimal for patients with higher complexity of need-including those with more advanced disease, poorer performance status, those less well known to treating clinicians and those identified to have additional language barriers.
Collapse
Affiliation(s)
- Anna Collins
- Department of Medicine, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, Victoria, Australia
| | - Sue-Anne McLachlan
- Department of Medicine, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, Victoria, Australia.,Medical Oncology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Leeanne Pasanen
- Department of Medicine, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, Victoria, Australia
| | - Olivia Wawryk
- Department of Medicine, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Philip
- Department of Medicine, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, Victoria, Australia.,Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
18
|
Pow V, Iankov I, Shierlaw E, Le H. A study in patient satisfaction regarding telemedicine consultations in radiation oncology. J Med Radiat Sci 2022; 69:327-335. [PMID: 35297219 PMCID: PMC9442294 DOI: 10.1002/jmrs.577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Telemedicine consultations can be a cost‐effective and convenient method of communication, particularly with patients living in remote areas. Given the dearth of patient‐reported satisfaction data with this form of consultation in Radiation Oncology, we surveyed patients to assess this in our department. Methods The study recruited patients who had experienced both a Telemedicine consultation and an in‐person consultation with the same radiation oncologist at our tertiary centre in South Australia. Eligible patients were identified from the Royal Adelaide Hospital oncology information system. The patient satisfaction questionnaire was sent via registered post with a reply‐paid envelope. The questionnaire consisted of 38 questions divided into four major categories, focusing on communication, medical care, privacy/confidentiality and convenience. Results of the survey were tabulated in an excel spreadsheet. Results Between 1 January 2018 and 1 January 2019, 130 eligible patients were identified. One hundred and nine patients were alive and contactable of whom 37 responded (34%). Two surveys were returned incomplete resulting in 35 patient responses available for analysis. The median age was 70 years (range 35–87); 74% were male. There was no statistically significant difference between the satisfaction scores for Telemedicine and in‐person consultations with regards to communication, privacy/confidentiality or overall satisfaction. The respondent felt it was more important to be examined when the consultation was conducted in‐person and found Telemedicine consultations more convenient in terms of cost and time. Conclusion Telemedicine used in Radiation Oncology is an effective form of consultation that is convenient, provides a similar level of patient satisfaction and maintains patient confidentiality. Telemedicine consultations should therefore be considered for all rural and remote cancer patients where feasible.
Collapse
Affiliation(s)
- Vincent Pow
- Radiation Oncology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ivan Iankov
- Radiation Oncology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Emma Shierlaw
- Radiation Oncology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Hien Le
- Radiation Oncology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
19
|
Grant C, Jones A, Land H. What are the perspectives of speech pathologists, occupational therapists and physiotherapists on using telehealth videoconferencing for service delivery to children with developmental delays? A systematic review of the literature. Aust J Rural Health 2022; 30:321-336. [PMID: 35157335 PMCID: PMC9303186 DOI: 10.1111/ajr.12843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/12/2021] [Accepted: 01/11/2022] [Indexed: 12/19/2022] Open
Abstract
Objective To identify the attitudes and perspectives of speech pathologists, occupational therapists and physiotherapists on using telehealth videoconferencing for service delivery to children with developmental delays. Design Systematic Literature Review. Method An electronic search of databases Scopus, CINAHL, MEDLINE, PEDro, Speechbite, OTseeker and ScienceDirect was undertaken in October 2020. Articles were compared with eligibility criteria by 2 authors. All articles were appraised for quality and level of evidence. Findings Fourteen studies were deemed to be eligible. Results were synthesised using a narrative analysis. The themes identified were technology, self‐efficacy, replacement of face‐to‐face services, time management, relationships, access and family‐centred care. Each of these themes was seen as both a potential barrier and a facilitator when trying to provide services via telehealth. Conclusions The results in this review cannot be generalised due to small sampling size, low response rates, lack of maximum variation sampling and under‐representation of occupational therapists and physiotherapists. Study design was either mixed‐methods survey or interview or only survey or interview. Risk of bias in studies was high. Further research is required including comparison studies and cost‐benefit analysis.
Collapse
Affiliation(s)
- Claire Grant
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Anne Jones
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Helen Land
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| |
Collapse
|
20
|
Vilanilam G, Abraham M, Radhakrishnan A, Keni R, Senanayake S, Attanayake D, Muhammed Rumi J, Sai Kiran NA, Varma R, Chowdhury F, Menon R, Thomas B, Venkat E. Telecollaboration: Telementorship for epilepsy surgery services in resource: Challenged lower-middle-income countries environs – A model and proof of concept. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2022. [DOI: 10.4103/amhs.amhs_105_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
21
|
Westley S, Mistry R, Dheansa B. Accuracy of virtual assessment in hand trauma. JPRAS Open 2021; 31:92-98. [PMID: 34917733 PMCID: PMC8669340 DOI: 10.1016/j.jpra.2021.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/21/2021] [Indexed: 11/14/2022] Open
Abstract
A virtual clinic was developed from an existing telemedicine system to manage hand trauma in the Queen Victoria Hospital, East Grinstead, UK, during the first wave of the COVID-19 pandemic. This study evaluates the accuracy of the assessments made and makes comparisons to the traditional face-to-face clinic. The accuracy of assessment was analysed by comparing diagnosis with findings at surgery. One hundred and eighty-nine virtual assessments conducted by telephone with photographic data or by video were compared to 129 face-to-face assessments conducted prior to the pandemic. There was no difference in the accuracy of virtual and face-to-face clinics for patients treated surgically (p=0.27); treatment was correctly predicted for 87% of the virtual group and 78% of the face-to-face group. However, fewer virtual assessments led to a surgical outcome (p=0.0064); 68% of the virtual group had surgical outcomes compared to 82% of the face-to-face group. Most face-to-face assessments were done by a specialty trainee compared to a range of clinicians in the virtual clinic. Accuracy of assessment among trainees was significantly associated with experience for the virtual (p=0.045) but not face-to-face clinics (p=0.94). Virtual assessment by video versus telephone plus photographs were similarly accurate. We conclude that virtual triage serves as a successful alternative to face-to-face appointments. It is robust and succeeds in reducing footfall to the hospital site in line with recent social distancing measures against COVID-19. We have shown that video conferencing triage is no better than telemedicine triage with telephone and photographs.
Collapse
Affiliation(s)
- S Westley
- The Department of Plastic Surgery, The Queen Victoria Hospital, Holtye Road, East Grinstead, RH19 3DZ
| | - R Mistry
- The Department of Plastic Surgery, The Queen Victoria Hospital, Holtye Road, East Grinstead, RH19 3DZ
| | - B Dheansa
- The Department of Plastic Surgery, The Queen Victoria Hospital, Holtye Road, East Grinstead, RH19 3DZ
| |
Collapse
|
22
|
Haydon HM, Snoswell CL, Thomas EE, Broadbent A, Caffery LJ, Brydon JA, Smith AC. Enhancing a community palliative care service with telehealth leads to efficiency gains and improves job satisfaction. J Telemed Telecare 2021; 27:625-630. [PMID: 34726990 DOI: 10.1177/1357633x211048952] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Telepalliative care services enable clinicians to provide essential palliation services to people with a life-limiting illness in or closer to home. This study aims to explore the costs, service activity and staff experiences resulting from the introduction of telehealth in a community palliative care service in Queensland, Australia. Pre- and post-activity and cost data from the 2016-2017 and 2019-2020 financial years were examined and staff members interviewed. Accounting for inflation and standard wage increases, the labour costs before and after the addition of telehealth were approximately equal. There were small variations in non-labour costs, but these were not directly attributable to the expansion of the telehealth services. Overall, the service activity increased by 189% for standard doctor and nurse consultations, due to the increased efficiency of telehealth compared to the previous outreach (travel) model. Thematic analysis of the staff interview data generated an overarching theme of Increased Job Satisfaction which staff attributed to the patient-centred nature of the telepalliative care service, the increased peer support and increased professional development. Compared with the traditional in-person service, the new telehealth-supported model resulted in equivalent costs, greater efficiency by allowing palliative care to reach more patients and improved staff job satisfaction.
