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Calafiore R, Khan A, Anderson D, Wu ZH, Lu J. Impact of dermoscopy-aided pediatric teledermatology program on the accessibility and efficiency of dermatology care at community health centers. J Telemed Telecare 2024; 30:519-526. [PMID: 34962174 DOI: 10.1177/1357633x211068275] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are few studies focusing on pediatric teledermatology, and the impact of a large-scale pediatric teledermatology program on the accessibility and efficiency of dermatology care remains unclear. This study evaluated the impact of a state-wide implementation of a store-and-forward teledermatology program augmented by the incorporation of dermoscopy in pediatric patients visiting community health centers. METHODS It was a descriptive, retrospective cohort study of 876 pediatric dermatology referrals. RESULTS In the traditional referral system, only 60 patients (17.6%) were seen by dermatologists with average waiting times of 75 days due to limited access. In comparison, with an implementation of dermoscopy-aided teledermatology, all 536 teledermatology referrals received dermatological care within 24 h, of which only 64 (12%) patients requires face-to-face (F2F) consultation. Patients referred for F2F consultation via eConsults had a much lower no-show rate as compared to the traditional referral system (39% vs. 71%). Side by side comparison between general population and pediatric population has demonstrated shared features in efficiency and access improvement but revealed specific characteristics of pediatric teledermatology in terms of diagnosis and treatment. CONCLUSION Coordinated store-and-forward teledermatology platform with incorporation of dermoscopy between large community care network and dermatology provider can greatly improve access to pediatric dermatology care especially in underserved population. The efficiency of teledermatology in access improvement for pediatric population is comparable with adult population in eConsults. There are also unique features and challenges in pediatric teledermatology that require further research.
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Affiliation(s)
| | - Aziz Khan
- Department of Internal Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Daren Anderson
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | - Zhao Helen Wu
- Weitzman Institute & Community Health Center, Inc., Middletown, CT, USA
| | - Jun Lu
- University of Connecticut School of Medicine, Farmington, CT, USA
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2
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Staykov E, Helmer-Smith M, Fung C, Tanuseputro P, Liddy C. Development of the electronic consultation long-term care utilization and savings estimator tool to model the potential impact of electronic consultation for residents living in long-term care. J Telemed Telecare 2024; 30:597-603. [PMID: 35073207 DOI: 10.1177/1357633x221074500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Ageing populations have resulted in more patients living in long-term care or nursing homes, where they face challenges to accessing prompt specialist care exacerbated in many cases by physical or cognitive decline. Electronic consultation has demonstrated an ability to improve access to specialist care for vulnerable groups and offers a potential solution to this gap in care. To support electronic consultation's uptake among long-term care homes, we created the electronic consultation long-term care utilization and savings estimator, an Excel-based tool that estimates the number of off-site appointments that patients in a long-term care home could avoid through electronic consultation, along with the consequent time and cost savings. In this brief report, we discuss the electronic consultation long-term care utilization and savings estimator's creation and function, and provide a case study using long-term care data to demonstrate its potential impact. We anticipate the electronic consultation long-term care utilization and savings estimator will be a highly impactful tool and intend to test it in real-world conditions following the relaxation of COVID-19 restrictions.
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Affiliation(s)
- Emiliyan Staykov
- Department of Biology, University of Ottawa, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Canada
- Ottawa Hospital Research Institute, Canada
| | - Mary Helmer-Smith
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Canada
- Department of Family Medicine, University of Ottawa, Canada
| | - Celeste Fung
- Department of Family Medicine, University of Ottawa, Canada
- St Patrick's Home of Ottawa, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Canada
- Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Canada
- Department of Family Medicine, University of Ottawa, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Canada
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3
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Niyibizi A, Haveric A, Irio G. Telehealth in opioid use disorder treatment: policy considerations for expanding access to care. J Osteopath Med 2024; 124:179-181. [PMID: 37976470 DOI: 10.1515/jom-2023-0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 was intended to address the online diversion of controlled substances. However, it inadvertently limited access to care for patients seeking medications for opioid use disorder (MOUD). During the COVID-19 pandemic, temporary flexibility in telemedicine prescriptions for MOUD were implemented. Now, with the conclusion of the public health emergency, policymakers need to develop strategies to maintain some of the lifted restrictions in order to maintain increased access to care for patients with opioid use disorder (OUD). One potential solution to address these issues is the implementation of a hybrid model combining outpatient clinics and telemedicine. This model offers the opportunity to maintain the benefits of telemedicine while ensuring comprehensive and safe care for OUD patients.
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Affiliation(s)
| | | | - Giselle Irio
- Mountainview Regional Medical Center, Las Cruces, NM, USA
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4
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Singh S, Jones L, Grant M, Freeland D. Federal Advance Care Planning Policy Primer - Key Aspects, Barriers, and Opportunities. Am J Hosp Palliat Care 2024; 41:348-354. [PMID: 37207663 DOI: 10.1177/10499091231175641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
Advance care planning (ACP) is a nuanced process where patients identify their goals and consider their preferences for medical care over time. Recent systematic reviews have shown mixed findings about the association of ACP with the provision of goal-concordant care, completion of advance directives, and health care utilization. Despite a lack of consistent benefit, patients and clinicians value ACP and policy makers at the state and federal level have been moving ACP policies forward. All fifty states have policies regarding advance directives, and federal policy has had important implications on promoting awareness of ACP and its corresponding legal documents such as advance directives. However, challenges to effectively incentivize and facilitate the delivery of high-quality ACP exist. This paper provides an overview of key federal policy aspects and barriers that affect ACP use including: limitations of Medicare ACP billing codes, disparities in telemedicine access, difficulties with interoperability of advance directives, and underutilization of ACP as a mandatory measure in federal programs. This paper highlights key opportunities to improve federal ACP policy. Because ACP is an essential part of high-quality care and is deeply embedded in state and federal policies, it is imperative that clinicians are knowledgeable about these issues so they may more effectively engage in ACP policy.
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Affiliation(s)
- Sarguni Singh
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - LaCinda Jones
- Senior Social Worker, Department of Veterans Affairs, Seattle, WA, USA
| | - Marian Grant
- Senior Regulatory Advisor, Coalition to Transform Advanced Care, Washington, DC, USA
| | - Deborah Freeland
- Division of Geriatric Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
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5
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Saragih ID, Tonapa SI, Osingada CP, Porta CM, Lee BO. Effects of telehealth-assisted interventions among people living with HIV/AIDS: A systematic review and meta-analysis of randomized controlled studies. J Telemed Telecare 2024; 30:438-450. [PMID: 34967240 DOI: 10.1177/1357633x211070726] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Taking antiretroviral therapy (ART) is a daily necessity for people living with HIV but these individuals experience multiple barriers and challenges to medication adherence. Interventions to support medication adherence have yielded effects in the expected direction, but the extent to which telehealth or virtually delivered interventions to promote adherence are effective among people living with HIV/AIDS remains unknown. We aimed to address this knowledge gap and inform future research and practice that promotes the well-being of people living with HIV/AIDs through telehealth interventions addressing medication use. METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted using the following databases: Academic Search Complete, Cochrane library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PubMed, OVID (UpToDate), and the Web of Science. Relevant full-text articles published through September 2021 were retrieved. The revised Cochrane risk of bias tool for randomized trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth-assisted interventions for people living with HIV/AIDS. Stata 16.0 was used for statistical analysis. RESULTS A total of 12 studies (N = 3557 participants) that used telehealth-assisted interventions for people living with HIV/AIDS were included. Telehealth interventions were found to increase the adherence to treatment (standardized mean difference [SMD]: 0.21; 95% confidence interval (CI): 0.03 to 0.40), to reduce depressive symptoms (SMD: -2,74; 95% CI: -3.39 to -2.09), and to improve perceived quality of life (SMD: 0.74; 95% CI: 0.37 to 1.10). DISCUSSION The meta-effects of telehealth-assisted interventions include significantly enhanced adherence to treatment, improved quality of life, and reduced depressive symptoms among people living with HIV/AIDS. These findings suggesting that delivering health management interventions remotely through telehealth-assisted modalities was both feasible and effective in yielding health benefits for people living with HIV/AIDS. Integrating telehealth-assisted interventions as a modality in HIV/AIDS care might support continuity of care and sustained well-being. Future research should evaluate telehealth intervention outcomes and examine mediating, moderating, or other tailorable variables affecting intervention effectiveness.
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Affiliation(s)
| | - Santo Imanuel Tonapa
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Nursing, Sam Ratulangi University, Manado, Indonesia
| | | | - Carolyn M Porta
- School of Nursing, University of Minnesota, Minneapolis, USA
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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6
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Monzon AD, Clements MA, Patton SR. Group engagement in parent-focused telehealth interventions for families of children with type 1 diabetes. J Telemed Telecare 2024; 30:505-513. [PMID: 34931878 DOI: 10.1177/1357633x211067074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Group engagement is an important component of video-based telehealth interventions, yet this construct remains understudied. In the present study, we applied a multidimensional conceptualization of group engagement in two video-based telehealth interventions that either aimed to reduce fear of hypoglycemia or diabetes distress in parents of children with type 1 diabetes. We examined variability in group engagement across parents and assessed the relationship between parents' level of group engagement and their treatment outcomes. METHODS Twenty-nine parents participated in one of two manualized, closed-group, telehealth interventions and completed outcome measures pre- and post-treatment. We behaviorally coded telehealth sessions based on six dimensions of group engagement using the Group Engagement Measure (inter-rater reliability = 0.94). We examined correlations between group engagement dimensions, parent psychosocial well-being, and child hemoglobin A1c. Further, we examined independent sample t-tests to assess differences between treatment groups. RESULTS Mean parent age was 37.69 ± 6.83 years, mean child age was 7.69 ± 3.76 years, and mean child hemoglobin A1c was 8.06 ± 1.27% (41.4% had a hemoglobin A1c <7.5%). Parents who spent more time attending to other group member's issues, reported lower hypoglycemia fear at post-treatment, and parents who showed more active support of the group leader's purpose/goals during the session also reported fewer depressive symptoms at post-treatment. DISCUSSION We identify several dimensions of group engagement that are associate with improved parent psychosocial and child hemoglobin A1c outcomes. Intervention designs that use group engagement to guide treatment planning or inform treatment-related decisions in video-based telehealth interventions could help families achieve more optimal treatment outcomes.
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Affiliation(s)
- Alexandra D Monzon
- University of Kansas College of Liberal Arts and Sciences, Clinical Child Psychology, USA
| | - Mark A Clements
- Children's Mercy Hospital and Clinics, Endocrine/Diabetes Clinical Research, USA
| | - Susana R Patton
- Nemours Children's Health, Nemours Center for Healthcare Delivery Science, USA
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7
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Cummins MR, Ivanova J, Ong T, Soni H, Barrera JF, Wilczewski H, Welch BM, Bunnell BE. Will the United States pass on telemedicine progress? JAMIA Open 2024; 7:ooae016. [PMID: 38410742 PMCID: PMC10896640 DOI: 10.1093/jamiaopen/ooae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 10/04/2023] [Accepted: 02/21/2024] [Indexed: 02/28/2024] Open
Abstract
Background During the COVID-19 pandemic, federal and state health policies allowed temporary flexibilities for Medicare and Medicaid beneficiaries, leading to a sharp increase in telemedicine use. However, many of the flexibilities that enabled innovation and growth in telemedicine continue temporarily since the federal emergency declaration ended in May 2023, and the United States has not made permanent decisions about telemedicine policy. Analysts have raised concerns about increased spending, program integrity, safety, and equity, and recommend strengthening oversight. Methods Here, we argue that we must continue the flexibilities to better understand telemedicine's quality, safety, and outcomes, and until the United States can develop an evidence-based digital health strategy. A premature regression to pre-pandemic telemedicine policies risks unintended consequences. Conclusion We must continue the current policy flexibilities, safeguard against fraud and abuse, and immediately prioritize research and evaluation of telemedicine's quality, safety, and outcomes, to avoid unintended consequences and support more permanent policy decision-making.
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Affiliation(s)
- Mollie R Cummins
- College of Nursing, University of Utah, Salt Lake City, UT 84112-5880, United States
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84112-5880, United States
- Doxy.me Research, Doxy.me Inc, Rochester, NY 14623, United States
| | - Julia Ivanova
- Doxy.me Research, Doxy.me Inc, Rochester, NY 14623, United States
| | - Triton Ong
- Doxy.me Research, Doxy.me Inc, Rochester, NY 14623, United States
| | - Hiral Soni
- Doxy.me Research, Doxy.me Inc, Rochester, NY 14623, United States
| | - Janelle F Barrera
- Doxy.me Research, Doxy.me Inc, Rochester, NY 14623, United States
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33613, United States
| | | | - Brandon M Welch
- Doxy.me Research, Doxy.me Inc, Rochester, NY 14623, United States
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Brian E Bunnell
- Doxy.me Research, Doxy.me Inc, Rochester, NY 14623, United States
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33613, United States
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8
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Hartono J, Cottrell M, Window P, Russell T. Performance of key physical tests for temporomandibular disorder via telehealth: Establishing validity and reliability. J Oral Rehabil 2024; 51:648-656. [PMID: 38151806 DOI: 10.1111/joor.13643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 08/17/2023] [Accepted: 12/08/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, many individuals sought healthcare virtually. Physiotherapy is integral in managing temporomandibular disorders (TMDs); therefore, establishing how key physical tests can be appropriately adapted to telehealth is paramount. OBJECTIVES To establish the validity and reliability of telehealth (specifically videoconferencing) assessments against in-person assessments on a battery of TMD physical tests. METHOD A repeated-measures study design was undertaken. Thirty-six adult participants (19 healthy and 17 TMD) underwent concurrent temporomandibular joint (TMJ) physiological movement measurements via videoconferencing and in-person as per standard clinical practice. Inclusion criteria included the presence of central incisors and no significant comorbidities precluding a safe telehealth examination. Participants with TMD completed seven additional pain provocation physical tests. RESULTS Agreement between telehealth and in-person physiological movement measures was excellent (ICC >0.90, 95% CI: 0.53 to >0.99). Inter- and intra-rater reliability for telehealth measures indicated excellent reliability (ICC >0.97, 95% CI: 0.91 to >0.99). Exact agreement between telehealth and in-person for provocation tests ranged between 58.8% and 94.1%. Fourteen of the twenty-six individual measures produced substantial to near perfect agreement (PABAK = 0.65-0.88), seven produced moderate agreement (PABAK = 0.53), while five produced poor to fair agreement (PABAK = 0.18-0.29). CONCLUSION There is high level of agreement between telehealth and in-person measurements of TMJ physiological movement and pain provocation tests.
