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Kleinschmidt L, Walendzik A, Wasem J, Höfer K, Nauendorf B, Brittner M, Brandenburg P, Aeustergerling A, Schneider U, Wadeck A, Sehlen S, Liersch S, Schwarze K, Schwenke C, Hüer T. Preference-Based Implementation of Video Consultations in Urban and Rural Regions in Outpatient Care in Germany: Protocol for a Mixed Methods Study. JMIR Res Protoc 2024; 13:e50932. [PMID: 38602749 PMCID: PMC11046389 DOI: 10.2196/50932] [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: 07/17/2023] [Revised: 11/07/2023] [Accepted: 11/29/2023] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Particularly in rural regions, factors such as lower physician density and long travel distances complicate adequate outpatient care. However, urban regions can also be affected by deficits in care, for example, long waiting times. One model of care intending to improve the situation is the implementation of video consultations. The study protocol presents the methodology of the research project titled "Preference-based implementation of the video consultation in urban and rural regions" funded by the German Federal Joint Committee (funding number 01VSF20011). OBJECTIVE This study aims to identify existing barriers to the use of video consultation and the preferences of insured individuals and physicians as well as psychotherapists in order to optimize its design and thus increase acceptance and use of video consultations in urban and rural regions. METHODS Built on a mixed methods approach, this study first assesses the status quo of video consultation use through claims data analysis and carries out a systematic literature review on barriers and promoting factors for the use of video consultations. Based on this preliminary work, focus groups are conducted in order to prepare surveys with insureds as well as physicians and psychotherapists in the second study phase. The central element of the survey is the implementation of discrete choice experiments to elicit relevant preferences of (potential) user groups and service providers. The summarized findings are discussed in a stakeholder workshop and translated into health policy recommendations. RESULTS The methodological approach used in this study is the focus of this paper. The study is still ongoing and will continue until March 2024. The first study phase has already been completed, in which preliminary work has been done on potential applications and hurdles for the use of video consultations. Currently, the survey is being conducted and analyses are being prepared. CONCLUSIONS This study is intended to develop a targeted strategy for health policy makers based on actual preferences and perceived obstacles to the use of video consultations. The results of this study will contribute to further user-oriented development of the implementation of video consultations in German statutory health insurance. Furthermore, the iterative and mixed methods approach used in this study protocol is also suitable for a variety of other research projects. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50932.
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Affiliation(s)
- Lara Kleinschmidt
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Anke Walendzik
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Jürgen Wasem
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Klemens Höfer
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | | | | | - Paul Brandenburg
- Kassenärztliche Vereinigung Schleswig-Holstein, Bad Segeberg, Germany
| | | | | | | | | | | | | | | | - Theresa Hüer
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
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Dathe AK, Greve S, Teschler U, Heuser-Spura KM, Cordier L, Albayrak B, Felderhoff-Mueser U, Huening BM. Adaption of Follow-Up Visits for Preterm and High-Risk Children for Video Consultations. Telemed J E Health 2024. [PMID: 38466975 DOI: 10.1089/tmj.2023.0594] [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: 03/13/2024] Open
Abstract
Introduction: Structured and standardized follow-up care for preterm and high-risk infants enables an early detection of developmental deficits. The aim is to adapt the in-person follow-up to video consultation. Developmental delays can thus be identified at an early stage, independently of in-person contact. Methods: The adaptation of these follow-up to video consultation is presented descriptively, compared with the in-person consultation (similarities, differences, challenges, and limitations). Professionals's experiences with the adaption are described. Results: The experience of n = 267 video consultations for follow-up of children up to 6 years shows that an adaptation of the in-person consultation is necessary and possible. Prerequisite is a digital medium with a stable internet connection on both sides: the professional and the family, as well as a portal for video consultations with certified, encrypted data transmission. Among infants, testing is almost entirely parent guided. For older children, testing procedures have been adapted. A neurological examination is largely possible, while a general pediatric examination is omitted. A survey on professionals' (n = 7) experiences with video- and in-person consultations found that the rate of complete follow-up visits and the resources required for taking medical histories, personnel, and time remained constant for both approaches. All reported that the video consultation is generally suitable for identifying developmental delays in children up to an age of 6 years comparable with in-person consultations. One professional stated that the physical examination of children aged ≥1 year is impossible. Discussion: Video consultation is an alternative despite some limitations when an in-person consultation is impossible. Developmental delays can be identified, and therapies recommended.