Collapse
Affiliation(s)
- Helen M Haydon
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Centaine L Snoswell
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Emma E Thomas
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Andrew Broadbent
- 3556Gold Coast Specialist and Supportive Palliative Care Service, Gold Coast Hospital, Australia
| | - Liam J Caffery
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Julie-Ann Brydon
- 3556Gold Coast Specialist and Supportive Palliative Care Service, Gold Coast Hospital, Australia
| | - Anthony C Smith
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
- Centre for Innovative Medical Technology, University of Southern Denmark, Denmark
| |
Collapse
|
23
|
Telephone consultation for two-week-wait ENT and head and neck cancer referrals: initial evaluation including patient satisfaction. The Journal of Laryngology & Otology 2021; 136:615-621. [PMID: 34698005 DOI: 10.1017/s0022215121003157] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
24
|
Morris BB, Rossi B, Fuemmeler B. The role of digital health technology in rural cancer care delivery: A systematic review. J Rural Health 2021; 38:493-511. [PMID: 34480506 DOI: 10.1111/jrh.12619] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Rural residents face higher cancer incidence rates and mortality rates, disparities that could be mitigated with health technology interventions, yet a digital divide is also apparent. This paper systematically and critically examines existing literature to understand how digital technologies have been used to support rural oncology care. METHODS PubMed, CINAHL Complete, PsycINFO, and Embase were searched using Medical Subject Headings terms and keywords. Studies were eligible if they presented empirical data investigating the use of technology in rural oncology and were published in English in a peer-reviewed journal within the last decade. The Mixed Methods Appraisal Tool was used to assess methodological quality. FINDINGS Digital health has been less extensively utilized in rural oncology compared with the general cancer population and other chronic diseases. We identified 54 studies that used technology in rural cancer care delivery, a comparatively small number, representing a significant gap in the literature. Studies were classified into 4 categories: Telemedicine (n = 32), phone calls (n = 11), Internet (n = 9), and mobile phone (n = 2). Of the 54 articles, 12 were RCTs, 17 were quasi-experimental, 3 were descriptive, 12 were mixed methods, and 10 were qualitative. Most of the studies involved patients only (n = 31) and were not specific to a cancer type (n = 41). CONCLUSIONS Further implementation and expansion of telemedicine and phone-based strategies in rural cancer care delivery are warranted. Rural cancer survivors value digital approaches to their care. However, social and behavioral determinants of health and access to technology must be considered.
Collapse
Affiliation(s)
- Bonny B Morris
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Brianna Rossi
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Bernard Fuemmeler
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| |
Collapse
|
25
|
Bunnell BE, Kazantzis N, Paige SR, Barrera J, Thakkar RN, Turner D, Welch BM. Provision of Care by "Real World" Telemental Health Providers. Front Psychol 2021; 12:653652. [PMID: 34025519 PMCID: PMC8138039 DOI: 10.3389/fpsyg.2021.653652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022] Open
Abstract
Despite its effectiveness, limited research has examined the provision of telemental health (TMH) and how practices may vary according to treatment paradigm. We surveyed 276 community mental health providers registered with a commercial telemedicine platform. Most providers reported primarily offering TMH services to adults with anxiety, depression, and trauma-and stressor-related disorders in individual therapy formats. Approximately 82% of TMH providers reported endorsing the use of Cognitive Behavioral Therapy (CBT) in their remote practice. The most commonly used in-session and between-session (i.e., homework) exercises included coping and emotion regulation, problem solving, mindfulness, interpersonal skills, relaxation, and modifying and addressing core beliefs. CBT TMH providers had a higher odds of using in-session and homework exercises and assigning them through postal mail, email or fax methods, as compared to non-CBT TMH providers. TMH providers, regardless of treatment paradigm, felt that assigning homework was neither easy nor difficult and they believed their patients were somewhat-to-moderately compliant to their assigned exercises. CBT TMH providers also collected clinical information from their patients more often than non-CBT TMH providers. They reported being less satisfied with their method, which was identified most often as paper-based surveys and forms. Overall, TMH providers employ evidence-based treatments to their patients remotely, with CBT TMH providers most likely to do so. Findings highlight the need for innovative solutions to improve how TMH providers that endorse following the CBT treatment paradigm remotely assign homework and collect clinical data to increase their satisfaction via telemedicine.
Collapse
Affiliation(s)
- Brian E. Bunnell
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Doxy.me Research, Doxy.me, Inc., Rochester, NYUnited States
| | - Nikolaos Kazantzis
- Cognitive Behavior Therapy Research Unit, Institute for Social Neuroscience Psychology, Melbourne, VIC, Australia
| | | | - Janelle Barrera
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Doxy.me Research, Doxy.me, Inc., Rochester, NYUnited States
| | - Rajvi N. Thakkar
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Dylan Turner
- Doxy.me Research, Doxy.me, Inc., Rochester, NYUnited States
| | - Brandon M. Welch
- Doxy.me Research, Doxy.me, Inc., Rochester, NYUnited States
- Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| |
Collapse
|
26
|
O'Cathail M, Aznar-Garcia L, Sivanandan A, Diver C, Patel P, Tang PS, Christian J. Use of Teleconsultations in a Regional Stereotactic Radiosurgery Service: Pilot Study. JMIR Form Res 2021; 5:e15598. [PMID: 33544082 PMCID: PMC7895639 DOI: 10.2196/15598] [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: 07/23/2019] [Revised: 11/27/2019] [Accepted: 12/16/2019] [Indexed: 11/13/2022] Open
Abstract
Background The National Health Service Long Term Plan details plans to make digital interactions available to all patients in 5 years. Teleconsultations can improve access to specialist services; however, there is a lack of evidence for the use of teleconsultations in an oncology setting in the United Kingdom. Objective We aim to describe a service evaluation of teleconsultations for patients attending a regional brain metastases clinic. These patients have unique travel restrictions that prevent them from driving. Methods From April to October 2018, all patients attending the brain metastases clinic were offered the choice of teleconsultation in place of a face-to-face appointment. Feedback was assessed using a satisfaction questionnaire, and data of all clinic attendances were collected. Results A total of 69 individual patients had 119 appointments over the duration of the pilot, of which 36 (30.2%) were new patient appointments and 73 (61.3%) were follow-ups. Of the 69 patients, 24 (35%) took part in teleconsultations (41/119, 34.5%). User satisfaction was high, and no patients who took part in a teleconsultation reverted to face-to-face appointments. These patients avoided 2521 miles (61.6 miles per appointment) of hospital-associated travel and travel costs of £441.48 (US $599.83) to £10.78 (US $14.65) per appointment. Conclusions Teleconsultations appear to be acceptable in this cohort of patients with brain metastases attending a regional stereotactic radiosurgery service with the potential for significant savings in travel and expenses.
Collapse
Affiliation(s)
- Micheal O'Cathail
- Department of Oncology & Radiotherapy, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom.,School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Luis Aznar-Garcia
- Department of Oncology & Radiotherapy, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Ananth Sivanandan
- Department of Oncology & Radiotherapy, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Claire Diver
- School of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Poulam Patel
- Department of Oncology & Radiotherapy, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom.,School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Pui-Shan Tang
- East Midlands Academic Health Science Network, Nottingham, United Kingdom
| | - Judith Christian
- Department of Oncology & Radiotherapy, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| |
Collapse
|
27
|
O'Reilly D, Carroll H, Lucas M, Sui J, Al Sendi M, McMahon D, Darwish W, McLaughlin R, Khan MR, Sullivan HO, Chew S, Dennehy C, Kelly CM, McCaffrey J, Greally M, Carney D, Higgins MJ. Virtual oncology clinics during the COVID-19 pandemic. Ir J Med Sci 2021; 190:1295-1301. [PMID: 33449331 PMCID: PMC7809230 DOI: 10.1007/s11845-020-02489-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/17/2020] [Indexed: 02/08/2023]
Abstract
Background The COVID-19 pandemic has resulted in radical changes in the delivery of healthcare worldwide. Our oncology service (at an Irish national cancer centre) rapidly transitioned to the use of telemedicine or virtual clinics (VC) to minimise potential risk of exposure to COVID-19 amongst an immunosuppressed, high-risk population. Our study aimed to evaluate the use of VC in this setting. Methods An 18-point questionnaire was designed to investigate the patient experience of VC during the COVID-19 pandemic in Ireland and compliance with guidelines developed in Ireland to conduct VC and the role of VC in the future. Questionnaires were distributed following the receipt of verbal consent from patients during the VC. Descriptive statistics were utilised for data analysis using SPSS®. Results One hundred and four patients returned completed surveys (n = 104/164, 63% response rate). Overall satisfaction levels were high with most patients (n = 58/100, 58%; no answer provided (NAP), n = 4) equally satisfied or nearly equally satisfied with VC in comparison to a usual clinic encounter. The majority of patients felt that there should be a role for VC in the future (n = 84/102, 82%; NAP, n = 2). The majority of patients (n = 61/99, 61%; NAP, n = 5) were very relieved to avoid a hospital visit due to perceived risk of potential exposure to COVID-19. Conclusion The majority of oncology patients were satisfied with a VC encounter. VC may have a role in the future of medical care in Ireland post the COVID-19 pandemic.