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Affiliation(s)
- Joseph Hartono
- School of Health & Rehabilitation Sciences, University of Queensland, St Lucia, Australia
| | - Michelle Cottrell
- School of Health & Rehabilitation Sciences, University of Queensland, St Lucia, Australia
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Peter Window
- School of Health & Rehabilitation Sciences, University of Queensland, St Lucia, Australia
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Trevor Russell
- School of Health & Rehabilitation Sciences, University of Queensland, St Lucia, Australia
- RECOVER Injury Research Centre, University of Queensland, Herston, Australia
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Mora-Traverso M, Prieto-Moreno R, Molina-Garcia P, Salas-Fariña Z, Martín-Martín L, Martín-Matillas M, Ariza-Vega P. Effects of the @ctivehip telerehabilitation program on the quality of life, psychological factors and fitness level of patients with hip fracture. J Telemed Telecare 2024; 30:549-558. [PMID: 35060784 DOI: 10.1177/1357633x211073256] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Telerehabilitation has emerged in the last decade as a promising alternative to conduct the rehabilitation process at home. However, there are no studies testing the effects of telerehabilitation interventions for patients with hip fracture on quality of life nor psychological factors, whereas the evidence on fitness level is scarce. Thus, the aim of this study is to test the effects of the @ctivehip telerehabilitation program on the quality of life, psychological factors and fitness level of patients who had suffered a hip fracture. METHODS The present study is a non-randomized clinical trial that includes patients older than 65 years old with a hip fracture and their family caregivers (ClinicalTrials.gov; Identifier: NCT02968589). Per-protocol (64 participants) and intention-to-treat (71 participants) analyses were performed, the first being the main analysis. The intervention group received a home-based multidisciplinary telerehabilitation intervention, called @ctivehip, that lasted 12 weeks. The control group received the traditional care and rehabilitation provided by the Andalusian Public Health Care System. The outcomes measured were the patients' quality of life through the EuroQol Quality of Life Questionnaire (EQ-5D), physiological factors (anxiety and depression) using the Hospital Anxiety and Depression Scale (HADS) and the fitness level, assessed with the International Fitness Scale. RESULTS The quality of life of the telerehabilitation group increased, while the control group scored worsened at the 3-month follow-up (medium effect size: 0.66 SDs; p = 0.006). The telerehabilitation group demonstrated a greater decrease than the control group in the total HADS score (medium effect size: -0.50 SDs; p = 0.015). Lastly, the telerehabilitation group recovered a fitness level close to the pre-hip fracture in comparison with the control group (small effect size: 0.49 SDs; p = 0.022). DISCUSSION The @ctivehip telerehabilitation program seems to be a promising treatment to improve the quality of life and psychological factors (i.e. anxiety and depression) of older adults after a hip fracture, as well as to recover their previous fitness level.
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Affiliation(s)
- Marta Mora-Traverso
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, Granada, Spain
| | - Rafael Prieto-Moreno
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, Granada, Spain
| | - Pablo Molina-Garcia
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Granada, Spain
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Zeus Salas-Fariña
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Lydia Martín-Martín
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
- Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain
- Sport and Health University Research Institute (iMUDS), Universtity of Granada, Granada, Spain
| | - Miguel Martín-Matillas
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Patrocinio Ariza-Vega
- Biohealth Research Institute (ibs.Granada) Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, Granada, Spain
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
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Kalwani NM, Osmanlliu E, Parameswaran V, Qureshi L, Dash R, Heidenreich PA, Scheinker D, Rodriguez F. Changes in telemedicine use and ambulatory visit volumes at a multispecialty cardiovascular center during the COVID-19 pandemic. J Telemed Telecare 2024; 30:543-548. [PMID: 35108126 PMCID: PMC8814611 DOI: 10.1177/1357633x211073428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022]
Abstract
Early in the COVID-19 pandemic, cardiology clinics rapidly implemented telemedicine to maintain access to care. Little is known about subsequent trends in telemedicine use and visit volumes across cardiology subspecialties. We conducted a retrospective cohort study including all patients with ambulatory visits at a multispecialty cardiovascular center in Northern California from March 2019 to February 2020 (pre-COVID) and March 2020 to February 2021 (COVID). Telemedicine use increased from 3.5% of visits (1200/33,976) during the pre-COVID period to 63.0% (21,251/33,706) during the COVID period. Visit volumes were below pre-COVID levels from March to May 2020 but exceeded pre-COVID levels after June 2020, including when local COVID-19 cases peaked. Telemedicine use was above 75% of visits in all cardiology subspecialties in April 2020 and stabilized at rates ranging from over 95% in electrophysiology to under 25% in heart transplant and vascular medicine. From June 2020 to February 2021, subspecialties delivering a greater percentage of visits through telemedicine experienced larger increases in new patient visits (r = 0.81, p = 0.029). Telemedicine can be used to deliver a significant proportion of outpatient cardiovascular care though utilization varies across subspecialties. Higher rates of telemedicine adoption may increase access to care in cardiology clinics.
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Affiliation(s)
- Neil M Kalwani
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Esli Osmanlliu
- Research Institute of the McGill University Health Centre, McGill University, Montréal, Canada
| | - Vijaya Parameswaran
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Lubna Qureshi
- Digital Health Care Integration, Stanford Health Care, Stanford, CA, USA
| | - Rajesh Dash
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - David Scheinker
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
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11
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Khou M, Lo A, Barclay G, Baytieh L. Exploration of Patient and Clinician Experience of Video Consultations in Community Palliative Care. J Pain Symptom Manage 2024; 67:e321-e331. [PMID: 38215897 DOI: 10.1016/j.jpainsymman.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/03/2023] [Accepted: 12/21/2023] [Indexed: 01/14/2024]
Abstract
CONTEXT Telehealth video consultations (VCs) were implemented in the community palliative care team (CPCT) in a regional NSW health district, Australia, as a response to restrictions to the COVID-19 pandemic, using patient's device in the absence of a clinician. OBJECTIVES To evaluate patient/carer and clinician satisfaction in using VCs for CPC consultations; to explore advantages and challenges of VCs. METHODS Self-reported online questionnaires to community-dwelling patients under care of the CPCT; seeking patients/carers and clinician perspectives on the VCs from April to September 2020. RESULTS Of 126 eSurveys completed, (85 clinicians; 41 patients/carers), 97% patient/carers and 97% clinicians indicated they were satisfied with VC. Overall, 93% clinicians agreed they provided same level of care compared to face-to-face review; 85% patients/carers agreed they received same level of care compared to face-to-face consultations and 98% agreed their issues were addressed. Of eSurvey responses 97% clinicians and 78% patients/carers indicated they would continue to use VCs in practice. Comments indicated dissatisfaction with lack of personal examination; some found technological issues to be barriers. Benefits discovered incidentally were empowering patient independence to live out their end-of-life desires while being treated/supported, improved service delivery, increased staff autonomy and upskilling staff. CONCLUSION Users in this study perceived VCs to have a place in CPC consultations. Using patient device enabled patient freedom, improved timeliness of clinical assessment, and communication to complement face-to-face consults, while minimizing infection risk. Unexpected, but valuable benefits were revealed. Workable technology is paramount.
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Affiliation(s)
- Muoi Khou
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia.
| | - Angela Lo
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Greg Barclay
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Lina Baytieh
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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Jazayeri A, Dinh JV, Eseonu D, Hollier JM, Shneider BL. Assessment of telemedicine versus in-person care in managing abdominal pain in children during the COVID-19 pandemic. J Telemed Telecare 2024; 30:538-542. [PMID: 36198032 PMCID: PMC9535455 DOI: 10.1177/1357633x221125836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The COVID-19 pandemic has led to a dramatic increase in telemedicine care delivery. This raises the question of whether the visit type affects the care provided to patients in the pediatric gastroenterology clinic. The aim of this study is to assess whether diagnostic, treatment, and outcome measures differ between telemedicine and in-person visits in patients seen in pediatric gastroenterology clinics for the chief complaint of abdominal pain. METHODS We conducted a retrospective analysis of patients aged 0-22 who underwent their initial pediatric gastroenterology clinic visit, for abdominal pain, between March and September 2020 (n = 1769). The patients were divided into two groups: in-person or telemedicine. Clinical outcome measures were compared from the initial gastroenterology visit and followed for a total of 3 months. RESULTS There was an increase number of images (M = 0.52 vs. 0.36, p < 0.001), labs (M = 4.87 vs. 4.05; p = 0.001), medications (M = 2.24 vs. 1.67; p < 0.001), and referrals (M = 0.70 vs. 0.54; p < 0.001) performed per visit in the in-person group. Electronic communications (3.97 vs. 5.12 p <0.003) was less frequent after in-person visits. There was no difference in number of procedures (M = 0.128 vs. 0.122, p = 0.718), emergency room visits (M = 0.037 vs. 0.017 p = 0.61), follow-up visits (M = 1.21 vs. 1.21 p = 0.922), or telephone encounters (M = 1.21 vs. 1.12 p = 0.35) between the two groups. CONCLUSION Telemedicine utilizes less resources while having comparable outcome measurements in children with a chief complaint of abdominal pain.
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Affiliation(s)
- Amir Jazayeri
- Department of Pediatrics, Hepatology, and Nutrition, Division of Pediatric Gastroenterology, Texas Children’s Hospital, Houston, TX, USA
| | - Julie V Dinh
- Department of Psychology, City University of New York, Baruch College, New York, NY, USA
- Department of Psychology, The Graduate Center at the City University of New York, New York, NY, USA
| | - Debra Eseonu
- Department of Pediatrics, Hepatology, and Nutrition, Division of Pediatric Gastroenterology, Texas Children’s Hospital, Houston, TX, USA
| | - John M Hollier
- Department of Pediatrics, Hepatology, and Nutrition, Division of Pediatric Gastroenterology, Texas Children’s Hospital, Houston, TX, USA
| | - Benjamin L Shneider
- Department of Pediatrics, Hepatology, and Nutrition, Division of Pediatric Gastroenterology, Texas Children’s Hospital, Houston, TX, USA
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Brewer DM, Bernstein CM, Calandrillo D, Muscato N, Introcaso K, Bosworth C, Olson A, Vovos R, Stillitano G, Sydlowski S. Teledelivery of Aural Rehabilitation to Improve Cochlear Implant Outcomes. Laryngoscope 2024; 134:1861-1867. [PMID: 37688797 DOI: 10.1002/lary.31031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/16/2023] [Accepted: 08/14/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE(S) This randomized controlled study evaluated the effectiveness of a Telehealth Aural Rehabilitation (TeleAR) training protocol to improve outcomes for adult cochlear implant (CI) users. METHODS This was a multisite clinical study with participants randomized to either an AR treatment or active control group. The AR protocol consisted of auditory training (words, sentences, and speech tracking), informational counseling, and communication strategies. The control group participants engaged in cognitive stimulation activities (crosswords, sudoku, etc.). Each group completed 6 weekly 90-min individual treatment sessions delivered remotely. Twenty postlingually deafened adult CI users participated. Assessments were completed pretreatment and 1 week and 2 months posttreatment. RESULTS Repeated-measures ANOVA and planned contrasts were used to compare group performance on AzBio Sentences, Hearing Handicap Inventory (HHI), Client Oriented Scale of Improvement (COSI), and Glasgow Benefit Inventory (GBI). The two groups were statistically equivalent on all outcome measures at pre-assessment. There was a statistically significant main effect of time for all measures. Improvement over time was observed for participants in both groups, with greater improvement seen for the AR than the CT group on all outcome measures. The AR group showed medium to large effect sizes on all measures over time, suggesting clinically significant outcomes. CONCLUSION This randomized controlled study provides evidence of improved speech recognition and psychosocial outcomes following 6 weeks of TeleAR intervention. For adult post-lingually deafened CI users, including those >3 months post-activation, AR treatment can leverage neuroplasticity to maximize outcomes. LEVEL OF EVIDENCE 2 Laryngoscope, 134:1861-1867, 2024.