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Affiliation(s)
- Anne-Kathrin Dathe
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences, Jena, Germany
| | - Sandra Greve
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Uta Teschler
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Katharina M Heuser-Spura
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Larissa Cordier
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Bilge Albayrak
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Britta M Huening
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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Castillo-Rodenas M, Vidal-Alaball J, Solanas-Bacardit N, Farràs-Company C, Fuster-Casanovas A, Miró Catalina Q, López Seguí F. Feasibility of a Pediatric Acute Video Consultation Process Among Health Care Professionals in Primary Care in a Rural Setting: Protocol for a Prospective Validation Study. JMIR Res Protoc 2024; 13:e52946. [PMID: 38300693 PMCID: PMC10870202 DOI: 10.2196/52946] [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: 09/20/2023] [Revised: 11/25/2023] [Accepted: 12/04/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND For years, in Catalonia and in the rest of Spain, there has been a deficit and an unequal geographical distribution of health professionals specializing in pediatrics, especially in rural areas. Among the proposals to improve this situation is the promotion of the use of information and communication technologies (ICT) among users and professionals. Moreover, with the outbreak of COVID-19, the use of telehealth has become an essential tool, with an overall increase in non-face-to-face visits, including in primary care pediatrics. In this context, telemedicine, when used in primary care pediatrics, can be an effective means of improving families' access to medical care. Currently, in Catalonia, telemedicine involving patients and health professionals is used in pediatric primary care through telephone consultation and asynchronous teleconsultation (eConsulta). Video consultation is in practice not used, although it could have different applications. OBJECTIVE The aim of this study is to evaluate the feasibility of a video consultation process with physical examination in acute pediatric pathology in rural areas among primary care professionals. In addition, the level of satisfaction with these remote consultations will be assessed from the perspective of both the users and the health care professionals. METHODS We will conduct a prospective experimental study to analyze the possibility of using video consultation in pediatric acute care in primary care in central Catalonia (Spain). A minimum of 170 children aged between 0 and 14 years attending the primary care center (PCC) for acute illness for a period of 1 year will be included in the study. Initially, the telemetric visit, including a physical examination, will include a nurse at the patient and family's side and a pediatrician who will participate remotely. Subsequently, the pediatrician will visit the patient in person and the physical examination and diagnosis made during the remote visit will be compared with the physical examination and diagnosis of the face-to-face visit, which is considered the gold standard. RESULTS Recruitment was planned to begin in the second half of 2023 and continue for at least 1 year. It is anticipated to be a good resource for a variety of acute pediatric conditions in primary care. The evaluation will focus on the feasibility of performing live remote visits and comparing their diagnostic accuracy with that of face-to-face visits. CONCLUSIONS We believe that this study could provide evidence on the feasibility and diagnostic accuracy of video consultation in pediatric acute primary care in a rural setting, as well as on satisfaction with video consultations among both users and professionals. If proven useful in addressing the acute needs of children in a variety of situations, it could become a digital health tool that improves the overall pediatric primary care service in rural areas, for both families and professionals. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52946.