Collapse
Affiliation(s)
- David O'Reilly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland.
| | - Hailey Carroll
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Mairi Lucas
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Jane Sui
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Maha Al Sendi
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - David McMahon
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Waseem Darwish
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Ronan McLaughlin
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Mohammed Raza Khan
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Hazel O Sullivan
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Sonya Chew
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Colum Dennehy
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Catherine M Kelly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - John McCaffrey
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Megan Greally
- Department of Medical Oncology, Mater Private Hospital, Eccles Street, Dublin, 7, Ireland
| | - Desmond Carney
- Department of Medical Oncology, Mater Private Hospital, Eccles Street, Dublin, 7, Ireland
| | - Michaela J Higgins
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| |
Collapse
|
28
|
Heyer A, Granberg RE, Rising KL, Binder AF, Gentsch AT, Handley NR. Medical Oncology Professionals' Perceptions of Telehealth Video Visits. JAMA Netw Open 2021; 4:e2033967. [PMID: 33443581 PMCID: PMC7809588 DOI: 10.1001/jamanetworkopen.2020.33967] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE Telehealth has emerged as a means of improving access and reducing cost for medical oncology care; however, use by specialists prior to the coronavirus disease 2019 (COVID-19) pandemic still remained low. Medical oncology professionals' perceptions of telehealth for cancer care are largely unknown, but are critical to telehealth utilization and expansion efforts. OBJECTIVE To identify medical oncology health professionals' perceptions of the barriers to and benefits of telehealth video visits. DESIGN, SETTING, AND PARTICIPANTS This qualitative study used interviews conducted from October 30, 2019, to March 5, 2020, of medical oncology health professionals at the Thomas Jefferson University Hospital, an urban academic health system in the US with a cancer center. All medical oncology physicians, physicians assistants, and nurse practitioners at the hospital were eligible to participate. A combination of volunteer and convenience sampling was used, resulting in the participation of 29 medical oncology health professionals, including 20 physicians and 9 advanced practice professionals, in semistructured interviews. MAIN OUTCOMES AND MEASURES Medical oncology health professionals' perceptions of barriers to and benefits of telehealth video visits as experienced by patients receiving cancer treatment. RESULTS Of the 29 participants, 15 (52%) were women and 22 (76%) were White, with a mean (SD) age of 48.5 (12.0) years. Respondents' perceptions were organized using the 4 domains of the National Quality Forum framework: clinical effectiveness, patient experience, access to care, and financial impact. Respondents disagreed on the clinical effectiveness and potential limitations of the virtual physical examination, as well as on the financial impact on patients. Respondents also largely recognized the convenience and improved access to care enabled by telehealth for patients. However, many reported concern regarding the health professional-patient relationship and their limited ability to comfort patients in a virtual setting. CONCLUSIONS AND RELEVANCE Medical oncology health professionals shared conflicting opinions regarding the barriers to and benefits of telehealth in regard to clinical effectiveness, patient experience, access to care, and financial impact. Understanding oncologists' perceptions of telehealth elucidates potential barriers that need to be further investigated or improved for telehealth expansion and continued utilization; further research is ongoing to assess current perceptions of health professionals and patients given the rapid expansion of telehealth during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Arianna Heyer
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | | | - Kristin L. Rising
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Adam F. Binder
- Sidney Kimmel Cancer Center, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexzandra T. Gentsch
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Nathan R. Handley
- Sidney Kimmel Cancer Center, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
29
|
Datta NR, Datta S, Samiei M. Strategies to Maximize Available Resources With Minimum Cost Escalation for Improving Radiation Therapy Accessibility in the Post-Coronavirus Disease 2019 Era: An Analysis for Asia. Adv Radiat Oncol 2021; 6:100565. [PMID: 32995668 PMCID: PMC7513874 DOI: 10.1016/j.adro.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/01/2020] [Accepted: 09/11/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE There is widespread accord among economists that the corona virus disease 2019 (COVID-19) pandemic will have a severe negative effect on the global economy. Establishing new radiation therapy (RT) infrastructure may be significantly compromised in the post-COVID-19 era. Alternative strategies are needed to improve the existing RT accessibility without significant cost escalation. The outcomes of these approaches on RT availability have been examined for Asia. METHODS AND MATERIALS The details of RT infrastructures in 2020 for 51 countries in Asia were obtained from the Directory of Radiotherapy Centers of the International Atomic Energy Agency. Using the International Atomic Energy Agency guidelines, the percent of RT accessibility and the additional requirements of teletherapy (TRT) units were computed for these countries. To maximize the utilization of the existing RT facilities, 5 options were evaluated, namely, hypofractionation RT (HFRT) alone, with/without 25% or 50% additional working hours. The effect of these strategies on the percent of RT access and additional TRT unit requirements to achieve 100% RT access were estimated. RESULTS In 46 countries, 4617 TRT units are available. The mean percent of RT accessibility is 62.4% in 43 countries (TRT units = 4491) where the information on cancer incidence was also available, and these would need an additional 6474 TRT units for achieving 100% RT accessibility. By adopting HFRT alone, increasing the working hours by 25% alone, 25% with HFRT, 50% alone, and 50% with HFRT, the percent of RT access could improve to 74.9%, 78%, 90.5%, 93.7%, and 106.1%, respectively. Correspondingly, the need for additional TRT units would progressively decrease to 4646, 4284, 3073, 2820, and 1958 units. CONCLUSIONS The economic slowdown in the post-COVID-19 period could severely impend establishment of new RT facilities. Thus, maximal utilization of the available RT infrastructure with minimum additional costs could be possible by adopting HFRT with or without increased working hours to improve the RT coverage.
Collapse
Affiliation(s)
- Niloy R. Datta
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Switzerland
| | - Sneha Datta
- Independent Researcher, London, United Kingdom
| | - Massoud Samiei
- International Atomic Energy Agency (IAEA), Vienna, Austria
| |
Collapse
|
30
|
Ngwa W, Olver I, Schmeler KM. The Use of Health-Related Technology to Reduce the Gap Between Developed and Undeveloped Regions Around the Globe. Am Soc Clin Oncol Educ Book 2020; 40:1-10. [PMID: 32223667 DOI: 10.1200/edbk_288613] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cancer is the second leading cause of death worldwide, with approximately 70% of the 9.6 million deaths per year occurring in low- and middle-income countries (LMICs), where there is critical shortage of human and material resources or infrastructure to deal with cancer. If the current trend continues, the burden of cancer is expected to increase to 22 million new cases annually by 2030, with 81% of new cases and almost 88% of mortality occurring in LMICs. Global health places a priority on improving health and reducing these disparities to achieve equity in health for all people worldwide. In today's hyper-connected world, information and communication technologies (ICTs) will increasingly play an integral role in global health. Here, we focus on how the use of health-related technology, specifically ICTs and artificial intelligence (AI), can help in closing the gap between high-income countries (HICs) and LMICs in cancer care, research, and education. Key examples are highlighted on the use of telemedicine and tumor boards, as well as other online resources that can be leveraged to advance global health.