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Affiliation(s)
- Diane Majerus Brewer
- Department of Speech, Language and Hearing Sciences, George Washington University, Washington, DC, U.S.A
| | - Claire Marcus Bernstein
- Department of Hearing, Speech, and Language Sciences, Gallaudet University, Washington, DC, U.S.A
| | - Dominique Calandrillo
- Department of Hearing, Speech, and Language Sciences, Gallaudet University, Washington, DC, U.S.A
| | - Nancy Muscato
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, Florida, U.S.A
| | - Kailey Introcaso
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, Florida, U.S.A
| | - Cassandra Bosworth
- Audiology and Speech Pathology in Department of Otolaryngology, Columbia University Irving Medical Center, New York City, New York, U.S.A
| | - Anne Olson
- Communication Sciences and Disorders, University of Kentucky College of Health Sciences, Lexington, Kentucky, U.S.A
| | - Rachel Vovos
- The Cleveland Clinic, Hearing Implant Program, Cleveland, Ohio, U.S.A
| | - Gina Stillitano
- The Cleveland Clinic, Hearing Implant Program, Cleveland, Ohio, U.S.A
| | - Sarah Sydlowski
- The Cleveland Clinic, Hearing Implant Program, Cleveland, Ohio, U.S.A
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14
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Sikka V, King C, Klinker S, Mont T, Sommers-Olson B, Hunt BE, Davis S, Fonseca J. Telemedicine for veterans in the setting of the COVID-19 pandemic: Lessons learned from a virtual urgent care center. J Telemed Telecare 2024; 30:514-518. [PMID: 34970932 DOI: 10.1177/1357633x211069018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Although telemedicine was predominantly adopted during the COVID-19 pandemic, its impact on healthcare outcomes in the veteran population in achieving first contact resolution, or the ability to safely manage patient care at home from an urgent care perspective, is yet to be determined. METHODS This study included 13,090 veteran patient episodes who presented to the Department of Veteran's Affairs Veterans Integrated Services Network 8's Clinical Contact Center, a virtual urgent care organization covering South Georgia, Florida, and U.S. Virgin Islands in providing episodic care, between March 2020 and February 2021. Multivariate logistic regression estimated the probability that veterans with COVID-19-related symptoms stayed at home compared to presenting to the emergency department (ED) or their primary care provider. RESULTS Patients with COVID-related symptoms were 33% less likely to present to the ED compared to patients who presented with non-COVID-related symptoms. DISCUSSION The virtual urgent care center enabled veterans to receive timely care and avoid public places that could potentially lead to a COVID-19 infection or infecting others.
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Affiliation(s)
- Veronica Sikka
- Virtual Care, Clinical Contact Center, VA Sunshine Healthcare Network (VISN 8), St Petersburg, FL, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Christian King
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, USA
- Orlando VA Healthcare System, Orlando, FL, USA
| | - Suzanne Klinker
- Virtual Care, Clinical Contact Center, VA Sunshine Healthcare Network (VISN 8), St Petersburg, FL, USA
| | - Theresa Mont
- Virtual Care, Clinical Contact Center, VA Sunshine Healthcare Network (VISN 8), St Petersburg, FL, USA
| | | | - Bruce E Hunt
- Virtual Care, Clinical Contact Center, VA Sunshine Healthcare Network (VISN 8), St Petersburg, FL, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Stacey Davis
- Virtual Care, Clinical Contact Center, VA Sunshine Healthcare Network (VISN 8), St Petersburg, FL, USA
| | - Jennifer Fonseca
- Virtual Care, Clinical Contact Center, VA Sunshine Healthcare Network (VISN 8), St Petersburg, FL, USA
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15
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Basnet R, Jensen MP, Pathak A, Gurung G, Thagunna NS, Elisa Maharjan, Hansford H, Riju Maharjan, Nicholas M, Sharma S. Self-Efficacy in Nepali Adults With Musculoskeletal Pain: Measurement Properties of Hard-Copy and Online Versions of the Pain Self-Efficacy Questionnaire. J Pain 2024; 25:918-933. [PMID: 37871683 DOI: 10.1016/j.jpain.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023]
Abstract
The Pain Self-Efficacy Questionnaire (PSEQ) is commonly used in pain self-efficacy research. Yet its Nepali translation is unavailable, limiting the ability to conduct cross-cultural research on the role of self-efficacy in musculoskeletal pain and its management. This study aimed to 1) translate and culturally adapt the 10-item (PSEQ-10) and 2-item (PSEQ-2) versions of the PSEQ into Nepali, 2) evaluate their measurement properties in Nepali adults with musculoskeletal pain, and 3) evaluate whether the type of administration (ie, hard-copy vs online) affected their measurement properties. The measurement properties of different administrations of the Nepali PSEQ-10 and PSEQ-2 were evaluated in 180 Nepali adults (120 hard-copy and 60 online administrations) with musculoskeletal pain. We conducted confirmatory factor analyses and estimated the measures' internal consistencies, test-retest reliabilities, and smallest detectable changes using standard error of measurement. We planned to conclude that the measures were valid if ≥ 75% of the validity hypotheses were supported. The results supported unidimensionality for the Nepali PSEQ-10. The Nepali PSEQ-2 and PSEQ-10 evidenced excellent internal consistencies (Cronbach alphas = .90-.95) and good to excellent test-retest reliabilities (intraclass correlation coefficient = .61-.85) for both administrations. Construct validity (r's ≥ .20) and concurrent validity (r's ≥ .83) were supported, as hypothesized. Both hard-copy and online administrations of the Nepali PSEQ-2 and PSEQ-10 are similar, reliable, and valid ways to assess self-efficacy in Nepali adults with musculoskeletal pain. The findings should facilitate telehealth and cross-cultural research on pain self-efficacy in Nepal. PERSPECTIVE: This is the first Nepali adaptation of a self-efficacy scale with testing of measurement properties for hard-copy and online administrations. It will facilitate the assessment of pain self-efficacy in clinical practice and research and facilitate a deeper cross-cultural understanding of the role of self-efficacy in musculoskeletal pain.
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Affiliation(s)
- Ritu Basnet
- Department of Psychology, K and K International College, Tribhuvan University, Kathmandu, Nepal; Department of Physiotherapy, Scheer Memorial Hospital, Banepa, Bagmati, Nepal; Department of Psychiatry and Mental Health, Maharajgunj Medical Campus, T.U. Institute of Medicine, Kathmandu, Nepal
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Anupa Pathak
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Gagan Gurung
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand; Te Whatu Ora, National Public Health Service, Southern, Dunedin, New Zealand
| | - Narendra Singh Thagunna
- Department of Psychology, K and K International College, Tribhuvan University, Kathmandu, Nepal; Department of Psychology, Padma Kanya Multiple Campus, Tribhuvan University, Kathmandu, Nepal
| | - Elisa Maharjan
- Department of Physical Medicine and Rehabilitation, Star Hospital, Lalitpur, Bagmati, Nepal
| | - Harrison Hansford
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Riju Maharjan
- Department of Physiotherapy, Upendra Devkota Memorial Hospital, Bansbari, Kathmandu, Nepal
| | - Michael Nicholas
- Pain Management Research Institute, The Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
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16
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Bruns BE, Lorenzo-Castro SA, Hale GM. Controlling Blood Pressure During a Pandemic: The Impact of Telepharmacy for Primary Care Patients. J Pharm Pract 2024; 37:364-368. [PMID: 36300296 PMCID: PMC9606639 DOI: 10.1177/08971900221136629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Introduction: Studies have shown positive clinical outcomes in chronic conditions, such as hypertension, through pharmacist-delivered medication therapy management and medication adherence services. Given the need for social distancing during the COVID-19 pandemic, increased utilization of telepharmacy strategies has been employed for managing blood pressure control. Methods: A retrospective single-center cohort study that compared in-person pharmacist visits and telepharmacy visits in primary care patients with hypertension via electronic chart review from January 2018 to July 2022. Subjects were included who were at least 18 years of age with hypertension. Comparator groups were patients who underwent an in-person pharmacy (pre-COVID-19) visit vs a telepharmacy visit (post-COVID-19). The primary outcome was the number of patients with controlled blood pressure based on a blood pressure goal of less than or equal to 130/80 following telepharmacy visit vs in-person visit. Medication adherence, pharmacist intervention, incidence of antihypertensive side-effects, and blood pressure maintenance based on a goal of ≤140/90 were also evaluated. Results: A total of 77 patients were included. There was no difference in the primary outcome following in person pharmacy visits compared to telepharmacy visits (P = .690). There was also no difference found for the secondary endpoints of blood pressure goal less than or equal to 140/90 mmHg (P = .481), medication adherence (P = 1.00), or antihypertensive adverse events (P = .344). Conclusion: Telepharmacy visits had a nonsignificant change in blood pressure control when compared to in-person visits. Results suggest that the utilization of either in-person or telepharmacy strategies benefit the management of hypertension.
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Affiliation(s)
- Bailey E. Bruns
- Nova Southeastern University College of Pharmacy, Palm Beach Gardens, FL, USA
| | | | - Genevieve M. Hale
- Nova Southeastern University College of Pharmacy, Palm Beach Gardens, FL, USA
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17
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Khalil K, Tsapepas D, West-Thielke P. Transplant Pharmacists' Experience With Telehealth During the COVID-19 Pandemic. J Pharm Pract 2024; 37:307-310. [PMID: 36218440 PMCID: PMC9554573 DOI: 10.1177/08971900221132594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: The adoption of telehealth became a necessity for healthcare organizations during the COVID-19 pandemic. Transplant pharmacists are integral members of the multi-disciplinary care team who quickly adapted application of these technologies to ensure continuity of care. Objective: To assess transplant pharmacists' experience with telehealth during the COVID-19 pandemic. Methods: A 23-question online survey was developed to assess transplant pharmacists' experience with telehealth during the COVID-19 pandemic. Results: Forty-five pharmacists responded to the survey from a broad range of transplant centers. The majority of respondents indicated infrequent use of telehealth (98%) before the COVID-19 pandemic, but this was significantly changed during the pandemic with only 9% reporting infrequent use. Pharmacists anticipated a decrease in future use, but 91% of respondents stated they would like to continue utilization of telehealth in their practice post-pandemic. Conclusions: The adoption of telehealth during COVID-19 was widespread and has the potential to facilitate continuity of care. Though pharmacists anticipated a decrease in future use, a majority favored continued utilization of telehealth in their practice.
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Affiliation(s)
- Karen Khalil
- Department of Pharmacy, NYU Langone Health, New York, NY, USA
| | - Demetra Tsapepas
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
- Department of Transplantation, New York-Presbyterian Hospital, New York, NY, USA
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18
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Rodrigues B, Parsons N, Haridy J, Bloom S, Day C, Haar G, Nicoll A, Sawhney R. A nurse-led, telehealth-driven hepatitis C management initiative in regional Victoria: Cascade of care from referral to cure. J Telemed Telecare 2024; 30:497-504. [PMID: 34142898 DOI: 10.1177/1357633x211024108] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Elimination of hepatitis C virus stands as an unresolved World Health Organization target, and is associated with complications including cirrhosis and hepatocellular carcinoma. Hepatitis C virus management has been revolutionised following the widespread availability of direct-acting antiviral agents in Australia since 2016; however, large proportions of the population remain untreated. Telehealth-based service delivery is an accessible and effective alternative, and we aimed to assess qualitative and clinical outcomes in a clinical nurse consultant-led regional telehealth model. METHODS A prospective cohort analysis of all patients referred to a Victorian regional hospital's hepatitis C virus telehealth clinic between 1 April 2017 and 10 June 2020 was conducted. Data were collated from outpatient and electronic medical records. RESULTS Fifty-five out of 71 referred patients were booked, with 44 patients (80%) attending at least one appointment. A history of alcohol use disorder and psychiatric comorbidity was seen in 25 (54%) and 24 (52%) patients, respectively. Twenty-one out of 24 (88%) eligible patients had direct-acting antiviral agent treatment and 14 out of 21 (67%) successfully completed the treatment. An average of 46.5 km, 54.6 min and $AUD30.70 was saved per patient for each visit. Observed benefits included: increased medical engagement, adherence to and completion of HCV treatment and cirrhosis monitoring. Telehealth-driven hepatocellular carcinoma surveillance was successful in the cirrhotic subgroup. CONCLUSION Clinical nurse consultant-led hepatitis C virus management via telehealth allows access to marginalised regional populations. Clinical outcomes were comparable to other cohorts with additional cost-benefit, efficiency gains and carbon footprint reduction amongst a previously unreported regional Victorian hepatitis C virus population.
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Affiliation(s)
| | - Nola Parsons
- Department of Gastroenterology, Eastern Health, Australia
| | - James Haridy
- Department of Gastroenterology, Eastern Health, Australia
| | - Stephen Bloom
- Department of Gastroenterology, Eastern Health, Australia
- Eastern Health Clinical School, Monash University, Australia
| | - Caroline Day
- Department of Gastroenterology, Eastern Health, Australia
| | - Geoffrey Haar
- Department of Gastroenterology, Eastern Health, Australia
| | - Amanda Nicoll
- Department of Gastroenterology, Eastern Health, Australia
- Eastern Health Clinical School, Monash University, Australia
| | - Rohit Sawhney
- Department of Gastroenterology, Eastern Health, Australia
- Eastern Health Clinical School, Monash University, Australia
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19
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Slovis BH, Ji X, Chang AM, Kairys J, Hollander JE. Relationship between on-demand telehealth visits and emergency department and hospital surge during the COVID-19 pandemic. J Am Coll Emerg Physicians Open 2024; 5:e13128. [PMID: 38420576 PMCID: PMC10897634 DOI: 10.1002/emp2.13128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/11/2023] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
Objectives The relationship between COVID-19-related telehealth calls could be used to predict emergency department visits and hospital surges 3 days later potentially facilitating staffing adjustments in advance of patient arrivals. The purpose of this research was to study the temporal association between frequencies of on demand telehealth calls and emergency department surges during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This cohort study examined patients who self-initiated synchronous audio-video on-demand telehealth calls between January 1, 2020 and June 30, 2022, and compared these to emergency department arrivals. The exposure in question was a synchronous audio-video on-demand telehealth visit. Our main outcome measured was frequency of emergency department visits. After autocorrelation, a multivariate linear regression model was utilized to determine temporal relationships between the two variables. Results This cohort study examined 42,429 synchronous audio-video on-demand telehealth calls, of which 43.6% were COVID-19 related, and 540,686 emergency department visits, of which 3.9% were diagnosed with COVID-19. COVID-19-related telehealth calls 3 days prior were predictive of emergency department encounters (r 2 = 0.85, p < 0.001). Emergency department encounters were strongly correlated with hospital admissions (r 2 = 0.71, p < 0.001). Conclusions Our results demonstrate that telehealth calls related to COVID-19 were an accurate predictor of emergency department encounters 3 days later, and emergency department encounters are highly correlated with hospital admissions. Limitations include that we only assessed a single health system in the region covered by the telemedicine healthcare professionals. We did not examine direct links between these two encounter types nor severity of illness at the patient level. Understanding that telehealth calls related to COVID-19 are highly predictive of emergency department encounters within 3 days may provide a brief but important window to upstaff hospitals at the beginning of future COVID-19 surges.