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Affiliation(s)
- Marta Castillo-Rodenas
- Centre d'Atenció Primària Cardona, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Cardona, Spain
| | - Josep Vidal-Alaball
- Cap de la Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
| | - Núria Solanas-Bacardit
- Centre d'Atenció Primària Cardona, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Cardona, Spain
| | - Clotilde Farràs-Company
- Direcció del Centre d'Atenció Primària Cardona, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Cardona, Spain
| | - Aïna Fuster-Casanovas
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Queralt Miró Catalina
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Francesc López Seguí
- Chair in ICT and Health, Centre for Health and Social Care Research, University of Vic–Central University of Catalonia, Vic, Spain
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Chen D, Gonzales E, Winget M, Shaw J, Artandi M, Tsai SA, Nelligan I. Evaluation of video visit appropriateness for common symptoms seen in primary care: A retrospective cohort study. J Telemed Telecare 2024:1357633X231224094. [PMID: 38254267 DOI: 10.1177/1357633x231224094] [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: 01/24/2024]
Abstract
INTRODUCTION Little is known about which conditions seen in primary care are appropriate for video visits. This study evaluated video visits compared to office visits for six conditions: abdominal pain, joint pain, back pain, headache, chest pain, and dizziness. METHODS Six hundred charts of adult patients from our institution's same-day outpatient clinic were reviewed in this study. Charts for video visits evaluating the aforementioned chief complaints that occurred between August and October 2020 were reviewed and compared with charts for office visits that occurred from August to September 2019. Frequencies of 3-week follow-up visits, Emergency Room visits, imaging, and referrals for office and video visits were measured. Reasons for in-person evaluation for patients seen by video were determined by review of clinician notes. RESULTS Three-week in-person follow-up was more frequent for patients presenting with chest pain (52% vs 18%, p = 0.0007) and joint pain (24% vs 8%, p = 0.05) after video evaluation, relative to an office evaluation. Three-week in-person follow-up was also more frequent for patients presenting with dizziness (38% vs 28%) and low back pain (24% vs 14%); however, this difference was not statistically significant. Patients presenting with headache and abdominal pain did not have a higher rate of follow-up. DISCUSSION Based on the frequency of in-person follow-up, this study suggests that video visits are generally adequate for evaluating headache and abdominal pain. Patients with dizziness and chest pain have the highest frequency of in-person and Emergency Room follow-up within 3 weeks when first seen by video compared to other conditions evaluated and may be less suitable for an initial video visit. Institutions can consider these findings when scheduling and providing guidance to patients on what type of visit is most appropriate for their symptoms.
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Affiliation(s)
- Doris Chen
- Department of Medicine, Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Elyse Gonzales
- Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Marcy Winget
- Department of Medicine, Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Jonathan Shaw
- Department of Medicine, Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Maja Artandi
- Department of Medicine, Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Sandra A Tsai
- Department of Medicine, Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Ian Nelligan
- Department of Primary Care, San Francisco Free Clinic, San Francisco, California, USA
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Catapan SDC, Haydon HM, Hickman IJ, Webb L, Isbel N, Johnson D, Campbell KL, Mayr HL, Canfell O, Scuffham P, Burton N, Caffery LJ, Smith AC, Kelly JT. Trust and confidence in using telehealth in people with chronic kidney disease: A cross-sectional study. J Telemed Telecare 2023; 29:16S-23S. [PMID: 38007696 DOI: 10.1177/1357633x231202275] [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: 11/28/2023]
Abstract
Consumer trust and confidence in telehealth is pivotal to successful service implementation and effective consultations. This cross-sectional study measured trust and confidence in telephone and video consultations and associated with experience in telehealth modalities among people with chronic kidney disease at a metropolitan hospital in Australia. Self-report data were collected using validated trust and confidence in telehealth scales and 5-point Likert responses. Non-parametric tests were used to compare trust and confidence in telephone and video consultations (Wilcoxon Matched Pairs) and associations with telehealth experience (Mann-Whitney). Of the 156 survey participants, 96.2% had used telephone consultations and 28.9% had used video. Overall trust and confidence in using telehealth were high. Confidence (range 1-5) in using telephone consultations (mean 3.75 ± 0.71) was significantly higher than video consultation (mean 3.64 ± 0.74), p = 0.039. Trust in telephone consultations (mean 3.93 ± 0.64) was significantly higher than in video consultations (mean 3.67 ± 0.66), p < 0.001. There was a significant association between experience with telephone consultations and reported levels of trust and confidence in telephone consultations. Experience with video was significantly related to trust in video consultations, but not confidence. Given the substantial difference in experience between telehealth modalities, trust and confidence may change as further exposure occurs.