Collapse
Affiliation(s)
- Wilfred Ngwa
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Ian Olver
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
31
|
Nightingale J, Travers L, Campbell J, Huang J, Green M, Warren T, Fitzgerald G. Outpatient surgical management of non-melanoma skin cancers of the head and neck in a regional centre: an analysis of costs and outcomes. ANZ J Surg 2020; 91:139-144. [PMID: 33205533 DOI: 10.1111/ans.16433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Non-melanoma skin cancer is the most commonly diagnosed malignancy in Australia. Lesions of the head and neck are often outside the scope of primary care providers. The challenges of cancer care in regional Australia necessitate careful resource planning. This study presents an outpatient model that minimizes health service cost with local general practitioner follow-up. METHODS A retrospective review of 105 patients with 122 skin lesions in a dedicated Facial Lesion Assessment Management and Excision clinic was performed from July 2018 to 2019. Clinical outcomes, patient travel and cost analysis/comparison were recorded. RESULTS There were 85 malignant cases with 59 basal cell carcinomas and 25 squamous cell carcinomas. For basal cell carcinoma, clear margins (≥3 mm), close margins (<3 mm) and positive margins were achieved in 24 (48%), 23 (46%) and three (6%) cases, respectively. For squamous cell carcinoma, clear margins (≥5 mm), close margins (<5 mm) and positive margins were achieved in seven (38.8%), 11 (61.1%) and none (0%) of the cases, respectively. Complications included one haematoma and two wound infections. For 37% of patients living >100 km from the department, 72.3% had local general practitioner follow-up. Inpatient cost was $2870, $5697 and $9300 for primary closure, local flap and full-thickness skin graft, respectively, and outpatient cost was $746 for a single facial lesion. CONCLUSION This study presents a cost-effective model for the management of non-melanoma skin cancers with improved departmental efficiency and streamlined patient care in an outpatient skin cancer management model in a regional centre.
Collapse
Affiliation(s)
- James Nightingale
- Ear, Nose and Throat, Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Liam Travers
- Ear, Nose and Throat, Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
| | - Jakob Campbell
- Ear, Nose and Throat, Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
| | - Johnson Huang
- Ear, Nose and Throat, Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
| | - Megan Green
- Ear, Nose and Throat, Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
| | - Tim Warren
- Ear, Nose and Throat, Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
| | - Garret Fitzgerald
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
32
|
Acceptability of Telemedicine Features to Promote Its Uptake in Practice: A Survey of Community Telemental Health Providers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228525. [PMID: 33212979 PMCID: PMC7698537 DOI: 10.3390/ijerph17228525] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 12/27/2022]
Abstract
Understanding what motivates mental health providers to use telemedicine (i.e., telemental health) is critical for optimizing its uptake, especially during unprecedented times (e.g., the COVID-19 pandemic). Drawing from the Technology Acceptance Model (TAM), this report examined the characteristics of telemental health providers and how the acceptability of telemedicine features contributes to their intention to use the technology more often in practice. Telemental health providers (N = 177) completed an online survey between March and May 2019. Most providers (75%) spent less than 25% of their work-week using telemedicine, but 70% reported an intention to use telemedicine more in the future. The belief that telemedicine affords greater access to patients, work-life balance, flexibility in providing care, and the opportunity to be at the forefront of innovative care were significant predictors of intentions to use the technology more in the future. Other significant predictors included needing assistance to coordinate insurance reimbursements, manage a successful telemedicine practice, and integrate the telemedicine program with other health IT software. Findings have important implications for increasing the frequency of telemedicine use among telemental health providers. Future research and practice should leverage providers' positive beliefs about telemedicine acceptability and consider their needs to enhance its uptake.
Collapse
|
33
|
Abstract
Obstructive sleep apnea (OSA) telehealth management may improve initial and chronic care access, time to diagnosis and treatment, between-visit care, e-communications and e-education, workflows, costs, and therapy outcomes. OSA telehealth options may be used to replace or supplement none, some, or all steps in the evaluation, testing, treatments, and management of OSA. All telehealth steps must adhere to OSA guidelines. OSA telehealth may be adapted for continuous positive airway pressure (CPAP) and non-CPAP treatments. E-data collection enhances uses for individual and group analytics, phenotyping, testing and treatment selections, high-risk identification and targeted support, and comparative and multispecialty therapy studies.
Collapse
|
34
|
Maurice AP, Punnasseril JEJ, King SE, Dodd BR. Improving Access to Bariatric Surgery for Rural and Remote Patients: Experiences from a State-Wide Bariatric Telehealth Service in Australia. Obes Surg 2020; 30:4401-4410. [PMID: 32617921 PMCID: PMC7331914 DOI: 10.1007/s11695-020-04804-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/08/2020] [Accepted: 06/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The state of Queensland, Australia, is large (1.85 million km2). The provision of bariatric care across the state is difficult as most major hospitals are concentrated in the capital city of Brisbane. We implemented a state-wide telehealth service to improve access for rural patients in a public bariatric service. We report our early experiences with this service. METHODS We reviewed all patients seen in the Bariatric Telehealth Clinic from 2017 to 2019. Patients underwent consultation through video-link software at their local hospital with the multidisciplinary team in Brisbane (surgeon, dietician and clinical nurse). Distances from Brisbane and number of visits were calculated. Telehealth patients were contacted by phone to complete a survey regarding their experiences. This was a 17-question Likert-style survey with scores from 1 (strongly disagree) to 5 (strongly agree). RESULTS A total of 85 new patients underwent their initial consultation via telehealth. Each patient had a variable number of in-person as well as telehealth consultations both before and after surgery. Mean distance from telehealth consultation site to Brisbane was 614 km (range 149-2472 km). In total, 41 (48%) completed the survey. With regard to telehealth saving time and money, improving access to bariatric care, and desire to use telehealth again, the mean score was 4 out of 5 or higher for all questions (i.e., agree or strongly agree). There was no identifiable post-operative complication that was caused or exacerbated by telehealth. CONCLUSION Bariatric surgical telehealth appointments are feasible and preferred by most patients residing in rural and remote locations. Each consultation avoids significant travel time and cost for the patient and health service, with no obvious adverse outcomes. Telehealth improves equity and access to specialist services for rural and remote patients.
Collapse
Affiliation(s)
- Andrew Phillip Maurice
- Department of Upper Gastrointestinal and Bariatric Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
- Discipline of Surgery, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Jaisil Eldo Joseph Punnasseril
- Department of Upper Gastrointestinal and Bariatric Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Discipline of Surgery, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Emily King
- Department of Upper Gastrointestinal and Bariatric Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Discipline of Surgery, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Benjamin Rees Dodd
- Department of Upper Gastrointestinal and Bariatric Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Discipline of Surgery, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
35
|
Barreto SG. Pancreatic cancer in Australia: is not it time we address the inequitable resource problem? Future Oncol 2020; 16:1385-1392. [PMID: 32412798 DOI: 10.2217/fon-2020-0109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The present study reviewed the geographical variations in the delivery of pancreatic cancer therapy and whether this impacts overall survival. The evidence suggests a difference in the accessibility of pancreatic cancer care to patients in rural as compared with urban Australia. While centralization of pancreatic surgery is essential to deliver high quality care to patients, it may be interfering with the ease of access of this form of care to patients in regional areas. Access to chemotherapy in regional Australia is also limited. There is need for a concerted effort to improve the overall care and uptake of medical services to patients in metropolitan and remote Australia with the overarching aim of improving survival and meaningful quality of life.
Collapse
Affiliation(s)
- Savio George Barreto
- Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia.,College of Medicine & Public Health, Flinders University, South Australia, Australia
| |
Collapse
|
36
|
Lugo VM, Garmendia O, Suarez-Girón M, Torres M, Vázquez-Polo FJ, Negrín MA, Moraleda A, Roman M, Puig M, Ruiz C, Egea C, Masa JF, Farré R, Montserrat JM. Comprehensive management of obstructive sleep apnea by telemedicine: Clinical improvement and cost-effectiveness of a Virtual Sleep Unit. A randomized controlled trial. PLoS One 2019; 14:e0224069. [PMID: 31647838 PMCID: PMC6812794 DOI: 10.1371/journal.pone.0224069] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/25/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction Obstructive sleep apnea (OSA) is a prevalent disease associated with significant morbidity and high healthcare costs. Information and communication technology could offer cost-effective management options. Objectives To evaluate an out-of-hospital Virtual Sleep Unit (VSU) based on telemedicine to manage all patients with suspected OSA, including those with and without continuous positive airway pressure (CPAP) therapy. Methods This was an open randomized controlled trial. Patients with suspected OSA were randomized to hospital routine (HR) or VSU groups to compare the clinical improvement and cost-effectiveness in a non-inferiority analysis. Improvement was assessed by changes in the Quebec Sleep Questionnaire (QSQ), EuroQol (EQ-5D and EQ-VAS), and Epworth Sleepiness Scale (ESS). The follow-up was 3 months. Cost-effectiveness was assessed by a Bayesian analysis based on quality-adjusted life-years (QALYs). Results The HR group (n: 92; 78% OSA, 57% CPAP) compared with the VSU group (n: 94; 83% OSA, 43% CPAP) showed: CPAP compliance was similar in both groups, the QSQ social interactions domain improved significantly more in the HR group whereas the EQ-VAS improved more in the VSU group. Total and OSA-related costs were lower in the VSU group than the HR. The Bayesian cost-effectiveness analysis showed that VSU was cost-effective for a wide range of willingness to pay for QALYs. Conclusions The VSU offered a cost-effective means of improving QALYs than HR. However, the assessment of its clinical improvement was influenced by the choice of the questionnaire; hence, additional measurements of clinical improvement are needed. Our findings indicate that VSU could help with the management of many patients, irrespective of CPAP use.