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Affiliation(s)
- Benjamin H. Slovis
- Office of the CMIOThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
- Department of Emergency MedicineJefferson NortheastThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | | | - Anna Marie Chang
- Department of Emergency MedicineSidney Kimmel Medical College of Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
- CSL BehringKing of PrussiaPennsylvaniaUSA
| | - John Kairys
- Office of the CMIOThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
- Department of SurgeryThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Judd E. Hollander
- Department of Emergency MedicineSidney Kimmel Medical College of Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
- National Center for Telehealth Education and Research of Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
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20
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Mamom J, Daovisan H. Telenursing: How do caregivers treat and prevent pressure injury in bedridden patients during the COVID-19 pandemic in Thailand? Using an embedded approach. J Telemed Telecare 2024; 30:589-596. [PMID: 35293254 PMCID: PMC8927889 DOI: 10.1177/1357633x221078485] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/16/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate telenursing for caregivers (CGs) to treat and prevent pressure injury (PI) in bedridden patients (BPs) during the COVID-19 pandemic in Thailand. METHODS Purposive sampling of 70 CGs [intervention group (i-group): n = 35 and control group (c-group): n = 35)] using an embedded approach was conducted from August 2020 to February 2021. The QUAN data were concurrently collected via online semi-structured interviews (OSIs) and video in-depth interviews (VIIs), then analysed using multivariate analysis of variance and thematic analysis. RESULTS The QUAN data showed that CGs treating and preventing PI in BPs has a significant and positive effect (p < 0.01). The qual data illustrates that telenursing for CGs treating and preventing PI in BPs is associated with training and education, skin cleaning, repositioning, monitoring, and assessment of PI during the COVID-19 pandemic. CONCLUSION AND IMPLICATIONS Telenursing for CGs treating and preventing PI in BPs is valuable to the professional consultation during the COVID-19 pandemic. Telenursing can reduce the CG burden, instructing them how to visually examine, clean, monitor, and risk assess the skin of BPs to prevent PIs.
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Affiliation(s)
- Jinpitcha Mamom
- Department Of Adult Nursing and the Aged, Faculty of Nursing, Thammasat University, Khlong Nueng, Pathum Thani, Thailand
- Center of Excellence in Creative Engineering Design and Development, Faculty of Engineering, Thammasat University, Khlong Nueng, Pathum Thani, Thailand
| | - Hanvedes Daovisan
- Human Security and Equity Research Unit, Chulalongkorn University Social Research Institute, Chulalongkorn University, Bangkok, Thailand
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21
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Bailey RC, Knowles NG, Grenyer BFS. Efficacy and recommendations for the delivery of telehealth psychotherapy for people with personality disorder. Australas Psychiatry 2024; 32:125-134. [PMID: 38103036 PMCID: PMC10913324 DOI: 10.1177/10398562231222768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
OBJECTIVE There are few studies on the efficacy and acceptability of psychotherapy conducted via telehealth technology for people with personality disorder. This study aims to examine clinician perspectives on virtual psychotherapy. METHOD Twenty multidisciplinary mental health clinicians (85% female, average age 42 years) with at least 2 years of experience in telehealth psychotherapy contributed quantitative and qualitative ratings of acceptability and efficacy of this modality. RESULTS Likert scale ratings (1 = not, 5 = very) demonstrated high client acceptability (mean = 4.0), effectiveness (4.0) and high clinician acceptability (4.2) and sustainability (4.2). Three recommendations emerged from qualitative analysis: prioritising frame establishment, ensuring client safety online and maximising alliance-enhancing strategies. CONCLUSIONS This study, which collected quantitative and qualitative ratings of virtual psychotherapy, found that telehealth psychotherapy can be effective and acceptable for people with personality disorder. Strategies associated with success included strong governance, secure technology and careful attending to relationship management.
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Affiliation(s)
- Rachel C. Bailey
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Nacquel G. Knowles
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Brin F. S. Grenyer
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
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Abstract
INTRODUCTION Health systems are increasingly implementing direct-to-consumer telemedicine for unscheduled acute care, however quality of care may be variable. Acute respiratory infection antibiotic prescribing rates in telemedicine visits performed by emergency physicians affiliated with medical centers has not been compared to care by unaffiliated, vendor-supplied physicians (a heterogeneous group). We hypothesized that, in virtual visits for acute respiratory infection, affiliated physicians would prescribe antibiotics at a lower rate than unaffiliated physicians. METHODS We performed a retrospective analysis of on-demand telemedicine visits available to health system employees and dependents at a large urban academic health system from March 2018 to July 2019. We performed multivariable logistic regression to determine the effect of physician affiliation on antibiotic prescribing patterns for acute respiratory infection, adjusting for patient age, visit weekday, and overnight visits. RESULTS Of 257 telemedicine encounters related to acute respiratory infection, affiliated physicians prescribed antibiotics in 18% of visits, compared to 37% of visits by vendor physicians. In multivariable analysis, patients seen by a vendor physician for acute respiratory infection had 2.3 higher odds (95%CI 1.1-4.5, p < 0.01) of being prescribed antibiotics, an average marginal effect of 15% (95%CI 2-29%). DISCUSSION In this study of virtual visits for unscheduled acute care in a single health system, vendor-supplied physicians were predicted to prescribe an antibiotic in 15% more acute respiratory infection visits compared to system-employed emergency physicians (35% vs 19%). Physician affiliation and familiarity with a health system, in addition to other factors, may be important in guideline adherence and antibiotic stewardship in direct-to-consumer telemedicine encounters.
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Affiliation(s)
- Kathleen Y Li
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, USA
- Department of Emergency Medicine, University of Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, USA
| | - Ka Ming Ngai
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, USA
| | - Nicholas Genes
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, USA
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Benda NC, Solomonov N, Galo C, Rollandi IO, Ceruso M, Czaja SJ, Sirey JA. Extending a Tablet System for Older Adults to Deliver a Remote Social Reward Psychotherapy - A Pilot Study of Engage & Connect. Am J Geriatr Psychiatry 2024; 32:514-516. [PMID: 38176965 DOI: 10.1016/j.jagp.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Natalie C Benda
- Columbia University School of Nursing (NCB), New York, NY, USA.
| | - Nili Solomonov
- Department of Psychiatry (NS, CG, IOR, JAS), Weill Cornell Medicine, New York, NY, USA
| | - Caroline Galo
- Department of Psychiatry (NS, CG, IOR, JAS), Weill Cornell Medicine, New York, NY, USA
| | - Isabel O Rollandi
- Department of Psychiatry (NS, CG, IOR, JAS), Weill Cornell Medicine, New York, NY, USA
| | - Marco Ceruso
- Department of Geriatrics and Palliative Medicine (MC, SJC), Weill Cornell Medicine, New York, NY, USA
| | - Sara J Czaja
- Department of Geriatrics and Palliative Medicine (MC, SJC), Weill Cornell Medicine, New York, NY, USA
| | - Jo Anne Sirey
- Department of Psychiatry (NS, CG, IOR, JAS), Weill Cornell Medicine, New York, NY, USA
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Perumalswami PV, Adams MA, Frost MC, Holleman R, Kim HM, Zhang L, Lin LA. Telehealth and delivery of alcohol use disorder treatment in the Veterans Health Administration. Alcohol Clin Exp Res (Hoboken) 2024. [PMID: 38529689 DOI: 10.1111/acer.15305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/09/2024] [Accepted: 03/06/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND The use of telehealth treatment of alcohol use disorder (AUD) has increased since the start of the COVID-19 pandemic. However, it is unclear which patients are using telehealth and how telehealth visits are associated with treatment duration. This study examined characteristics associated with telehealth use among Veterans Health Administration patients receiving AUD treatment. METHODS Using a national retrospective cohort study, we examined data from March 01, 2020 to February 28, 2021 to: First, identify patient characteristics associated with (a) any telehealth versus only in-person care for AUD treatment, and (b) video (≥1 video visit) versus only telephone visits for AUD treatment (≥1 telephone visit, no video) among any telehealth users. This analysis used mixed-effects logistic regression models to adjust for potential correlation across patients treated at the same facility. Second, we assessed whether visit modality was associated with the amount of AUD treatment received (number of AUD psychotherapy visits or medication coverage days). This analysis used mixed-effects negative binomial regression models. RESULTS Among 138,619 patients who received AUD treatment, 52.8% had ≥1 video visit, 38.1% had ≥1 telephone but no video visits, and 9.1% had only in-person visits. In the regression analyses, patients who were male or had an opioid or stimulant use disorder (compared to having no non-AUD substance use disorder) were less likely to receive any telehealth-delivered AUD treatment compared to only in-person AUD treatment. Among patients who received any telehealth-delivered AUD treatment, those who were ≥45 years old (compared to 18-29 years old), Black (compared to White), diagnosed with a cannabis or stimulant use disorder, or diagnosed with a serious mental illness were less likely to receive a video visit than only telephone visits. Receiving any AUD telehealth was associated with receiving more psychotherapy visits and medication coverage days than only in-person care. CONCLUSIONS Telehealth, a common modality for AUD treatment, supported a greater number of psychotherapy visits and a longer duration of medication treatment for AUD. However, some groups were less likely to receive any video telehealth than telephone visits, suggesting that multiple treatment modalities should remain available to ensure treatment access.
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Affiliation(s)
- Ponni V Perumalswami
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Gastroenterology Section, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
| | - Megan A Adams
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Gastroenterology Section, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
| | - Madeline C Frost
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, USA
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Rob Holleman
- Health Services Research & Development, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Hyungjin Myra Kim
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Consulting for Statistics, Computing & Analytics Research (CSCAR), University of Michigan, Ann Arbor, Michigan, USA
| | - Lan Zhang
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, Addiction Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Lewei Allison Lin
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
- Department of Psychiatry, Addiction Center, University of Michigan, Ann Arbor, Michigan, USA
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Phillips J, Tomlin D, Graydon K, Sarant J. Family-Perceived Barriers and Facilitators Toward a Tele-Audiology Infant Diagnostic Testing Approach in Victoria, Australia. Telemed J E Health 2024. [PMID: 38527282 DOI: 10.1089/tmj.2023.0652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Background: Universal newborn hearing screening programs allow for early identification of congenital hearing loss. However, some families experience difficulties accessing diagnostic audiology services following a refer screen result. Methods: This study aimed to assess the opinions of families who had experienced infant diagnostic audiology assessments regarding a telehealth option for these appointments within Victoria, Australia. Families who attended in-person infant diagnostic audiology appointments were sent a questionnaire exploring their experiences of the service and their opinion regarding a proposed telehealth option for infant diagnostic audiology (50 responses received). These results were also compared to those of families who were surveyed following testing in 2020, where the audiologist conducted the appointment remotely to comply with COVID-19-related social distancing recommendations at the time (10 responses received). Results: There were not significant differences between the duration or number of appointments, perceived understanding of results, or concerns regarding a tele-audiology model between families who experienced face-to-face and tele-audiology infant diagnostic audiology appointments. Opinions of infant diagnostic audiology appointments utilizing telehealth technology were largely positive, and minimal technological difficulties were identified. Conclusion: Overall positive attitudes of many families with infant diagnostic appointment experiences toward a tele-audiology option of this service suggest that offering a telehealth model of appointments may be an appropriate model to improve service access for families requiring infant diagnostic audiology in Victoria.
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Affiliation(s)
- Jocelyn Phillips
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
| | - Dani Tomlin
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
| | - Kelley Graydon
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
| | - Julia Sarant
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
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26
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Haimi M, Wheeler SQ. Safety in Teletriage by Nurses and Physicians in the United States and Israel: Narrative Review and Qualitative Study. JMIR Hum Factors 2024; 11:e50676. [PMID: 38526526 DOI: 10.2196/50676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/25/2023] [Accepted: 02/28/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND The safety of telemedicine in general and telephone triage (teletriage) safety in particular have been a focus of concern since the 1970s. Today, telehealth, now subsuming teletriage, has a basic structure and process intended to promote safety. However, inadequate telehealth systems may also compromise patient safety. The COVID-19 pandemic accelerated rapid but uneven telehealth growth, both technologically and professionally. Within 5-10 years, the field will likely be more technologically advanced; however, these advances may still outpace professional standards. The need for an evidence-based system is crucial and urgent. OBJECTIVE Our aim was to explore ways that developed teletriage systems produce safe outcomes by examining key system components and questioning long-held assumptions. METHODS We examined safety by performing a narrative review of the literature using key terms concerning patient safety in teletriage. In addition, we conducted system analysis of 2 typical formal systems, physician led and nurse led, in Israel and the United States, respectively, and evaluated those systems' respective approaches to safety. Additionally, we conducted in-depth interviews with representative physicians and 1 nurse using a qualitative approach. RESULTS The review of literature indicated that research on various aspects of telehealth and teletriage safety is still sparse and of variable quality, producing conflicting and inconsistent results. Researchers, possibly unfamiliar with this complicated field, use an array of poorly defined terms and appear to design studies based on unfounded assumptions. The interviews with health care professionals demonstrated several challenges encountered during teletriage, mainly making diagnosis from a distance, treating unfamiliar patients, a stressful atmosphere, working alone, and technological difficulties. However, they reported using several measures that help them make accurate diagnoses and reasonable decisions, thus keeping patient safety, such as using their expertise and intuition, using structured protocols, and considering nonmedical factors and patient preferences (shared decision-making). CONCLUSIONS Remote encounters about acute, worrisome symptoms are time sensitive, requiring decision-making under conditions of uncertainty and urgency. Patient safety and safe professional practice are extremely important in the field of teletriage, which has a high potential for error. This underregulated subspecialty lacks adequate development and substantive research on system safety. Research may commingle terminology and widely different, ill-defined groups of decision makers with wide variation in decision-making skills, clinical training, experience, and job qualifications, thereby confounding results. The rapid pace of telehealth's technological growth creates urgency in identifying safe systems to guide developers and clinicians about needed improvements.