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Affiliation(s)
- Soraia de Camargo Catapan
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Lindsey Webb
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
| | - Nicole Isbel
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - David Johnson
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Katrina L Campbell
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Hannah L Mayr
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Oliver Canfell
- Queensland Digital Health Centre, Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Digital Health Cooperative Research Centre, Australian Government, Sydney, Australia
- UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, Australia
| | - Paul Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Nicola Burton
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
- Centre for Mental Health, Griffith University, Mount Gravatt, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark
| | - Jaimon T Kelly
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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Tan MS, Kang GCY, Fong RJK, Cheong NK, Shi H, Tan NC. Patients' perspectives on video consultation for non-communicable diseases: a qualitative study in Singapore. BJGP Open 2023; 7:BJGPO.2023.0103. [PMID: 37591556 DOI: 10.3399/bjgpo.2023.0103] [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: 06/05/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic increased the use of telemedicine in primary care services. Understanding patients' perspectives on telemedicine is pivotal for its wider adoption in managing non-communicable diseases (NCDs) in the community. AIM To explore the views and concerns of patients who have yet to use video consultation (VC) for NCD management in Singapore. DESIGN & SETTING This qualitative study was conducted in a primary care clinic in Singapore. METHOD In total, 16 patients participated in individual in-depth interviews. The participants had type 2 diabetes mellitus and/or hypertension and/or hyperlipidaemia without prior VC experience. They were purposively enrolled in the polyclinic. Audited transcripts were independently coded by two investigators. Thematic analysis was performed to identify perspectives on telemedicine based on the health, information, and technology zones of the Health Information Technology Acceptance Model. RESULTS The following three themes emerged: perceived benefits of VC utility; perceived barriers of VC adoption; and potential challenges of VC. Participants viewed VC as safe and convenient if they had stable NCD. They voiced concerns on possible suboptimal care owing to the absence of physical examination, network connectivity, and personal medical data security. Participants highlighted challenges of VC uptake such as digital health familiarity, availability of their own mobile and telemonitoring devices, and healthcare costs consideration. CONCLUSION Addressing the concerns and challenges highlighted by non-VC users can help physicians and policymakers explore ways to scale up telemedicine in Singapore. A hybrid clinical care model comprising in-person visits and VC may be the way forward for NCD management.
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Affiliation(s)
- Mui Suan Tan
- SingHealth Polyclinics, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore
| | - Gary Chun-Yun Kang
- SingHealth Polyclinics, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore
| | | | - Nian Kai Cheong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Haixiao Shi
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore
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Mazouri-Karker S, Lüchinger R, Braillard O, Bajwa N, Achab S, Hudelson P, Dominicé Dao M, Junod Perron N. Perceptions of and Preferences for Telemedicine Use Since the Early Stages of the COVID-19 Pandemic: Cross-Sectional Survey of Patients and Physicians. JMIR Hum Factors 2023; 10:e50740. [PMID: 37934574 PMCID: PMC10664018 DOI: 10.2196/50740] [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: 07/25/2023] [Accepted: 08/12/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND While the use of telemedicine (TLM) increased worldwide during the early phases of the COVID-19 pandemic, little is known about the use and acceptance of TLM post the COVID-19 pandemic. OBJECTIVE This study aims to evaluate patients' and physicians' self-reported use, preferences, and acceptability of different types of TLM after the initial phases of the COVID-19 pandemic. METHODS We conducted a cross-sectional survey among patients and physicians in Geneva, Switzerland, between September 2021 and January 2022. Patients in waiting rooms of both private and public medical centers and emergency services were invited to answer a web-based questionnaire. Physicians working in private and public settings were invited by email