Collapse
Affiliation(s)
- Vera M. Lugo
- Sleep Unit, Respiratory Department, Hospital Clínic, Barcelona, Spain
| | - Onintza Garmendia
- Sleep Unit, Respiratory Department, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Madrid, Spain
| | - Monique Suarez-Girón
- Sleep Unit, Respiratory Department, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Madrid, Spain
| | - Marta Torres
- Sleep Unit, Respiratory Department, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Madrid, Spain
- Biophysics and Bioengineering Department, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francisco J. Vázquez-Polo
- Quantitative Methods Department and TiDES Institute, Las Palmas de Gran Canaria University, Las Palmas de Gran Canaria, Spain
| | - Miguel A. Negrín
- Quantitative Methods Department and TiDES Institute, Las Palmas de Gran Canaria University, Las Palmas de Gran Canaria, Spain
| | - Anabel Moraleda
- Sleep Unit, Respiratory Department, Hospital Clínic, Barcelona, Spain
| | - Mariana Roman
- Sleep Unit, Respiratory Department, Hospital Clínic, Barcelona, Spain
| | - Marta Puig
- Sleep Unit, Respiratory Department, Hospital Clínic, Barcelona, Spain
| | - Concepcion Ruiz
- Sleep Unit, Respiratory Department, Hospital Clínic, Barcelona, Spain
| | - Carlos Egea
- Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Madrid, Spain
- Sleep Unit, Respiratory Department, Alava University Hospital, Vitoria, Spain
| | - Juan F. Masa
- Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Madrid, Spain
- Respiratory Unit, San Pedro de Alcántara Hospital, Cáceres, Spain
- Instituto Universitario de investigación Biosanitaria de Extremadura, Cáceres, Spain
| | - Ramon Farré
- Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Madrid, Spain
- Biophysics and Bioengineering Department, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Josep M. Montserrat
- Sleep Unit, Respiratory Department, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Madrid, Spain
- Institut d’Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Medicine Department, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- * E-mail:
| |
Collapse
|
37
|
Implementation of the Australasian Teletrial Model: Lessons from practice. Asia Pac J Clin Oncol 2019; 15 Suppl 8:3-14. [DOI: 10.1111/ajco.13249] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
38
|
Aitken P. Aeromedical services in Australia: a vision shared. Med J Aust 2019; 211:348-349. [PMID: 31595511 DOI: 10.5694/mja2.50364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Peter Aitken
- Health Disaster Management Unit, Queensland Health, Brisbane, QLD.,Queensland University of Technology, Brisbane, QLD
| |
Collapse
|
39
|
Bertucci F, Le Corroller-Soriano AG, Monneur A, Fluzin S, Viens P, Maraninchi D, Goncalves A. [E-health and "Cancer outside the hospital walls", Big Data and artificial intelligence]. Bull Cancer 2019; 107:102-112. [PMID: 31543271 DOI: 10.1016/j.bulcan.2019.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/15/2019] [Accepted: 07/04/2019] [Indexed: 12/25/2022]
Abstract
To heal otherwise in oncology has become an imperative of Public Health and an economic imperative in France. Patients can therefore receive live most of their care outside of hospital with more ambulatory care. This ambulatory shift will benefit from the digital revolution and the development of digital health or e-health. Cancer research will also benefit with Big Data and artificial intelligence, which gather and analyze a huge amount of data. In this synthesis, we describe the different e-health tools and their potential impacts in oncology, at the levels of education and information of patients and caregivers, prevention, screening and diagnosis, treatment, follow-up, and research. A few randomized studies have already demonstrated clinical benefits. Large Big Data projects such as ConSoRe and Health Data Hub have been launched in France. We also discuss the issues and limitations of "cancer outside the hospital walls and e-health" from the point of view of patients, health care professionals, health facilities and government. This new organization will have to provide remote support "outside the walls" with care and follow-up of quality, continuous and prolonged in total safety and equity. Ongoing and future randomized clinical trials will need to definitively demonstrate areas of interest, advantages and drawbacks not only for patients, but also for caregivers, health facilities and governments.
Collapse
Affiliation(s)
- François Bertucci
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France.
| | - Anne-Gaëlle Le Corroller-Soriano
- Aix-Marseille université, SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, Inserm UMR912, 13009 Marseille, France
| | - Audrey Monneur
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France
| | - Sylvain Fluzin
- Institut Paoli-Calmettes, direction du système d'information et de l'organisation, 13009 Marseille, France
| | - Patrice Viens
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France
| | - Dominique Maraninchi
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France
| | - Anthony Goncalves
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France
| |
Collapse
|
40
|
Asano M, Tai BC, Yeo FY, Yen SC, Tay A, Ng YS, De Silva DA, Caves K, Chew E, Hoenig H, Koh GC. Home-based tele-rehabilitation presents comparable positive impact on self-reported functional outcomes as usual care: The Singapore Tele-technology Aided Rehabilitation in Stroke (STARS) randomised controlled trial. J Telemed Telecare 2019; 27:231-238. [PMID: 31462136 DOI: 10.1177/1357633x19868905] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of this research was to evaluate the impact of a novel tele-rehabilitation system on self-reported functional outcomes compared to usual care during the first three months after stroke. METHODS A parallel, two-arm, evaluator-blinded, randomised controlled trial was conducted. Adults aged ≥40 years who had suffered a stroke within four weeks of the start of the study were recruited from the general community. The intervention group received access to a novel tele-rehabilitation system and programme for three months. The primary outcome measures utilised were the frequency and limitation total scores of the Late-Life Function and Disability Instrument (LLFDI) at three months. RESULTS A total of 124 individuals were recruited. The mean differences in the LLDFI frequency and limitation total scores at three months comparing the intervention and control groups were -3.30 (95% confidence interval (CI) -7.81 to 1.21) and -6.90 (95% CI -15.02 to 1.22), respectively. Adjusting for the respective baseline covariates and baseline Barthel Index also showed no significant difference between interventions in the LLFDI outcomes. DISCUSSION The intervention and control groups self-reported similar improvements in functional outcomes. Tele-rehabilitation may be a viable option to provide post-stroke rehabilitation services in Singapore while reducing barriers to continue rehabilitation conventionally after discharge from hospital and encouraging more participation.
Collapse
Affiliation(s)
- Miho Asano
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore
| | - Bee C Tai
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore
| | - Felicity Yt Yeo
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore
| | - Shi C Yen
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore
| | - Arthur Tay
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore
| | - Yee S Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore
| | | | - Kevin Caves
- Department of Surgery, Duke University Medical Center, USA
| | - Eiffie Chew
- Department of Rehabilitation Medicine, National University Hospital, Singapore
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham Veterans Affairs Medical Center, USA.,Department of Medicine, Duke University Medical Center, USA
| | - Gerald C Koh
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore
| |
Collapse
|
41
|
Cottrell M, Judd P, Comans T, Easton P, Chang AT. Comparing fly-in fly-out and telehealth models for delivering advanced-practice physiotherapy services in regional Queensland: An audit of outcomes and costs. J Telemed Telecare 2019; 27:32-38. [PMID: 31280639 DOI: 10.1177/1357633x19858036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Recruitment of advanced-practice physiotherapists to regional and rural healthcare facilities in Queensland, Australia remains a challenge. To overcome this barrier, two different service delivery models (Fly-In, Fly-Out (FIFO), Telehealth) were trialled by one regional facility. This study aims to describe the economic- and service-related outcomes of these two methods of service delivery. METHODS A retrospective audit was conducted where two nine-week time periods were selected for each service delivery model. Outcomes of interests include patient demographics and case-mix, service utilisation, clinical actions, adverse events and costs. Net financial position for both models was calculated based upon costs incurred and revenue generated by service activity. RESULTS A total of 33 appointment slots were recorded for each service delivery model. Patient case-mix was variable, where the Telehealth model predominately involved patients with musculoskeletal spinal conditions managed from a neurosurgical waiting list. Appointment slot utilisation and pattern of referral for further investigations were similar between models. No safety incidents occurred in either service delivery model. An estimated cost-savings of 13% for the Telehealth model could be achieved when compared to the FIFO model. DISCUSSION Telehealth is a safe, efficient and viable option when compared to a traditional in-person outreach service, while providing cost-savings. Telehealth should be seen as a service delivery medium in which sustainable recruitment of advanced-practice physiotherapists to regional and rural healthcare facilities can be achieved.