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Affiliation(s)
- Motti Haimi
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Health Systems Management Department, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
- Meuhedet Healthcare Services - North District, Tel Aviv, Israel
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27
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Kummer B, Hwang S, Agarwal P. Descriptive Analysis of Patients Receiving Outpatient eConsults for Neurological Disorders in the United States. Telemed J E Health 2024. [PMID: 38527283 DOI: 10.1089/tmj.2023.0598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Introduction: Interprofessional consultations ("eConsults"), which facilitate asynchronous specialist consultations, remain understudied in neurological disorders. We aimed to describe the patient population receiving eConsult services for neurological disorders nationwide and to conduct a comparative analysis between rural and urban patients within this eConsult cohort. Methods: We analyzed a dataset of U.S. outpatient claims from employer-sponsored commercial and Medicare plans. Using standardized mean differences, we compared clinical and sociodemographic patient characteristics between urban and rural patients within the eConsult group. Results: We identified 1,374 patients who had an eConsult order for a neurological disorder. Overall eConsult volume increased by 548.5% between 2019 and 2021. A majority of the cohort were aged 65 years or older (23.7%), had an eConsult order in 2021 (52.4%), and live in an urban area (90.4%). The primary diagnosis for our cohort was likely to be a sleep-wake disorder (21.9%), cerebrovascular disease (14.3%), neurological sign or symptom (14.2%), or headache (13.7%). In the secondary analysis, rural eConsult patients exhibited higher rates of primary diagnoses for traumatic brain injury, neuroophthalmic disorders, or neuropathy than their urban counterparts. Discussion: In this national sample of commercially insured patients, the utilization of eConsults for neurological conditions increased nationwide since 2019, especially for patients living in rural areas.
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Affiliation(s)
- Benjamin Kummer
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Clinical Neuro-Informatics Program, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Soonmyung Hwang
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Parul Agarwal
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Population Science and Health Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Flood C, Hirani SP, Mulligan K, Taylor J, Harris S, Wedderburn LR, Newman SP. Economic evaluation of a trial exploring the effects of a web-based support tool for parents of children with juvenile idiopathic arthritis. Rheumatology (Oxford) 2024:keae188. [PMID: 38519117 DOI: 10.1093/rheumatology/keae188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVE To explore the cost-effectiveness of a web-based support tool for parents of children with Juvenile Idiopathic Arthritis. METHODS A multi-centred randomised controlled trial was conducted in paediatric rheumatology centres in England. The WebParC intervention consisted of online information about JIA and its treatment and a toolkit using cognitive-behavioural therapy principles to support parents manage their child's JIA. An economic evaluation was performed alongside the trial involving 220 parents. The primary outcome was the self-report Pediatric Inventory for Parents measure of illness-related parenting stress, with two dimensions; difficulty and frequency. These measures along with costs were assessed post intervention at 4 months and 12 months. Costs were calculated for healthcare usage using a UK NHS economic perspective. Data was collected and analysed on the impact of caring costs on families. Uncertainty around cost effectiveness was explored using bootstrapping and cost-effectiveness acceptability curves. RESULTS The intervention arm showed improved average Pediatric Inventory for Parents scores for the dimensions of frequency and difficulty, of 1.5 and 3.6 respectively at 4 months and. 0.35 and 0.39 at 12 months, representing improved PIP scores for the intervention arm. At both 4 and 12 month follow up the average total cost per case was higher in the control group when compared with the intervention arm with mean differences of £360 (95% CI £29.6 to £691) at 4 months and £203 (95% CI £16 to £390) at 12 months. The probability of the intervention being cost effective ranged between 49% and 54%. CONCLUSION The WebParC intervention led to reductions in primary and secondary healthcare resource use and costs at 4 and 12 months. The intervention demonstrated particular savings for rheumatology services at both follow ups. Future economies of scale could be realised by health providers with increased opportunities for cost effectiveness over time. TRIAL REGISTRATION ISRCTN, ISRCTN13159730.
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Affiliation(s)
- Chris Flood
- Institute of Health and Social Care, London South Bank University, London, UK
- Centre for Health Services Research, School of Health & Psychological Sciences, City, University of London, London, United Kingdom
| | - Shashivadan P Hirani
- Centre for Health Services Research, School of Health & Psychological Sciences, City, University of London, London, United Kingdom
| | - Kathleen Mulligan
- Centre for Health Services Research, School of Health & Psychological Sciences, City, University of London, London, United Kingdom
- East London NHS Foundation Trust, United Kingdom, London
| | - Jo Taylor
- Centre for Health Services Research, School of Health & Psychological Sciences, City, University of London, London, United Kingdom
| | - Sally Harris
- University Hospitals Sussex NHS Trust, Brighton, United Kingdom
| | - Lucy R Wedderburn
- University College London Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Centre for Adolescent Rheumatology Versus Arthritis at University College London Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital, London, United Kingdom
| | - Stanton P Newman
- Centre for Health Services Research, School of Health & Psychological Sciences, City, University of London, London, United Kingdom
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Linggonegoro D, Williams K, Hlobik M, Huang J. Inequities in Technology Access and Digital Health Literacy Among Patients With Dermatologic Conditions: Cross-Sectional Analysis of the National Health Interview Survey. JMIR Dermatol 2024; 7:e51511. [PMID: 38517468 DOI: 10.2196/51511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 03/23/2024] Open
Abstract
Certain sociodemographic factors are associated with low technology access and digital healthy literacy.
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Affiliation(s)
- Danny Linggonegoro
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Kathryn Williams
- Biostatistics and Research Design Center, ICCTR, Boston Children's Hospital, Boston, MA, United States
| | - Madeline Hlobik
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, MA, United States
| | - Jennifer Huang
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, MA, United States
- Department of Dermatology, Harvard Medical School, Boston, MA, United States
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30
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Ridout B, Forsyth R, Amon KL, Navarro P, Campbell AJ. The Urgent Need for an Evidence-Based Digital Mental Health Practice Model of Care for Youth. JMIR Ment Health 2024; 11:e48441. [PMID: 38534006 DOI: 10.2196/48441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 01/07/2024] [Accepted: 01/25/2024] [Indexed: 03/28/2024] Open
Abstract
Abstract
Australian providers of mental health services and support for young people include private and public allied health providers, government initiatives (eg, headspace), nongovernment organizations (eg, Kids Helpline), general practitioners (GPs), and the hospital system. Over 20 years of research has established that many young people prefer to seek mental health support online; however, clear client pathways within and between online and offline mental health services are currently lacking. The authors propose a Digital Mental Health Practice model of care for youth to assist with digital mental health service mapping. The proposed model offers accessible pathways for a client to engage with digital mental health services, provides clear navigation to access support for individual needs, and facilitates a seamless connection with offline mental health services using a transferable electronic health records system. This future-looking model also includes emerging technologies, such as artificial intelligence and the metaverse, which must be accounted for as potential tools to be leveraged for digital therapies and support systems. The urgent need for a user-centered Digital Mental Health Practice model of care for youth in Australia is discussed, highlighting the shortcomings of traditional and existing online triage models evident during the COVID-19 pandemic, and the complex challenges that must be overcome, such as the integration of diverse mental health care providers and establishment of a robust electronic health records system. Potential benefits of such a model include reduced pressure on emergency rooms, improved identification of immediate needs, enhanced referral practices, and the establishment of a cost-efficient national digital mental health care model with global applicability. The authors conclude by stressing the consequences of inaction, warning that delays may lead to more complex challenges as new technologies emerge and exacerbate the long-term negative consequences of poor mental health management on the economic and biopsychosocial well-being of young Australians.
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Affiliation(s)
- Brad Ridout
- Cyberpsychology Research Group, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rowena Forsyth
- Cyberpsychology Research Group, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Krestina L Amon
- Cyberpsychology Research Group, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Andrew J Campbell
- Cyberpsychology Research Group, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Rettinger L, Putz P, Aichinger L, Javorszky SM, Widhalm K, Ertelt-Bach V, Huber A, Sargis S, Maul L, Radinger O, Werner F, Kuhn S. Telehealth Education in Allied Health Care and Nursing: Web-Based Cross-Sectional Survey of Student's Perceived Knowledge, Skills, Attitudes, and Experience. JMIR Med Educ 2024; 10:e51112. [PMID: 38512310 DOI: 10.2196/51112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/04/2023] [Accepted: 02/13/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The COVID-19 pandemic has highlighted the growing relevance of telehealth in health care. Assessing health care and nursing students' telehealth competencies is crucial for its successful integration into education and practice. OBJECTIVE We aimed to assess students' perceived telehealth knowledge, skills, attitudes, and experiences. In addition, we aimed to examine students' preferences for telehealth content and teaching methods within their curricula. METHODS We conducted a cross-sectional web-based study in May 2022. A project-specific questionnaire, developed and refined through iterative feedback and face-validity testing, addressed topics such as demographics, personal perceptions, and professional experience with telehealth and solicited input on potential telehealth course content. Statistical analyses were conducted on surveys with at least a 50% completion rate, including descriptive statistics of categorical variables, graphical representation of results, and Kruskal Wallis tests for central tendencies in subgroup analyses. RESULTS A total of 261 students from 7 bachelor's and 4 master's health care and nursing programs participated in the study. Most students expressed interest in telehealth (180/261, 69% very or rather interested) and recognized its importance in their education (215/261, 82.4% very or rather important). However, most participants reported limited knowledge of telehealth applications concerning their profession (only 7/261, 2.7% stated profound knowledge) and limited active telehealth experience with various telehealth applications (between 18/261, 6.9% and 63/261, 24.1%). Statistically significant differences were found between study programs regarding telehealth interest (P=.005), knowledge (P<.001), perceived importance in education (P<.001), and perceived relevance after the pandemic (P=.004). Practical training with devices, software, and apps and telehealth case examples with various patient groups were perceived as most important for integration in future curricula. Most students preferred both interdisciplinary and program-specific courses. CONCLUSIONS This study emphasizes the need to integrate telehealth into health care education curricula, as students state positive telehealth attitudes but seem to be not adequately prepared for its implementation. To optimally prepare future health professionals for the increasing role of telehealth in practice, the results of this study can be considered when designing telehealth curricula.
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Affiliation(s)
- Lena Rettinger
- Health Assisting Engineering, FH Campus Wien, University of Applied Sciences, Vienna, Austria
- Institute of Digital Medicine, Philipps-University & University Hospital of Giessen and Marburg, Marburg, Germany
| | - Peter Putz
- Competence Center INDICATION, FH Campus Wien, University of Applied Sciences, Vienna, Austria
| | - Lea Aichinger
- Health Assisting Engineering, FH Campus Wien, University of Applied Sciences, Vienna, Austria
| | - Susanne Maria Javorszky
- Logopedics - Phoniatrics - Audiology, FH Campus Wien, University of Applied Sciences, Vienna, Austria
| | - Klaus Widhalm
- Physiotherapy, FH Campus Wien, University of Applied Sciences, Vienna, Austria
| | - Veronika Ertelt-Bach
- Occupational Therapy, FH Campus Wien, University of Applied Sciences, Vienna, Austria
| | - Andreas Huber
- Orthoptics, FH Campus Wien, University of Applied Sciences, Vienna, Austria
| | - Sevan Sargis
- Midwifery, FH Campus Wien, University of Applied Sciences, Vienna, Austria
| | - Lukas Maul
- Health Assisting Engineering, FH Campus Wien, University of Applied Sciences, Vienna, Austria
| | - Oliver Radinger
- Competence Center Nursing Sciences, FH Campus Wien, University of Applied Sciences, Vienna, Austria
| | - Franz Werner
- Health Assisting Engineering, FH Campus Wien, University of Applied Sciences, Vienna, Austria
| | - Sebastian Kuhn
- Institute of Digital Medicine, Philipps-University & University Hospital of Giessen and Marburg, Marburg, Germany
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Sequeira GM, Kidd KM, Slekar A, Kahn NF, Costello LM, Negrin I, Huzurbazar S, Narumanchi J. Comfort Providing Gender-Affirming Care and Preferences for Consultative Support Among Rural Pediatric Primary Care Providers. Telemed J E Health 2024. [PMID: 38512469 DOI: 10.1089/tmj.2023.0537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Objective: To examine how specialist-to-pediatric primary care provider (PPCP) consultative support may impact PPCP comfort in providing gender-affirming care. Methods: PPCPs in West Virginia completed an electronic survey. T-tests compared comfort providing gender-affirming care and rank-sum tests compared the practicality of four consultative support modalities by time in practice and specialty. Results: Of 51 participants, 47.1% had been in practice for <10 years and 59.6% were trained in pediatrics. PPCPs with <10 years in practice and those trained in pediatrics were more comfortable providing gender-affirming care than those in practice >10 years and those trained in family medicine. PPCPs felt that telemedicine was more practical than tele-education, although they reported all consultative support modalities would increase comfort providing this care. Conclusions: Access to consultative support can increase PPCP comfort providing gender-affirming care, although certain modalities may be more effective for PPCPs with varying levels of experience and specialty training.