to answer a similar questionnaire. The questionnaires assessed participants' sociodemographics and digital literacy; self-reported use of TLM; as well as preferences and acceptability of TLM for different clinical situations. RESULTS A total of 567 patients (309/567, 55% women) and 448 physicians (230/448, 51% women and 225/448, 50% in private practice) responded to the questionnaire. Patients (263/567, 46.5%) and physicians (247/448, 55.2%) generally preferred the phone over other TLM formats and considered it to be acceptable for most medical situations. Email (417/567, 73.6% and 308/448, 68.8%) was acceptable for communicating exam results, and medical certificates (327/567, 67.7% and 297/448, 66.2%) and video (302/567, 53.2% and 288/448, 64.3%) was considered acceptable for psychological support by patients and physicians, respectively. Older age was associated with lower acceptability of video for both patients and physicians (odds ratio [OR] 0.03, 95% CI 0.00-0.33 and OR 0.23, 95% CI 0.08-0.66) while previous use of video was positively associated with video acceptability (OR 3.16, 95% CI 1.84-5.43 and OR 3.34, 95% CI 2.91-5.54). Psychiatrists and hospital physicians were more likely to consider video to be acceptable (OR 10.79, 95% CI 3.96-29.30 and OR 3.97, 95% CI 2.23-7.60). CONCLUSIONS Despite the development of video, the acceptability of video remains lower than that of the phone for most health issues or patient requests. There is a need to better define for which patients and in which medical situations video can become safe and efficient.
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Affiliation(s)
- Sanae Mazouri-Karker
- E-health and Telemedicine Division, Geneva University Hospitals, Geneva, Switzerland
| | - Robin Lüchinger
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olivia Braillard
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia Bajwa
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of General Pediatrics at the Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Sophia Achab
- Treatment Centre ReConnecte, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Clinical and Sociological Research Unit, WHO Collaborating Centre for Training and Research in Mental Health, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Melissa Dominicé Dao
- Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Noelle Junod Perron
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Medical Directory, Geneva University Hospitals, Geneva, Switzerland
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Brodoehl S, Wagner F, Klingner C, Srowig A, Finke K. [Telemedicine Care of Dementia Patients During the COVID-19 Pandemic]. Fortschr Neurol Psychiatr 2023; 91:444-454. [PMID: 37494147 PMCID: PMC10635742 DOI: 10.1055/a-2073-3947] [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: 07/20/2022] [Accepted: 03/23/2023] [Indexed: 07/28/2023]
Abstract
In our multidisciplinary memory center at Jena University Hospital, we initiated a regular video consultation for patients at risk of developing dementia or with dementia disease and their relatives at the beginning of the SARS-CoV2 pandemic in spring 2020.Over a 12-month period, we conducted a systematic survey of satisfaction among patients in regular face-to-face contact (F2F) and video consultations (VC).The aim of this study was to evaluate the potential use of telemedicine in older people with incipient cognitive deficits in the context of dementia. In particular, we aimed to evaluate patient satisfaction and feasibility.Initial presentations to our memory center for suspected dementia were evaluated in a standardized regular on-site setting (n=50) and in a standardized video consultation (n=40). In both settings, a neuropsychologist's and a physician's consultation were performed consecutively. Both groups were similarly distributed in terms of age and sex (71.4 vs. 72.3 years, 52 vs. 50% female (F2F vs. VC)). Cognitive status was slightly better in the VC group (ACE III significant, MMST not significant).In the survey of the patients using a 12-question inventory (patient satisfaction, rated 1 to 5), there was no significant difference between the two groups overall. However, the F2F tended to be rated slightly better here in terms of advice. More than 80% of the physicians and neuropsychologists rated the technical process of VC as good/very good.A general assessment of the cognitive deficits by physicians and neuropsychologists correlated extremely highly with the results of the subsequent specific testing (MMST and ACE) in F2F and VC. With a tendency to better agreement in VC, the difference between the correlations was not significant.Overall, we could not find any significant differences in patients' satisfaction between VC and classical F2F presentation. Technical aspects in the preparation of a VC and during a VC were less problematic than initially anticipated.