Collapse
Affiliation(s)
- Michelle Cottrell
- Physiotherapy Department, Royal Brisbane & Women's Hospital, Australia
| | - Perry Judd
- Physiotherapy Department, Royal Brisbane & Women's Hospital, Australia
| | - Tracy Comans
- Centre for Health Services Research, University of Queensland, Australia
| | - Paula Easton
- Physiotherapy Department, Mackay Base Hospital, Australia
| | - Angela T Chang
- Centre for Allied Health Research, Royal Brisbane & Women's Hospital, Australia
| |
Collapse
|
42
|
Vinayagamoorthy K, Acharya S, Kumar M, Pentapati KC, Acharya S. Efficacy of a remote screening model for oral potentially malignant disorders using a free messaging application: A diagnostic test for accuracy study. Aust J Rural Health 2019; 27:170-176. [PMID: 30942518 DOI: 10.1111/ajr.12496] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 10/16/2018] [Accepted: 12/02/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To assess the feasibility of using a remote sensing model as a free messaging application tool in the preventive screening of oral potentially malignant disorders in a rural area of India. DESIGN An observational cross-sectional study. SETTING Primary care setting in Udupi District, Karnataka, South India. PARTICIPANTS One-hundred and thirty-one individuals with a mean (SD) age of 37.34 (11.31) years, of whom 64.1% and 35.9% were men and women, respectively. INTERVENTIONS Clinical oral examination followed by photo capture of five areas of the patients' mouth. MAIN OUTCOME MEASURES Reliability measures for the use of a photo messaging service in diagnosing oral potentially malignant disorders, as compared to the clinical examination. RESULTS When lesions were categorised as normal and abnormal, the reliability (kappa) between the diagnoses, based on photo messaging and clinical oral examination, was 0.68 and 0.67 for Examiners 1 and 2, respectively. The sensitivity values for Examiners 1 and 2 were 98.5% and 99.04%, respectively, whereas the specificity was 72% and 64%, respectively. When the agreement between photo messaging and clinical oral examination for an exact diagnostic match was assessed, the reliability (kappa) was 0.59 and 0.55 for Examiners 1 and 2, respectively. The sensitivity values for Examiners 1 and 2 were 98.1% and 98.7%, respectively, whereas the specificity was 64% and 52% respectively. CONCLUSION There was a substantial agreement between the diagnosis based on clinical examination and WhatsApp image for both the examiners, when the lesions were dichotomised as normal and abnormal, but slightly reduced when assessed for the exact diagnostic match. Screening for oral potentially malignant disorders using photo messaging can serve as an effective adjunct and a potential cost-effective tool in a low-resource setting.
Collapse
Affiliation(s)
- Kalaiselvi Vinayagamoorthy
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Shruthi Acharya
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Mathangi Kumar
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Kalyana Chakravarthy Pentapati
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Shashidhar Acharya
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
43
|
Outpatient Cancer Care Delivery in the Context of E-Oncology: A French Perspective on "Cancer outside the Hospital Walls". Cancers (Basel) 2019; 11:cancers11020219. [PMID: 30769858 PMCID: PMC6406853 DOI: 10.3390/cancers11020219] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/06/2019] [Accepted: 02/10/2019] [Indexed: 01/21/2023] Open
Abstract
In oncology, the treatment of patients outside of hospitals has become imperative due to an increasing number of patients who are older and live longer, along with issues such as medical desertification, oncologist hyperspecialization, and difficulties in financing mounting health expenditures. Treatments have become less "invasive", with greater precision and efficiency. Patients can therefore receive most of their care outside of hospitals. The development of e-health can address these new imperatives. In this letter, we describe the different e-health tools and their potential clinical impacts in oncology, as already reported at every level of care, including education, prevention, diagnosis, treatment, and monitoring. A few randomized studies have yet demonstrated the clinical benefit. We also comment on issues and limits of "cancer outside the hospital walls" from the point of view of patients, health care professionals, health facilities, and public authorities. Care providers in hospitals and communities will have to adapt to these changes within well-coordinated networks in order to better meet patient expectations regarding increasing education and personalizing management. Ultimately, controlled studies should aim to definitively demonstrate areas of interest, benefits, and incentives, for not only patients, but also caregivers (formal and informal) and health care providers, health care facilities, and the nation.
Collapse
|
44
|
Onuma AE, Palmer Kelly E, Chakedis J, Paredes AZ, Tsilimigras DI, Wiemann B, Johnson M, Merath K, Akgul O, Cloyd J, Pawlik TM. Patient preferences on the use of technology in cancer surveillance after curative surgery: A cross-sectional analysis. Surgery 2019; 165:782-788. [PMID: 30770135 DOI: 10.1016/j.surg.2018.12.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Advances in communication technology have enabled new methods of delivering test results to cancer survivors. We sought to determine patient preferences regarding the use of newer technology in delivering test results during cancer surveillance. METHODS A single institutional, cross-sectional analysis of the preferences of adult cancer survivors regarding the means (secure digital communication versus phone call or office visit) to receive surveillance test results was undertaken. RESULTS Among 257 respondents, the average age was 59.1 years (SD 13.5) and 61.8% were female. Common malignancies included melanoma/sarcoma (29.5%), thyroid (25.7%), breast (22.8%), and gastrointestinal (22.0%) cancer. Although patients expressed a relative preference to receive normal surveillance results via MyChart or secure e-mail, the majority preferred abnormal imaging (87.2%) or blood results (85.9%) to be communicated by in-office appointments or phone calls irrespective of age or cancer type. Patients with a college degree or higher were more likely to prefer electronic means of communication of abnormal blood results compared with a telephone call or in-person visit (odds ratio 2.18, 95% confidence interval: 1.01-4.73, P < .05). In contrast, patients >65 years were more likely to express a preference for telephone or in-person communication of normal imaging results (odds ratio: 2.03, 95% CI: 1.16-3.56, P < .05) versus patients ≤65 years. Preference also varied according to malignancy type. CONCLUSION Although many cancer patients preferred to receive "normal" surveillance results electronically, the majority preferred receiving abnormal results via direct conversation with their provider. Shifting routine communication of normal surveillance results to technology-based applications may improve patient satisfaction and decrease health care system costs.
Collapse
Affiliation(s)
- Amblessed E Onuma
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
| | | | - Jeffery Chakedis
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Anghela Z Paredes
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
| | | | - Brianne Wiemann
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Morgan Johnson
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Katiuscha Merath
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Ozgur Akgul
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus.