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Affiliation(s)
- Gina M Sequeira
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kacie M Kidd
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Alana Slekar
- West Virginia University, Morgantown, West Virginia, USA
| | - Nicole F Kahn
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lisa M Costello
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Isabela Negrin
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Snehalata Huzurbazar
- Department of Biostatistics, West Virginia University School of Public Health, Morgantown, West Virginia, USA
| | - Janani Narumanchi
- Department of Pediatrics, University of Tennessee School of Medicine, Memphis, Tennessee, USA
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Pines R, Haverfield MC, Wong Chen S, Lee E, Brown-Johnson C, Kline M, Weimer-Elder B. Evaluating the Implementation of a Relationship-Centered Communication Training for Connecting With Patients in Virtual Visits. J Patient Exp 2024; 11:23743735241241179. [PMID: 38515761 PMCID: PMC10956136 DOI: 10.1177/23743735241241179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
The use of telehealth, specifically virtual visits, has increased and adoption continues. Providers need effective training for how to communicate with patients to develop a connection during virtual visits. This article describes the implementation and evaluation of a course called Mastering Presence in Virtual Visits. Results show that although providers perceive lack of time, technology issues, and lacking experiential knowledge as barriers to enacting course behaviors, the course was feasible and acceptable. Following the course, providers rated key course behaviors as helpful for practice, and 80.7% of providers were likely to recommend the course to a colleague. The course shifted provider perceptions of the purpose, patient experience, and procedures in virtual visits. Prior to the course, providers perceived virtual visits as fundamentally different than in-person visits. However, after the course, they recognized the importance of connection in virtual visits and how to foster that connection. Providers continue to require support in conducting high-quality virtual visits. Online, asynchronous courses, developed in partnership with providers, are feasible and effective for encouraging behavior change. Key findings: When asked on a needs assessment in 2020, communication strategies to connect with patients in virtual visits were a top provider need. Partnering with providers to create online, communication training content is effective for increasing the acceptability of courses about virtual visits. Asynchronous, online courses can meet provider needs for communication strategies to connect with patients in virtual visits.
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Affiliation(s)
- Rachyl Pines
- Department of Patient Experience, Physician Partnership Program, Stanford Medicine, Palo Alto, CA, USA
| | - Marie C. Haverfield
- Department of Communication Studies, San José State University, San Jose, CA, USA
| | - Stephanie Wong Chen
- Department of Patient Experience, Physician Partnership Program, Stanford Medicine, Palo Alto, CA, USA
| | - Ethan Lee
- Department of Patient Experience, Physician Partnership Program, Stanford Medicine, Palo Alto, CA, USA
| | | | - Merisa Kline
- Department of Patient Experience, Physician Partnership Program, Stanford Medicine, Palo Alto, CA, USA
| | - Barbette Weimer-Elder
- Department of Patient Experience, Physician Partnership Program, Stanford Medicine, Palo Alto, CA, USA
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Gotthardt CJ, Haynes SC, Murphy RK, Marcin P. Patient and Parent Experience with Pediatric Care Providers During the COVID-19 Pandemic: A Comparison of Press Ganey Survey Scores for Telehealth and In-Person Encounters. Telemed J E Health 2024. [PMID: 38512471 DOI: 10.1089/tmj.2024.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Background: Prior research suggests that pediatric patients and their parents/guardians are generally satisfied with care provided through telehealth. The objective of this study was to compare Press Ganey provider-oriented experience survey scores between telehealth and in-person patient encounters among a variety of pediatric clinical specialties at a large academic medical center. Methods: We analyzed Press Ganey survey data from pediatric patient encounters from UC Davis Health, collected between August 2020 and February 2022. Survey results analyzed respondents' satisfaction with care providers, including satisfaction with explanations given, discussions led, concern showed, and inclusion by providers; and the likelihood the survey respondent would recommend the provider to others. We used logistic regression models, which included case mix variables and clinical specialty to compare the odds of scoring the highest possible survey response ("top box" score). Results: Of the 6,093 survey responses that met inclusion criteria, 1,157 (19%) were associated with telehealth encounters and 4,936 (81%) were associated with in-person encounters. We found no significant difference in the odds of respondents giving a top box score to rate their satisfaction with their care provider between telehealth and in-person encounters. When respondents were asked whether they would recommend the care provider to others, the odds of giving a top box score following a telehealth encounter relative to an in-person encounter was 1.22 (95% confidence interval [0.97-1.52]; p-value = 0.09). Discussion: We found that survey respondents' experiences with their care provider are high and comparable for telehealth and in-person encounters in a pediatric population.
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Affiliation(s)
- Christine J Gotthardt
- Department of Pediatrics, Davis School of Medicine, University of California, Sacramento, California, USA
| | - Sarah C Haynes
- Department of Pediatrics, Davis School of Medicine, University of California, Sacramento, California, USA
| | - Riley K Murphy
- University of California Davis Health, Sacramento, California, USA
| | - P Marcin
- Department of Pediatrics, Davis School of Medicine, University of California, Sacramento, California, USA
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Nieto-Calvache AJ, Fox KA, Jauniaux E, Maya J, Stefanovic V, Weizsäcker K, van Beekhuizen H, Adu-Bredu T, Collins S, Siaulys M, Hussein AM, Duvekot J, Aryananda R, Nieto-Calvache AS, Pajkrt E, Rijken MJ. Is telehealth useful in the management of placenta accreta spectrum in low-resource settings? Results of an exploratory survey. Int J Gynaecol Obstet 2024. [PMID: 38509726 DOI: 10.1002/ijgo.15474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/25/2024] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE The optimal management of placenta accreta spectrum (PAS) requires the participation of multidisciplinary teams that are often not locally available in low-resource settings. Telehealth has been increasingly used to manage complex obstetric conditions. Few studies have explored the use of telehealth for PAS management, and we aimed evaluate the usage of telehealth in the management of PAS patients in low-resource settings. METHODS Between March and April 2023, an observational, survey-based study was conducted, and obstetricians-gynecologists with expertise in PAS management in low- and middle-income countries were contacted to share their opinion on the potential use of telehealth for the diagnosis and management of patients at high-risk of PAS at birth. Participants were identified based on their authorship of at least one published clinical study on PAS in the last 5 years and contacted by email. This is a secondary analysis of the results of that survey. RESULTS From 158 authors contacted we obtained 65 responses from participants in 27 middle-income countries. A third of the participants reported the use of telehealth during the management obstetric emergencies (38.5%, n = 25) and PAS (36.9%, n = 24). Over 70% of those surveyed indicated that they had used "informal" telemedicine (phone call, email, or text message) during PAS management. Fifty-nine participants (90.8%) reported that recommendations given remotely by expert colleagues were useful for management of patients with PAS in their setting. CONCLUSION Telehealth has been successfully used for the management of PAS in middle-income countries, and our survey indicates that it could support the development of specialist care in other low resource settings.
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Affiliation(s)
- Albaro José Nieto-Calvache
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Clínica de Espectro de Acretismo Placentario, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Karin A Fox
- University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Eric Jauniaux
- Faculty of Population Health Sciences, EGA Institute for Women's Health, University College London (UCL), London, UK
| | | | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, Fetomaternal Medical Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Katharina Weizsäcker
- Department of Obstetrics and Division of Experimental Obstetrics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Heleen van Beekhuizen
- Department of Gynecological Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Theophilus Adu-Bredu
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Sally Collins
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Monica Siaulys
- Hospital e Maternidade Santa Joana, Centro de Ensino, Pesquisa e Inovação, São Paulo, São Paulo, Brazil
| | - Ahmed M Hussein
- Department of Obstetrics and Gynecology, University of Cairo, Cairo, Egypt
| | - Johannes Duvekot
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rozi Aryananda
- Maternal-Fetal Medicine Division, Obstetrics and Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | | | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Marcus J Rijken
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Julius Global Health, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Gahungu N, Lan NSR, Gamalath S, Phan J, Bhat V, Spencer R, Hitchen SA, Rankin JM, Dwivedi G, Ihdayhid AR. Telehealth during COVID-19 restrictions in patients with cardiovascular disease: impact on medication prescriptions and patient satisfaction. Intern Med J 2024. [PMID: 38506546 DOI: 10.1111/imj.16378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND AND AIMS Telehealth plays an integral part in healthcare delivery. The impact of telehealth and the COVID-19 pandemic on medication prescribing and patient satisfaction with telehealth in cardiology clinics remains unknown. METHODS A retrospective study of cardiology clinic patients at an Australian tertiary hospital was conducted; 630 patients seen before the COVID-19 pandemic (0.6% telehealth) and 678 during the pandemic (91.2% telehealth) were included. Medication changes, new prescriptions and time to obtaining prescriptions after clinic were compared. To evaluate patients' experiences, cardiology clinic patients reviewed during the pandemic were prospectively invited to participate in an electronic survey sent to their mobile phones. RESULTS The overall rates of medication changes made in the clinic between the prepandemic and the pandemic periods did not differ significantly (26.9% vs 25.8%). Compared with prepandemic, new cardiac medication prescriptions during clinic were significantly less (9.3% vs 2.5%; P < 0.0001) and recommendations to general practitioners (GP) to initiate cardiac medications were significantly more (2.6% vs 9.1%; P < 0.0001). Time to obtaining new prescriptions was significantly longer in the pandemic cohort (median 0 days (range: 0-32) vs 10.5 days (range: 0-231); P < 0.0001). Two hundred forty-three (32.7%) patients participated in the survey; 50% reported that telehealth was at least as good as face-to-face consultations. Most patients (61.5%) were satisfied with telehealth and most (62.9%) wished to see telehealth continued postpandemic. CONCLUSION Telehealth during the COVID-19 pandemic was associated with greater reliance on GP to prescribe cardiac medications and delays in obtaining prescriptions among cardiology clinic patients. Although most patients were satisfied with telehealth services, nearly half of the cardiac patients expressed preference towards traditional face-to-face consultations.
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Affiliation(s)
- Nestor Gahungu
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Nick S R Lan
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Sameera Gamalath
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Jane Phan
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Vikas Bhat
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Rhys Spencer
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Sarah A Hitchen
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - James M Rankin
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Girish Dwivedi
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Abdul Rahman Ihdayhid
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
- Medical School, Curtin University, Perth, Western Australia, Australia
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Friedlander A, Sinai D, Zilcha-Mano S, Weiser M, Caspi A, Lichtenberg P, Amitai Z, Tzur Bitan D. Development of the Therapeutic Alliance in Alternative Settings to Psychiatric Hospitalization: An Open Comparative Study. Psychiatr Serv 2024:appips20230009. [PMID: 38500450 DOI: 10.1176/appi.ps.20230009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Patient-therapist alliance in two alternative treatment settings developed similarly to that in traditional psychiatric hospitalization.
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Affiliation(s)
- Avraham Friedlander
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Dana Sinai
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Sigal Zilcha-Mano
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Mark Weiser
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Asaf Caspi
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Pesach Lichtenberg
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Ziv Amitai
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
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Montiel C, Jackson M, Clovin T, Bogdanova E, Côté C, Descoteaux A, Wong C, Dumez V, Pomey MP, Hanna D. Patient Learning Pathway: Identifying Patient Competencies in Teledermatology for Effective Management of Dermatological Conditions. J Cutan Med Surg 2024:12034754241238716. [PMID: 38504209 DOI: 10.1177/12034754241238716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Dermatology consultations in Québec, Canada, face accessibility challenges, with most dermatologists concentrated in urban areas. Teledermatology, offering remote diagnosis and treatment, holds promise in overcoming these limitations. However, concerns regarding patient-doctor relationships and logistical issues exist. OBJECTIVES This article aims to introduce a dermatology patient learning pathway (PLP) developed by the Centre of Excellence on Partnership with Patients and the Public (CEPPP), focusing on knowledge, abilities, and skills mobilized by patients and their loved ones at key moments of the life course with an illness, as well as emerging educational needs. METHODS The PLP development was co-developed with dermatology patient and caregiver partners, stakeholders, and the CEPPP team. The process encompassed stakeholder engagement, exploration, recruitment of patient and caregiver partners, co-development of the PLP draft, and validation through consensus building. RESULTS The PLP methodology led to the creation of 44 learning objectives, comprising a total of 107 subobjectives. These objectives were organized into 8 phases of the patient life course with a dermatological condition: (1) prevention and predisposition; (2) discovery, self-examination, or observation of a change; (3) first consultation; (4) wandering; (5) consultation with a dermatologist; (6) diagnosis; (7) treatments; and (8) living with it. CONCLUSIONS The dermatology PLP serves as a resource outlining patient competency across different stages of managing a dermatological condition throughout their life course. In the context of teledermatology, the PLP might facilitate patient and caregiver engagement by helping select appropriate information and tools to support active participation in care.
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Affiliation(s)
- Corentin Montiel
- Université du Québec à Montréal, Montréal, QC, Canada
- Centre of Excellence on Partnership with Patients and the Public, Montreal, QC, Canada
| | - Mathieu Jackson
- Centre of Excellence on Partnership with Patients and the Public, Montreal, QC, Canada
| | - Tiffany Clovin
- Centre of Excellence on Partnership with Patients and the Public, Montreal, QC, Canada
| | - Eleonora Bogdanova
- Centre of Excellence on Partnership with Patients and the Public, Montreal, QC, Canada
| | | | - Annie Descoteaux
- Bureau du Patient Partenaire, Faculté de médecine de l'Université de Montréal, Montreal, QC, Canada
| | - Caroline Wong
- Université du Québec à Montréal, Montréal, QC, Canada
| | - Vincent Dumez
- Université du Québec à Montréal, Montréal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
| | - Marie-Pascale Pomey
- Université du Québec à Montréal, Montréal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Dominique Hanna
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
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Barnawi NA, Al-Otaibi H, Alkhudairy AI, Alajlan MA, Alajlan RA, Alay SM, Alqahtani SM, Bushnak IA, Abolfotouh MA. Awareness, Knowledge, Attitude, and Skills (AKAS) of Telemedicine and Its Use by Primary Healthcare Providers. Int J Gen Med 2024; 17:1047-1058. [PMID: 38532847 PMCID: PMC10964027 DOI: 10.2147/ijgm.s452641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
Background This study aimed to determine the rate of telemedicine (TM) use and the levels of awareness, knowledge, attitude, and skills of TM among primary healthcare (PHC) providers. Methods In a cross-sectional study, 104 PHC providers were subjected to a validated AKAS scale via Survey Monkey. The tool consists of 4 parameters that users can respond to using a 4-point Likert scale to assess their awareness (12 statements), knowledge (11 statements), attitude (11 statements), and skills (13 statements) on TM. Total and percentage mean scores (PMS) were calculated for each parameter. Participants were categorized in each parameter into three categories: low (≤ 49% score), average (50-70% score), and high (≥ 71% score) levels. The association of AKAS levels with personal characteristics and TM use was investigated. The significance was set at p<0.05. Results One-half of participants (51%) reported current use of TM, and two-thirds (63.5%) reported a high level of AKAS, with a PMS of 72.9±14.7, 95% CI: 70.1-75.7. There were significant associations between the following: years of experience and levels of knowledge (Χ2LT = 6.77, p= 0.009) and skills (Χ2LT = 4.85, p = 0.028), respectively; and total household income and levels of skills (Χ2LT = 6.91, p= 0.009). The rate of TM use was significantly associated with awareness levels (Χ2LT = 6.14, p = 0.013). Lack of training ranked as the first barrier (45.5%), followed by connection problems and tools' unavailability (35.1% each). The participants recommended providing TM training (41.1%) and stabilization of connection and networking signals (30.1%). Conclusion Despite their high level of TM awareness, the rate of TM use by PHC providers is less than satisfactory. Establishing standardized TM training and supporting the network signals are recommended. A large-scale study on the impact of TM integration with PHC services is necessary.