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Affiliation(s)
| | | | | | - Annie Srowig
- Gedächtniszentrum/Neurologie, Jena University Hospital,
Jena, Germany
| | - Kathrin Finke
- Gedächtniszentrum/Neurologie, Jena University Hospital,
Jena, Germany
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Rome D, Sales A, Cornelius T, Malhotra S, Singer J, Ye S, Moise N. Impact of Telemedicine Modality on Quality Metrics in Diverse Settings: Implementation Science-Informed Retrospective Cohort Study. J Med Internet Res 2023; 25:e47670. [PMID: 37494087 PMCID: PMC10413089 DOI: 10.2196/47670] [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: 03/28/2023] [Revised: 05/15/2023] [Accepted: 05/31/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Video-based telemedicine (vs audio only) is less frequently used in diverse, low socioeconomic status settings. Few prior studies have evaluated the impact of telemedicine modality (ie, video vs audio-only visits) on clinical quality metrics. OBJECTIVE The aim of this study was to assess telemedicine uptake and impact of visit modality (in-person vs video and phone visits) on primary care quality metrics in diverse, low socioeconomic status settings through an implementation science lens. METHODS Informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, we evaluated telemedicine uptake, assessed targeted primary care quality metrics by visit modality, and described provider-level qualitative feedback on barriers and facilitators to telemedicine implementation. RESULTS We found marginally better quality metrics (ie, blood pressure and depression screening) for in-person care versus video and phone visits; de-adoption of telemedicine was marked within 2 years in our population. CONCLUSIONS Following the widespread implementation of telemedicine during the COVID-19 pandemic, the impact of visit modality on quality outcomes, provider and patient preferences, as well as technological barriers in historically marginalized settings should be considered.
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Affiliation(s)
- Danielle Rome
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Alyssa Sales
- Columbia University, New York, NY, United States
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Sujata Malhotra
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Jessica Singer
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Siqin Ye
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
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Smits M, van Dalen D, Popping D, Bleeker R, Stommel MWJ, van Goor H. Designing a video consultation area for hybrid care delivery: the Garden Room with a view. Front Digit Health 2023; 5:1198565. [PMID: 37564883 PMCID: PMC10411545 DOI: 10.3389/fdgth.2023.1198565] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/12/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction Accelerated by the coronavirus pandemic, the healthcare landscape is rapidly evolving, with a shift towards hybrid care models combining in-person and online care. To support this shift, the Radboudumc, an academic hospital in the Netherlands, decided to redesign an existing space facilitating the conduction of video consultations. Method The design process involved participation of end-users to ensure that the physical space met their needs. The look and feel of the area was based on evidence-based design guidelines. Two prototype setups were built and tested, and the feedback informed the final design of the Garden Room. Results Identified end-user needs were divided into 3 major categories entailing consultation room setup, optimal use of technology and practical issues involving room availability. Combined with the look and feel of the hospital, final design requirements were developed. The Garden Room consists of 18 video consultation rooms, 4 shared workspaces, relaxation area with kitchen, and meeting rooms. Specific attention is given to the ergonomics, technology and privacy in the rooms to facilitate optimal video conversations between patients and healthcare providers. In the Garden Room, natural elements and an open design supports working in a healing environment. Discussion Next challenge will be optimizing the use of the Garden Room, which may be hindered by various barriers like resistance to change, existing work processes, and lack of skills training. To address these barriers and support use of the Garden Room, the hospital should focus on the implementation of education, changes in work processes, and the presence of advocates for telehealth.