| |
Collapse
|
45
|
He C, Zhou Q, Chen W, Tian J, Zhou L, Peng H, Luan S, Wang S. Using an Internet-Based Hospital to Address Maldistribution of Health Care Resources in Rural Areas of Guangdong Province, China: Retrospective and Descriptive Study. JMIR Med Inform 2018; 6:e51. [PMID: 30578195 PMCID: PMC6320436 DOI: 10.2196/medinform.9495] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 04/30/2018] [Accepted: 07/20/2018] [Indexed: 11/15/2022] Open
Abstract
Background Health care maldistribution is a long-term problem in China. Telemedicine is an efficient way to deliver medical resources to remote areas; however, there are few studies on the effectiveness and challenges in providing health care from rural to urban areas in China. Objective The objective was to describe the effectiveness and challenges of telemedicine for providing health care from Guangzhou to rural areas in Guangdong Province. Methods We designed surveys and conducted them immediately after the consultation and 2-4 weeks later. Data were collected from June 2015 to May 2016 including patients’ demographic features, patient satisfaction, medicine effect, patient compliance, acceptability of prescription expenses, patients’ desire to revisit the department, the top 10 diseases, and self-reported difficulties in telemedicine experience. The monthly average prescription expense was described using a line chart. The monthly consultation and prescription, as well as monthly prescriptions of Western medicines and herbs, were described using a bar chart. Results Women comprised majority (45,386/67,740, 67.00%) of participants and men comprised the minority (22,354/67,740, 33.00%). The top 3 diseases were upper respiratory diseases (12,371/36,311, 34.07%), laryngopharyngitis (4938/36,311, 13.60%), and menstrual disorders (4669/36,311, 12.86%). The monthly prescription for Western medicine was much more than that for Chinese herbs. The annual average medicine expense per prescription was 62.9 ¥. The participants’ perception of expense was acceptable (8775/12,450, 70.48%), mostly acceptable (2497/12,450, 20.01%), accepted but somewhat expensive (980/12,450, 7.9%), and unacceptable because of high cost (198/12,450, 1.6%). The surveys on patient satisfaction demonstrated very satisfied (55,687/67,740, 82.21%), satisfied (5891/67,740, 8.70%), basic satisfaction (3561/67,740, 5.26%), dissatisfaction (1454/67,740, 2.15%), and no comment (1147/67,740, 1.69%). Participants reported their treatment outcome as follows: full recovery (5008/12,450, 40.22%), recovering (4873/12,450, 39.14%), no effect (2153/12,450, 17.29%), or worsening (416/12,450, 3.3%). Approximately 89.01% (20,240/22,740) of participants will revisit the department, whereas 10.99% (2500/22,740) will not. Most patients complied with the doctors’ advice completely (5430/10,290, 52.77%), whereas the rest reported partial compliance (3684/10,290, 35.80%) or no compliance at all (1176/10,290, 11.43%). The participants reported poor computer skills (4980/22,740, 21.90%), transportation inconvenience (4670/22,740, 20.50%), unstable internet connection (3820/22,740, 16.80%), language barriers (3708/22,740, 16.30%), medication and medical hardware shortage (2459/22,740, 10.82%), tiring commute (2068/22,740, 9.08%), family care burdens (679/22,740, 3.0%), and other unclassified difficulties (356/22,740, 1.6%) as difficulties in using telemedicine. Conclusions Telemedicine has a wide disease spectrum, similar to ordinary medicine in China. It saves costs, has high patient satisfaction and price acceptability, and can relieve disease and syndromes. However, certain problems need to be resolved. Telemedicine could be a feasible approach to address the health care maldistribution in rural China. This study may provide useful information for policy making and guidance for further telemedicine practice in China and other developing countries.
Collapse
Affiliation(s)
- Cui He
- Department of Rehabilitation, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Qiru Zhou
- Department of Guangdong Online Hospital, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Wei Chen
- Outpatient Department, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Junzhang Tian
- Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Lihua Zhou
- Nursing Department, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Hong Peng
- Department of Otorhinolaryngology, Head and Neck Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shuo Luan
- Department of Rehabilitation, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shengfei Wang
- Department of Guangdong Online Hospital, Guangdong Second Provincial General Hospital, Guangzhou, China
| |
Collapse
|
46
|
Abstract
Telemedicine uses telecommunications technology as a tool to deliver health care to populations with limited access to care. Telemedicine has been tested in multiple clinical settings, demonstrating at least equivalency to in-person care and high levels of patient and health professional satisfaction. Teleoncology has been demonstrated to improve access to care and decrease health care costs. Teleconsultations may take place in a synchronous, asynchronous, or blended format. Examples of successful teleoncology applications include cancer telegenetics, bundling of cancer-related teleapplications, remote chemotherapy supervision, symptom management, survivorship care, palliative care, and approaches to increase access to cancer clinical trials. Telepathology is critical to cancer care and may be accomplished synchronously and asynchronously for both cytology and tissue diagnoses. Mobile applications support symptom management, lifestyle modification, and medication adherence as a tool for home-based care. Telemedicine can support the oncologist with access to interactive tele-education. Teleoncology practice should maintain in-person professional standards, including documentation integrated into the patient's electronic health record. Telemedicine training is essential to facilitate rapport, maximize engagement, and conduct an accurate virtual exam. With the appropriate attachments, the only limitation to the virtual exam is palpation. The national telehealth resource centers can provide interested clinicians with the latest information on telemedicine reimbursement, parity, and practice. To experience the gains of teleoncology, appropriate training, education, as well as paying close attention to gaps, such as those inherent in the digital divide, are essential.
Collapse
Affiliation(s)
- S Joseph Sirintrapun
- From Memorial Sloan Kettering Cancer Center, New York, NY; University of Utah, Salt Lake City, UT
| | - Ana Maria Lopez
- From Memorial Sloan Kettering Cancer Center, New York, NY; University of Utah, Salt Lake City, UT
| |
Collapse
|
47
|
Tchero H, Tabue Teguo M, Lannuzel A, Rusch E. Telerehabilitation for Stroke Survivors: Systematic Review and Meta-Analysis. J Med Internet Res 2018; 20:e10867. [PMID: 30368437 PMCID: PMC6250558 DOI: 10.2196/10867] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/18/2018] [Accepted: 07/22/2018] [Indexed: 01/12/2023] Open
Abstract
Background Telerehabilitation is an emerging technology through which medical rehabilitation care can be provided from a distance. Objective This systematic review and meta-analysis aims to investigate the efficacy of telerehabilitation in poststroke patients. Methods Eligible randomized controlled trials (RCTs) were identified by searching MEDLINE, Cochrane Central, and Web of Science databases. Continuous data were extracted for relevant outcomes and analyzed using the RevMan software as the standardized mean difference (SMD) and 95% CI in a fixed-effect meta-analysis model. Results We included 15 studies (1339 patients) in our systematic review, while only 12 were included in the pooled analysis. The combined effect estimate showed no significant differences between the telerehabilitation and control groups in terms of the Barthel Index (SMD –0.05, 95% CI –0.18 to 0.08), Berg Balance Scale (SMD –0.04, 95% CI –0.34 to 0.26), Fugl-Meyer Upper Extremity (SMD 0.50, 95% CI –0.09 to 1.09), and Stroke Impact Scale (mobility subscale; SMD 0.18, 95% CI –0.13 to 0.48]) scores. Moreover, the majority of included studies showed that both groups were comparable in terms of health-related quality of life (of stroke survivors), Caregiver Strain Index, and patients’ satisfaction with care. One study showed that the cost of telerehabilitation was lower than usual care by US $867. Conclusions Telerehabilitation can be a suitable alternative to usual rehabilitation care in poststroke patients, especially in remote or underserved areas. Larger studies are needed to evaluate the health-related quality of life and cost-effectiveness with the ongoing improvements in telerehabilitation networks.
Collapse
Affiliation(s)
- Huidi Tchero
- Unit of Wounds and Healing, Department of Trauma and Orthopaedic Surgery, Centre Hospitalier Louis Constant Fleming Saint Martin, Saint Martin, Guadeloupe, France
| | - Maturin Tabue Teguo
- Centre Hospitalier Universitaire de Guadeloupe, Université des Antilles, Guadeloupe, France.,Le Centre de Recherche Inserm - U1219, Université de Bordeaux, Bordeaux, France.,Institut de santé publique, d'épidémiologie et de développement, Université de Bordeaux, Bordeaux, France.,Le Gérontopôle du Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Annie Lannuzel
- Department of Neurology, University Hospital Center Pointe-à-Pitre, Guadeloupe, France
| | - Emmanuel Rusch
- Service d'Information Médicale, Epidémiologie et Economie de la Santé, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| |
Collapse
|
48
|
Sabesan S, Senko C, Schmidt A, Joshi A, Pandey R, Ryan CA, Lyle M, Rainey N, Varma S, Otty Z, Ansari Z, Vaughan K, Vangaveti V, Black J, Brown A. Enhancing Chemotherapy Capabilities in Rural Hospitals: Implementation of a Telechemotherapy Model (QReCS) in North Queensland, Australia. J Oncol Pract 2018; 14:e429-e437. [DOI: 10.1200/jop.18.00110] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction: The Queensland Remote Chemotherapy Supervision (QReCS) model enables rural nurses to administer chemotherapy in smaller rural towns under supervision by health professionals from larger centers using telehealth. Its implementation began in North Queensland, Australia (population, 650,000), in 2014 between two regional cancer centers (Townsville and Cairns as primary sites) and six rural sites (125 to 1,000 kilometers from primary sites). Our study examined the implementation processes, feasibility, and safety of this model. Methods: Details of implementation and patients’ clinical details for the period of 2014 to 2016 for descriptive analysis were extracted from telechemotherapy project notes and oncology information systems of North Queensland, respectively. Results: After a successful pilot study in Townsville Cancer Centre, statewide rural and cancer networks of Queensland Health, in collaboration with clinicians and managers across the state of Queensland, developed the QReCS model and a guide for operationalizing it. QReCS was implemented at six sites from 2014 to 2016. Main enablers across North Queensland included collaboration among clinicians and managers, availability of common electronic medical records, funding from Queensland Health, and installation of telehealth infrastructure by statewide telehealth services. Main barriers included turnover of senior management and nursing staff at two rural towns. Sixty-two patients received 327 cycles of low- to medium-risk chemotherapy agents. Rates of treatment delays, adverse events, and hospital admissions were similar to those in face-to-face care. Conclusion: Implementation of the QReCS model across a large geographic region is feasible with acceptable safety profiles. Leadership by and collaboration among clinicians and managers, adequacy of resources and common governance are key enablers.