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Affiliation(s)
- Najla A Barnawi
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Nursing, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | - Hazza Al-Otaibi
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abdulaziz I Alkhudairy
- College of Medicine, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | - Mohammed A Alajlan
- College of Medicine, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | - Renad A Alajlan
- College of Medicine, Imam Muhammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Saeed M Alay
- College of Pharmacy, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | | | - Ibraheem A Bushnak
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mostafa A Abolfotouh
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Danielson ML, Claussen AH, Arifkhanova A, Gonzalez MG, Surman C. Who Provides Outpatient Clinical Care for Adults With ADHD? Analysis of Healthcare Claims by Types of Providers Among Private Insurance and Medicaid Enrollees, 2021. J Atten Disord 2024:10870547241238899. [PMID: 38500256 DOI: 10.1177/10870547241238899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
OBJECTIVE To characterize provider types delivering outpatient care overall and through telehealth to U.S. adults with ADHD. METHOD Using employer-sponsored insurance (ESI) and Medicaid claims, we identified enrollees aged 18 to 64 years who received outpatient care for ADHD in 2021. Billing provider codes were used to tabulate the percentage of enrollees receiving ADHD care from 10 provider types overall and through telehealth. RESULTS Family practice physicians, psychiatrists, and nurse practitioners/psychiatric nurses were the most common providers for adults with ESI, although the distribution of provider types varied across states. Lower percentages of adults with Medicaid received ADHD care from physicians. Approximately half of adults receiving outpatient ADHD care received ADHD care by telehealth. CONCLUSION Results may inform the development of clinical guidelines for adult ADHD and identify audiences for guideline dissemination and education planning.
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Affiliation(s)
| | | | | | | | - Craig Surman
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Heidari O, Winiker AK, Pollock S, Sodder S, Tsui JI, Tobin KE. A qualitative exploration of the use of telehealth for opioid treatment: Implications for nurse-managed care. J Clin Nurs 2024. [PMID: 38500003 DOI: 10.1111/jocn.17125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/25/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
AIM To characterise experiences with telehealth for Medications for Opioid Use Disorder (MOUD) services among patients, prescribers, nurses and substance use counsellors to inform future best practices. DESIGN We engaged a qualitative descriptive study design. METHODS Semi-structured interviews were conducted with prescribers (nurse practitioners and physicians, n = 20), nurses and substance use counsellors (n = 7), and patients (n = 20) between June and September 2021. Interviews were verbatim transcribed. Thematic analysis was conducted using a qualitative descriptive method. RESULTS Among both providers and patients, four themes were identified: (1) Difficulties with telehealth connection (2) Flexibility in follow-up and retention, (3) Policy changes that enabled expanded care, (4) Path forward with telehealth. Two additional findings emerged from provider interviews: (1) Expansion of nurse-managed office-based opioid treatment, and (2) Novel methods to engage patients. CONCLUSIONS Patients and providers continued to view telehealth as an acceptable means for delivery and management of MOUD, particularly when utilised in a hybrid manner between in-person visits. Nurse-managed care for this service was evident as nurses extended the breadth of services offered and utilised novel methods such as text messages and management of 'call-in' lines to engage patients. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Use of telehealth for MOUD should be incorporated into practice settings to reach patients in a flexible manner. Nurses in particular can use this medium to extend office-based opioid treatment by conducting assessments and expanding capacity for other wrap-around services. IMPACT We identify recommendations for best practices in the use of telehealth for opioid use disorder management and highlight the value of nurse-managed care. REPORTING METHOD The consolidated criteria for reporting qualitative research. PATIENT OR PUBLIC CONTRIBUTION Patients with opioid use disorder and prescribers with experience using telehealth were interviewed for this study.
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Affiliation(s)
- Omeid Heidari
- School of Nursing, Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | - Abigail K Winiker
- Bloomberg School of Public Health, Department of Health, Behavior, and Society, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sarah Pollock
- Bloomberg School of Public Health, Department of Health, Behavior, and Society, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shereen Sodder
- Bloomberg School of Public Health, Department of Health, Behavior, and Society, Johns Hopkins University, Baltimore, Maryland, USA
| | - Judith I Tsui
- Harborview Medical Center, School of Medicine, Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Karin E Tobin
- Bloomberg School of Public Health, Department of Health, Behavior, and Society, Johns Hopkins University, Baltimore, Maryland, USA
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Moulton JE, Botfield JR, Subasinghe AK, Withanage NN, Mazza D. Nurse and midwife involvement in task-sharing and telehealth service delivery models in primary care: A scoping review. J Clin Nurs 2024. [PMID: 38500016 DOI: 10.1111/jocn.17106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 03/20/2024]
Abstract
AIM To synthesise and map current evidence on nurse and midwife involvement in task-sharing service delivery, including both face-to-face and telehealth models, in primary care. DESIGN This scoping review was informed by the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. DATA SOURCE/REVIEW METHODS Five databases (Ovid MEDLINE, Embase, PubMed, CINAHL and Cochrane Library) were searched from inception to 16 January 2024, and articles were screened for inclusion in Covidence by three authors. Findings were mapped according to the research questions and review outcomes such as characteristics of models, health and economic outcomes, and the feasibility and acceptability of nurse-led models. RESULTS One hundred peer-reviewed articles (as 99 studies) were deemed eligible for inclusion. Task-sharing models existed for a range of conditions, particularly diabetes and hypertension. Nurse-led models allowed nurses to work to the extent of their practice scope, were acceptable to patients and providers, and improved health outcomes. Models can be cost-effective, and increase system efficiencies with supportive training, clinical set-up and regulatory systems. Some limitations to telehealth models are described, including technological issues, time burden and concerns around accessibility for patients with lower technological literacy. CONCLUSION Nurse-led models can improve health, economic and service delivery outcomes in primary care and are acceptable to patients and providers. Appropriate training, funding and regulatory systems are essential for task-sharing models with nurses to be feasible and effective. IMPACT Nurse-led models are one strategy to improve health equity and access; however, there is a scarcity of literature on what these models look like and how they work in the primary care setting. Evidence suggests these models can also improve health outcomes, are perceived to be feasible and acceptable, and can be cost-effective. Increased utilisation of nurse-led models should be considered to address health system challenges and improve access to essential primary healthcare services globally. REPORTING METHOD This review is reported against the PRISMA-ScR criteria. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. PROTOCOL REGISTRATION The study protocol is published in BJGP Open (Moulton et al., 2022).
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Affiliation(s)
- Jessica E Moulton
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Jessica R Botfield
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
- Family Planning NSW, Sydney, New South Wales, Australia
| | - Asvini K Subasinghe
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Nishadi Nethmini Withanage
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Danielle Mazza
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
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Tilhou AS, Burns M, Chachlani P, Chen Y, Dague L. How Does Telehealth Expansion Change Access to Healthcare for Patients With Different Types of Substance Use Disorders? Subst Use Addctn J 2024:29767342241236028. [PMID: 38494728 DOI: 10.1177/29767342241236028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Patients with substance use disorders (SUDs) exhibit low healthcare utilization despite high medical need. Telehealth could boost utilization, but variation in uptake across SUDs is unknown. METHODS Using Wisconsin Medicaid enrollment and claims data from December 1, 2018, to December 31, 2020, we conducted a cohort study of telemedicine uptake in the all-ambulatory and the primary care setting during telehealth expansion following the COVID-19 public health emergency (PHE) onset (March 14, 2020). The sample included continuously enrolled (19 months), nonpregnant, nondisabled adults aged 19 to 64 years with opioid (OUD), alcohol (AUD), stimulant (StimUD), or cannabis (CannUD) use disorder or polysubstance use (PSU). Outcomes: total and telehealth visits in the week, and fraction of visits in the week completed by telehealth. Linear and fractional regression estimated changes in in-person and telemedicine utilization. We used regression coefficients to calculate the change in telemedicine utilization, the proportion of in-person decline offset by telemedicine uptake ("offset"), and the share of visits completed by telemedicine ("share"). RESULTS The cohort (n = 16 756) included individuals with OUD (34.8%), AUD (30.1%), StimUD (9.5%), CannUD (9.5%), and PSU (19.7%). Total and telemedicine utilization varied by group post-PHE. All-ambulatory: total visits dropped for all, then rose above baseline for OUD, PSU, and AUD. Telehealth expansion was associated with visit increases: OUD: 0.489, P < .001; PSU: 0.341, P < .001; StimUD: 0.160, P < .001; AUD: 0.132, P < .001; CannUD: 0.115, P < .001. StimUD exhibited the greatest telemedicine share. Primary care: total visits dropped for all, then recovered for OUD and CannUD. Telemedicine visits rose most for PSU: 0.021, P < .001; OUD: 0.019, P < .001; CannUD: 0.011, P < .001; AUD: 0.010, P < .001; StimUD: 0.009, P < .001. PSU and OUD exhibited the greatest telemedicine share, while StimUD exhibited the lowest. Telemedicine fully offset declines for OUD only. CONCLUSIONS Telehealth expansion helped maintain utilization for OUD and PSU; StimUD and CannUD showed less responsiveness. Telehealth expansion could widen gaps in utilization by SUD type.
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Affiliation(s)
- Alyssa Shell Tilhou
- Department of Family Medicine, Boston University Medical Center, Boston, MA, USA
| | - Marguerite Burns
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Preeti Chachlani
- Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI, USA
| | - Ying Chen
- Department of Risk and Insurance, Wisconsin School of Business, University of Wisconsin-Madison, Madison, WI, USA
| | - Laura Dague
- The Bush School of Government and Public Service, Texas A&M University, College Station, TX, USA
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Hofner M, Hurnaus P, DiStefano D, Philip S, Kim S, Shaw J, Waring AC. Outcomes of an Asynchronous Care Model for Chronic Conditions in a Diverse Population: 12-Month Retrospective Chart Review Study. JMIR Diabetes 2024; 9:e53835. [PMID: 38363585 DOI: 10.2196/53835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/06/2023] [Accepted: 02/16/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Diabetes and hypertension are some of the most prevalent and costly chronic conditions in the United States. However, outcomes continue to lag behind targets, creating further risk of long-term complications, morbidity, and mortality for people living with these conditions. Furthermore, racial and ethnic disparities in glycemic and hypertension control persist. Flexible telehealth programs leveraging asynchronous care allow for increased provider access and more convenient follow-up, ultimately improving critical health outcomes across demographic groups. OBJECTIVE We aim to evaluate the 12-month clinical outcomes of participants in the 9amHealth web-based clinic for diabetes and hypertension. We hypothesized that participation in the 9amHealth program would be associated with significant improvements in glycemic and blood pressure (BP) control across a diverse group of individuals. METHODS We enrolled 95 patients in a completely web-based care clinic for diabetes and hypertension who received nutrition counseling, health coaching, and asynchronous physician consultations for medication prescribing. Patients received standard or cellular-connected glucose meters and BP cuffs in order to share data. Laboratory tests were completed either with at-home phlebotomy draws or a self-administered test kit. Patients' first and last hemoglobin A1c (HbA1c) and BP results over the 12-month period were compared, and analyses were repeated across race and ethnicity groups. RESULTS Among all 95 patients, the average HbA1c decreased by -1.0 (from 8.2% to 7.2%; P<.001) over 12 months of program participation. In those with a baseline HbA1c >8%, the average HbA1c decreased by -2.1 (from 10.2% to 8.1%; P<.001), and in those with a baseline HbA1c >9%, the average HbA1c decreased by -2.8 (from 11% to 8.2%; P<.001). Among participants who identified as a race or ethnicity other than White, the HbA1c decreased by -1.2 (from 8.6% to 7.4%, P=.001). Further examination of subgroups confirmed HbA1c lowering within each race or ethnicity group. In the overall population, the average systolic BP decreased by 17.7 mm Hg (P=.006) and the average diastolic BP decreased by 14.3 mm Hg (P=.002). Among participants self-identifying as a race or ethnicity other than White, the results similarly showed a decrease in BP (average reduction in systolic BP of 10 mm Hg and in diastolic BP of 9 mm Hg). CONCLUSIONS A fully web-based model leveraging all-asynchronous physician review and prescribing, combined with synchronous and asynchronous coaching and nutrition support, was associated with clinically meaningful improvement in HbA1c and BP control over a 12-month period among a diverse group of individuals. Further studies should prospectively evaluate the effectiveness of such models among larger populations, assess the longer-term sustainability of these outcomes, and explore financial models to make these types of programs broadly accessible.