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Affiliation(s)
| | - Demi van Dalen
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Danny Popping
- Radboud University Medical Center, Nijmegen, Netherlands
| | - René Bleeker
- Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
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11
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Shaker AA, Austin SF, Storebø OJ, Schaug JP, Ayad A, Sørensen JA, Tarp K, Bechmann H, Simonsen E. Psychiatric Treatment Conducted via Telemedicine Versus In-Person Modality in Posttraumatic Stress Disorder, Mood Disorders, and Anxiety Disorders: Systematic Review and Meta-Analysis. JMIR Ment Health 2023; 10:e44790. [PMID: 37277113 PMCID: PMC10357375 DOI: 10.2196/44790] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/28/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Telemedicine has played a vital role in providing psychiatric treatment to patients during the rapid transition of services during the COVID-19 pandemic. Furthermore, the use of telemedicine is expected to expand within the psychiatric field. The efficacy of telemedicine is well described in scientific literature. However, there is a need for a comprehensive quantitative review that analyzes and considers the different clinical outcomes and psychiatric diagnoses. OBJECTIVE This paper aimed to assess whether individual psychiatric outpatient treatment for posttraumatic stress disorder, mood disorders, and anxiety disorders in adults using telemedicine is equivalent to in-person treatment. METHODS A systematic search of randomized controlled trials was conducted using recognized databases for this review. Overall, 4 outcomes were assessed: treatment efficacy, levels of patient satisfaction, working alliance, and attrition rate. The inverse-variance method was used to summarize the effect size for each outcome. RESULTS A total of 7414 records were identified, and 20 trials were included in the systematic review and meta-analysis. The trials included posttraumatic stress disorder (9 trials), depressive disorder (6 trials), a mix of different disorders (4 trials), and general anxiety disorder (1 trial). Overall, the analyses yielded evidence that telemedicine is comparable with in-person treatment regarding treatment efficacy (standardized mean difference -0.01, 95% CI -0.12 to 0.09; P=.84; I2=19%, 17 trials, n=1814), patient satisfaction mean difference (-0.66, 95% CI -1.60 to 0.28; P=.17; I2=44%, 6 trials, n=591), and attrition rates (risk ratio 1.07, 95% CI 0.94-1.21; P=.32; I2=0%, 20 trials, n=2804). The results also indicated that the working alliance between telemedicine and in-person modalities was comparable, but the heterogeneity was substantial to considerable (mean difference 0.95, 95% CI -0.47 to 2.38; P=.19; I2=75%, 6 trials, n=539). CONCLUSIONS This meta-analysis provided new knowledge on individual telemedicine interventions that were considered equivalent to in-person treatment regarding efficacy, patient satisfaction, working alliance, and attrition rates across diagnoses. The certainty of the evidence regarding efficacy was rated as moderate. Furthermore, high-quality randomized controlled trials are needed to strengthen the evidence base for treatment provided via telemedicine in psychiatry, particularly for personality disorders and a range of anxiety disorders where there is a lack of studies. Individual patient data meta-analysis is suggested for future studies to personalize telemedicine. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021256357; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256357.
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Affiliation(s)
- Ali Abbas Shaker
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stephen F Austin
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Ole Jakob Storebø
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Julie Perrine Schaug
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
| | - Alaa Ayad
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
| | - John Aasted Sørensen
- Department of Engineering Technology and Didactics, Research unit: AI, Mathematics and Software, Technical University of Denmark, Ballerup, Denmark
| | - Kristine Tarp
- Research Unit for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Bechmann
- Department of Engineering Technology and Didactics, Research unit: AI, Mathematics and Software, Technical University of Denmark, Ballerup, Denmark
| | - Erik Simonsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Mental Health Services East, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
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Dreher J, Meryk A, Riedl D, Kropshofer G, Hetzer B, Neururer S, Pfeifer B, Schneeberger-Carta V, Holzner B, Crazzolara R. Can virtual care reduce treatment burden in pediatric leukemia? A retrospective cost analysis. Pediatr Blood Cancer 2023:e30498. [PMID: 37337270 DOI: 10.1002/pbc.30498] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
We conducted a retrospective analysis to determine the potential reduction in treatment burden through the expansion of virtual care among children with leukemia (n = 152). Patients living in urban areas traveled median distances of 1555 km compared with 7536 km for patients living in rural areas (p < .05). For the latter group, a median reduction in travel distance of 3560 km (interquartile range [IQR], 2136-5787 km), travel time of 51 h (IQR, 26-78 h), and CO2 emissions of 623 kg (IQR, 374-1013 kg) was estimated, if every second visit was replaced by video consultations.