Collapse
Affiliation(s)
- Sabe Sabesan
- Townsville Cancer Centre; Liz Plummer Cancer Care Centre, Cairns; Mackay Base Hospital; and James Cook University, Queensland, Australia
| | - Clare Senko
- Townsville Cancer Centre; Liz Plummer Cancer Care Centre, Cairns; Mackay Base Hospital; and James Cook University, Queensland, Australia
| | - Andrew Schmidt
- Townsville Cancer Centre; Liz Plummer Cancer Care Centre, Cairns; Mackay Base Hospital; and James Cook University, Queensland, Australia
| | - Abhishek Joshi
- Townsville Cancer Centre; Liz Plummer Cancer Care Centre, Cairns; Mackay Base Hospital; and James Cook University, Queensland, Australia
| | - Ritwik Pandey
- Townsville Cancer Centre; Liz Plummer Cancer Care Centre, Cairns; Mackay Base Hospital; and James Cook University, Queensland, Australia
| | - Corinne A. Ryan
- Townsville Cancer Centre; Liz Plummer Cancer Care Centre, Cairns; Mackay Base Hospital; and James Cook University, Queensland, Australia
| | - Megan Lyle
- Townsville Cancer Centre; Liz Plummer Cancer Care Centre, Cairns; Mackay Base Hospital; and James Cook University, Queensland, Australia
| | - Natalie Rainey
- Townsville Cancer Centre; Liz Plummer Cancer Care Centre, Cairns; Mackay Base Hospital; and James Cook University, Queensland, Australia
| | - Suresh Varma
- Townsville Cancer Centre; Liz Plummer Cancer Care Centre, Cairns; Mackay Base Hospital; and James Cook University, Queensland, Australia
| | - Zulfiquer Otty
- Townsville Cancer Centre; Liz Plummer Cancer Care Centre, Cairns; Mackay Base Hospital; and James Cook University, Queensland, Australia
| | - Zia Ansari
- Townsville Cancer Centre; Liz Plummer Cancer Care Centre, Cairns; Mackay Base Hospital; and James Cook University, Queensland, Australia
| | - Kerrie Vaughan
- Townsville Cancer Centre; Liz Plummer Cancer Care Centre, Cairns; Mackay Base Hospital; and James Cook University, Queensland, Australia
| | - Venkat Vangaveti
- Townsville Cancer Centre; Liz Plummer Cancer Care Centre, Cairns; Mackay Base Hospital; and James Cook University, Queensland, Australia
| | - Jason Black
- Townsville Cancer Centre; Liz Plummer Cancer Care Centre, Cairns; Mackay Base Hospital; and James Cook University, Queensland, Australia
| | - Amy Brown
- Townsville Cancer Centre; Liz Plummer Cancer Care Centre, Cairns; Mackay Base Hospital; and James Cook University, Queensland, Australia
| |
Collapse
|
49
|
Javat D, Heal C, Banks J, Buchholz S, Zhang Z. Regional to tertiary inter-hospital transfer versus in-house percutaneous coronary intervention in acute coronary syndrome. PLoS One 2018; 13:e0198272. [PMID: 29927947 PMCID: PMC6013182 DOI: 10.1371/journal.pone.0198272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 05/16/2018] [Indexed: 11/19/2022] Open
Abstract
RATIONALE To address the inaccessibility of interventional cardiac services in North Queensland a new cardiac catheterisation laboratory (CCL) was established in Mackay Base Hospital (MBH) in February 2014. OBJECTIVE To determine whether the provision of in-house angiography and/or percutaneous coronary intervention (PCI) 1) minimises treatment delays 2) further reduces the risk of mortality, recurrent myocardial infarction (MI) and recurrent ischaemia 3) improves patient satisfaction and 4) minimises cost expenditure compared with inter-hospital transfer for patients with acute coronary syndrome (ACS). METHODS We compared ACS patients who were transferred to tertiary centres from July 2012 to June 2013 with those who received in-house angiography and/or PCI from February 2015 to January 2016. The primary outcome was the composite of all-cause mortality, recurrent myocardial infarction (MI) or recurrent ischaemia at six months. Pre-specified secondary outcomes were the composite of all-cause mortality, recurrent MI or recurrent ischaemia at one month, a summated patient satisfaction score and the proportional cost savings generated between 2015 and 2016. RESULTS We included consecutive samples of 203 patients from July 2012 to June 2013 and 229 patients from February 2015 to January 2016. There was a reduction in the median time to treatment of 3.2 days and a reduction in the median length of stay of four days amongst all ACS patients receiving in-house angiography and/or PCI. The primary outcome occurred in 14 (6.9%) patients in the 2012 to 2013 group, as compared with 18 (7.9%) patients in the 2015 to 2016 group (OR = 0.71, 95% CI 0.24-2.1, P = 0.54). The secondary outcome at one month occurred in four (2.0%) patients in the 2012 to 2013 group, as compared with three (1.3%) patients in the 2015 to 2016 group (OR = 1.2, 95% CI 0.11-13.1, P = 0.87). There was a statistically significant improvement in the summated patient satisfaction score amongst patients who received in-house angiography and/or PCI (U = 1918, P <0.05 two tailed). A calculation of estimated cost savings showed a reduction in proportional cost of $14 481 (51%) per ACS patient receiving in house angiography and/or PCI between 2015 and 2016. CONCLUSION This study suggests that the provision of regional in-house angiography and/or PCI for the treatment of ACS minimises delays to invasive treatment by 3.2 days, minimises the median length of stay by four days, significantly improves patient satisfaction and reduces proportional treatment costs by $14 481 (51%) per patient. Currently, however, it appears that that in-house treatment does not further reduce the risk of mortality, recurrent MI and recurrent ischaemia at one and six months.
Collapse
Affiliation(s)
- Delara Javat
- Department of Cardiology, Mackay Base Hospital, Mackay, QLD, Australia
- Mackay Clinical School, School of Medicine and Dentistry, James Cook University, Mackay Campus, Mackay, QLD, Australia
- * E-mail:
| | - Clare Heal
- Mackay Clinical School, School of Medicine and Dentistry, James Cook University, Mackay Campus, Mackay, QLD, Australia
- Mackay Institute for Research and Innovation (MIRI), Mackay, QLD, Australia
| | - Jennifer Banks
- Mackay Clinical School, School of Medicine and Dentistry, James Cook University, Mackay Campus, Mackay, QLD, Australia
- Mackay Institute for Research and Innovation (MIRI), Mackay, QLD, Australia
| | - Stefan Buchholz
- Department of Cardiology, Mackay Base Hospital, Mackay, QLD, Australia
- Mackay Clinical School, School of Medicine and Dentistry, James Cook University, Mackay Campus, Mackay, QLD, Australia
- HeartCare Western Australia, Suite 21, St John of God Hospital, Southwest Health Campus, Bunbury, WA, Australia
| | - Zhihua Zhang
- Department of Cardiology, Mackay Base Hospital, Mackay, QLD, Australia
- Mackay Clinical School, School of Medicine and Dentistry, James Cook University, Mackay Campus, Mackay, QLD, Australia
| |
Collapse
|
50
|
McGill AF, North JB. A review of the experience of the Princess Alexandra Hospital teleconference fracture clinics over six years. J Orthop 2018; 15:527-528. [PMID: 29881187 DOI: 10.1016/j.jor.2018.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Indexed: 10/17/2022] Open
Affiliation(s)
- Alison F McGill
- Department of Orthopaedic Surgery, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
| | - John B North
- Department of Orthopaedic Surgery, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
| |
Collapse
|