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Affiliation(s)
| | | | | | - Shaji Philip
- Washington Permanente Medical Group, Seattle, WA, United States
| | - Sarah Kim
- Zuckerberg San Francisco General Hospital, Division of Endocrinology, Diabetes and Metabolism, University of California, San Francisco, San Francisco, CA, United States
| | - Julie Shaw
- The Ottawa Hospital and EORLA, University of Ottawa, Ottowa, ON, Canada
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Mannoubi C, Kairy D, Menezes KV, Desroches S, Layani G, Vachon B. The Key Digital Tool Features of Complex Telehealth Interventions Used for Type 2 Diabetes Self-Management and Monitoring With Health Professional Involvement: Scoping Review. JMIR Med Inform 2024; 12:e46699. [PMID: 38477979 DOI: 10.2196/46699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 09/21/2023] [Accepted: 12/07/2023] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Therapeutic education and patient self-management are crucial in diabetes prevention and treatment. Improving diabetes self-management requires multidisciplinary team intervention, nutrition education that facilitates self-management, informed decision-making, and the organization and delivery of appropriate health care services. The emergence of telehealth services has provided the public with various tools for educating themselves and for evaluating, monitoring, and improving their health and nutrition-related behaviors. Combining health technologies with clinical expertise, social support, and health professional involvement could help persons living with diabetes improve their disease self-management skills and prevent its long-term consequences. OBJECTIVE This scoping review's primary objective was to identify the key digital tool features of complex telehealth interventions used for type 2 diabetes or prediabetes self-management and monitoring with health professional involvement that help improve health outcomes. A secondary objective was to identify how these key features are developed and combined. METHODS A 5-step scoping review methodology was used to map relevant literature published between January 1, 2010 and March 31, 2022. Electronic searches were performed in the MEDLINE, CINAHL, and Embase databases. The searches were limited to scientific publications in English and French that either described the conceptual development of a complex telehealth intervention that combined self-management and monitoring with health professional involvement or evaluated its effects on the therapeutic management of patients with type 2 diabetes or prediabetes. Three reviewers independently identified the articles and extracted the data. RESULTS The results of 42 studies on complex telehealth interventions combining diabetes self-management and monitoring with the involvement of at least 1 health professional were synthesized. The health professionals participating in these studies were physicians, dietitians, nurses, and psychologists. The digital tools involved were smartphone apps or web-based interfaces that could be used with medical devices. We classified the features of these technologies into eight categories, depending on the intervention objective: (1) monitoring of glycemia levels, (2) physical activity monitoring, (3) medication monitoring, (4) diet monitoring, (5) therapeutic education, (6) health professional support, (7) other health data monitoring, and (8) health care management. The patient-logged data revealed behavior patterns that should be modified to improve health outcomes. These technologies, used with health professional involvement, patient self-management, and therapeutic education, translate into better control of glycemia levels and the adoption of healthier lifestyles. Likewise, they seem to improve monitoring by health professionals and foster multidisciplinary collaboration through data sharing and the development of more concise automatically generated reports. CONCLUSIONS This scoping review synthesizes multiple studies that describe the development and evaluation of complex telehealth interventions used in combination with health professional support. It suggests that combining different digital tools that incorporate diabetes self-management and monitoring features with a health professional's advice and interaction results in more effective interventions and outcomes.
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Affiliation(s)
- Choumous Mannoubi
- School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
- Centre interdisciplinaire en readaptation du Montreal Métropolitain, Institut Universitaire sur la readaptation en déficience physique de Montreal, Montréal, QC, Canada
| | - Dahlia Kairy
- School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
- Centre interdisciplinaire en readaptation du Montreal Métropolitain, Institut Universitaire sur la readaptation en déficience physique de Montreal, Montréal, QC, Canada
| | - Karla Vanessa Menezes
- School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
- Centre interdisciplinaire en readaptation du Montreal Métropolitain, Institut Universitaire sur la readaptation en déficience physique de Montreal, Montréal, QC, Canada
| | - Sophie Desroches
- Institute of Nutrition and Functional Foods, Université Laval, Quebec, QC, Canada
- Centre nutrition, santé et société NUTRISS, Université Laval, Québec, QC, Canada
- School of Nutrition, Université Laval, Québec, QC, Canada
| | - Geraldine Layani
- Centre de recherche du centre hospitalier de l'universite de Montreal, Montréal, QC, Canada
- Département de médecine de famille et de médecine d'urgence, Universté de Montréal, Montreal, QC, Canada
| | - Brigitte Vachon
- School of Rehabilitation, Université de Montréal, Montreal, QC, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Centre integre de sante et de services sociaux de l'Est-de-l'ile-de-Montreal, Montréal, QC, Canada
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Rienecke RD, Blalock DV, Tallent CN, Duffy A, Mehler PS. Eating disorder virtual intensive outpatient program: patient satisfaction according to age group. Eat Disord 2024:1-16. [PMID: 38468571 DOI: 10.1080/10640266.2024.2325296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
The COVID-19 pandemic has required a shift to telehealth services. However, not all patients are similarly satisfied with this shift, with some studies finding that midlife and older adults are less comfortable with telehealth. The current study examined patient satisfaction with a virtual intensive outpatient program (VIOP) for eating disorders (EDs) among 305 adults (ages 18-25, ages 26-39, and ages 40+), and compared adult satisfaction to satisfaction among children/adolescents (n = 33) receiving VIOP treatment between August 2020 and March 2022 from a large ED treatment facility. It was hypothesized that adults aged 40+ would report lower satisfaction than younger age groups. Patients completed several questions regarding satisfaction with treatment upon discharge, including a question about likelihood of recommending the program, which was used to calculate a Net Promoter Score (NPS). The NPS was 33.3 for children/adolescents, 33.3 for 18-25 year-olds, 57.7 for 26-39 year-olds, and 30.9 for the 40+ year age group. NPS of 31-50 = quality services; 51-70 = excellent customer experiences. Satisfaction was high, with no statistically significant differences between age groups after Bonferroni correction. The current study adds to the limited literature on the treatment experiences of midlife adults with EDs.
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Affiliation(s)
- Renee D Rienecke
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, CO, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Casey N Tallent
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, CO, USA
| | - Alan Duffy
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, CO, USA
| | - Philip S Mehler
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, CO, USA
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
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DeHart D, Iachini AL, Browne T, Reitmeier M, King LB. Telehealth Use during COVID-19: An Exploratory Study on Adaptations and Experiences of Providers. Health Soc Work 2024:hlae001. [PMID: 38459817 DOI: 10.1093/hsw/hlae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/07/2023] [Accepted: 09/07/2023] [Indexed: 03/10/2024]
Abstract
The current exploratory study examines the impact of the rapid acceleration of telehealth during the COVID-19 pandemic from the perspective of healthcare providers. Understanding provider perspectives, particularly in terms of adaptations made during this critical time, is a useful lens into service innovation in times of crisis and can help elucidate successful strategies for continuing the use of telehealth during the postpandemic period. Fourteen providers from 11 different service agencies in a southeastern state were interviewed. Findings identified three themes: (1) dynamic adaptations enacted by healthcare providers at the onset of the pandemic, such as hybrid services, rapid innovations in workflow, collective decision making among providers, and outreach to educate patients; (2) the relaxation of policies by regulators/insurers, focused most often on reimbursement of services; and (3) how patient engagement was impacted via telehealth, including openness to telehealth, more family-level accessibility, and reduced no-show rates. Implications for social workers include heightened professional training on telehealth as well as increasing the critical role that social workers serve in educating providers and patients on telehealth.
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Affiliation(s)
- Dana DeHart
- research professor emerita, College of Social Work, University of South Carolina, 332 Hamilton College, Columbia, SC 29208, USA
| | - Aidyn L Iachini
- associate dean for research and faculty, College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Teri Browne
- dean, College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Melissa Reitmeier
- clinical professor, College of Social Work, University of South Carolina, Columbia, SC, USA
| | - L Bailey King
- manager of corporate and foundation partnerships, The Mission Continues, Atlanta, GA, USA
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Mackwood M, Pashchenko O, Leggett C, Fontanet C, Skinner J, Fisher E. Telehealth Trends and Hypertension Management Among Rural and Medicaid Patients After COVID-19. Telemed J E Health 2024. [PMID: 38457122 DOI: 10.1089/tmj.2023.0628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Objective: Examine the associations between rurality and low income with primary care telehealth utilization and hypertension outcomes across multiple years pre- and post-COVID-19 pandemic onset. Methods: We compiled electronic health record data from the mixed rural/urban Dartmouth Health system in New Hampshire, United States, on patients with pre-existing hypertension or diabetes receiving primary care in the period before (January 2018-February 2020) and after the transition period to telehealth during the COVID-19 Pandemic (October 2020-December 2022). Stratifying by rurality and Medicaid enrollment, we examined changes in synchronous (office and telehealth visits, including audio/video use) and asynchronous (patient portal or telephone message) utilization, and control of mean systolic blood pressure (SBP) <140. Results: Analysis included 46,520 patients, of whom 8.2% were Medicaid enrollees, 42.7% urban residents. Telehealth use rates were 12% for rural versus 6.4% for urban, and 15% for Medicaid versus 8.4% non-Medicaid. The overall postpandemic telehealth visit rate was 0.29 per patient per year. Rural patients had a larger increase in telehealth use (additional 0.21 per year, 95% CI, 0.19-0.23) compared with urban, as did Medicaid (0.32, 95% CI 0.29-0.36) compared with non-Medicaid. Among the 38,437 patients with hypertension, SBP control worsened from 83% to 79% of patients across periods. In multivariable analysis, rurality corresponded to worsened control rates compared with urban (additional 2.4% decrease, 95% CI 2.1-2.8%); Medicaid and telehealth use were not associated with worsened control. Conclusions: Telehealth expansion enabled a higher shift to telehealth for rural and low-income patients without impairing hypertension management.
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Affiliation(s)
- Matthew Mackwood
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, New Hampshire, USA
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Oleksandra Pashchenko
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Full Circle Health Family Medicine Residency, Boise, Idaho, USA
| | - Christopher Leggett
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | | | - Jonathan Skinner
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Department of Economics, Dartmouth College, Lebanon, New Hampshire, USA
| | - Elliott Fisher
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Chien SY, Wong AMK, Tseng W, Hu HC, Cho HY. Feasibility and Design Factors for Home-Based Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease and Chronic Lung Diseases Based on a People-Object-Environment Framework: Qualitative Interview Study. JMIR Hum Factors 2024; 11:e51150. [PMID: 38452366 PMCID: PMC10958338 DOI: 10.2196/51150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/01/2023] [Accepted: 01/24/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The feasibility of implementing home-based pulmonary rehabilitation (PR) can be assessed from the perspectives of patients with chronic lung disease and health care professionals involved in PR. OBJECTIVE Through a qualitative inquiry using interviews and the adoption of the people-object-environment framework, this study aims to understand the influences of interpersonal, environmental, and situational factors on the perceptions and considerations of individuals involved in home-based PR for patients with chronic lung disease. METHODS One-on-one interviews were conducted with 20 patients with chronic lung disease and 20 health care professionals for investigating their attitudes and opinions based on their experiences regarding home-based PR as well as for identifying the key factors affecting the benefits and drawbacks of such therapies. This study further evaluates the feasibility of using digital tools for medical diagnosis and treatment by examining the technology usage of both parties. RESULTS The 4 key issues that all participants were the most concerned about were as follows: distance to outpatient medical care, medical efficiency, internet connectivity and equipment, and physical space for diagnosis and treatment. Interviews with patients and health care professionals revealed that the use of technology and internet was perceived differently depending on age and area of residence. Most participants reported that digital tools and internet connectivity had many benefits but still could not solve all the problems; moreover, these same digital tools and network transmission could lead to problems such as information security and digital divide concerns. This study also emphasizes the significant impact of human behavior and thinking on shaping the design of health care interventions and technologies. Understanding user perspectives and experiences is crucial for developing effective solutions for unmet needs. CONCLUSIONS The results of this study indicate that despite the different perspectives of patients and health care professionals, their considerations of the key issues are very similar. Therefore, the implementation of plans related to telemedicine diagnosis, treatment, or rehabilitation should take the suggestions and considerations of both parties into account as crucial factors for telehealth care design.
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Affiliation(s)
- Shih-Ying Chien
- Department of Industrial Design, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Alice May-Kuen Wong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Winston Tseng
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, CA, United States
| | - Han-Chung Hu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Respiratory Therapy, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiu-Ying Cho
- Department of Respiratory Therapy, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Carrard VC, Roxo-Gonçalves M, Santos IDS, Romanini J, Carvalho F, Umpierre RN. Could Teledentistry Be a Solution in the Diagnosis of Oral Lesions? Telemed J E Health 2024. [PMID: 38452335 DOI: 10.1089/tmj.2023.0404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
In recent years, teledentistry has gained visibility, especially because of the COVID-19 pandemic. Concerning oral medicine, there is great expectation, particularly about its potential to promote early diagnosis of oral lesions. In southern Brazil, two initiatives have shown a positive influence on each other and have led to greater awareness of oral cancer and more access to qualified advice on diagnosing and managing oral lesions. Although the contributions of this approach are promising, there are barriers to be overcome.
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Affiliation(s)
- Vinicius Coelho Carrard
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- TelessaúdeRS-UFRGS, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Department of Oral Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Michelle Roxo-Gonçalves
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Ingrid da Silva Santos
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- TelessaúdeRS-UFRGS, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliana Romanini
- Dental Specialty/Oral Medicine Center, Porto Alegre City Hall, Porto Alegre, Brazil
| | - Fabiana Carvalho
- TelessaúdeRS-UFRGS, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Roberto Nunes Umpierre
- TelessaúdeRS-UFRGS, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Department of Social Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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