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Affiliation(s)
- Jonas Dreher
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Meryk
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - David Riedl
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Gabriele Kropshofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Hetzer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Sabrina Neururer
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Bernhard Pfeifer
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | | | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Roman Crazzolara
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
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Paul J, Govindan R, Vijayalakshmi P, Kathyayani BV, Gandhi S, Madegowda RK, Basavarajappa C, Manjunatha N, Kumar CN, Math SB. An audit of initial six years of 5885 telepsychiatric direct video consultations: Findings from "benefits of savings" analysis and the effect of COVID-19 pandemic. Indian J Psychiatry 2023; 65:611-616. [PMID: 37485418 PMCID: PMC10358816 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_131_23] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 07/25/2023] Open
Abstract
Background Telepsychiatric direct video consultations (DVCs) meant for continuity of care began in 2017 and continued during the coronavirus disease 2019 (COVID-19) pandemic. Telemedicine-based consultation gained its long-due importance during the COVID-19 travel restriction, despite its existence for a long. The authors intend to share the utility and growth of the initial six years of live telepsychiatric DVCs from an academic hospital in India and also plan to understand the effects of the COVID-19 pandemic on its growth and report findings from an innovative "benefits of savings" (BOS) analysis from these clinics. Methods A first six years of medical audit of the files and registers of telepsychiatric DVCs from two kinds of continuity of care clinics during 2017-2022 is performed. An analysis of 4991 (84.8%) live DVCs is successfully conducted for 1570 patients from the 5885 scheduled appointments. Year-on-year (YOY) growth and BOS analysis of successful DVCs from these clinics were performed. Results and Discussion The growth suggests a gradual increase in DVCs yearly. The BOS analysis suggests its increased acceptability, feasibility at both user and provider ends, and possible cost-effectiveness of these video clinics. YOY analysis suggests a natural growth of these clinics than from the effect of the COVID-19 pandemic, except for an initial surge in 2020 and 2021 and observing stabilization effect by 2022. Conclusion In the authors' understanding, this is the largest study of providing DVCs from India, irrespective of any medical/surgical specialty. The video/remote clinics could be an alternative model for regular follow-ups in ensuring the continuity of care among patients with psychiatric disorders. These clinics also saved significant travel time, travel distance, and travel costs for the patients that could have occurred for their in-person consultations.
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Affiliation(s)
- James Paul
- Department of Nursing, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Radhakrishnan Govindan
- Department of Nursing, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | | | | | - Sailaxmi Gandhi
- Department of Nursing, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | | | | | - Narayana Manjunatha
- Tele-Medicine Centre, NIMHANS Digital Academy, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - C Naveen Kumar
- Tele-Medicine Centre, NIMHANS Digital Academy, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Tele-Medicine Centre, NIMHANS Digital Academy, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
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14
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Chai JX, Lim WY, Au Yong APS, Ong SGK. A Feasibility Study on a Telemedicine Hybrid Protocol for Preoperative Anesthetic Assessment. Cureus 2023; 15:e40449. [PMID: 37456373 PMCID: PMC10349366 DOI: 10.7759/cureus.40449] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
Background Over the past decade, telemedicine has experienced significant growth due to technological advancement, and the coronavirus disease 2019 (COVID-19) pandemic further accelerated its adoption. However, the field of anesthesiology has been slow in integrating and embracing telemedicine compared to other medical specialties. Methods We conducted an observational pilot feasibility study at a tertiary hospital in Singapore to assess the viability of a telemedicine hybrid protocol for preoperative anesthetic assessment. The study included patients aged 21 to 65 years, classified as American Society of Anesthesiology (ASA) physical status class 1 or 2, with a body mass index (BMI) below 35 kg/m2, who were capable of managing video conferencing. The patients selected were scheduled for low-risk surgeries. The primary objective was to evaluate the medical and technical feasibility of our telemedicine hybrid protocol, while the secondary objectives included assessing patient satisfaction and obtaining feedback from relevant stakeholders. Results From November 2021 to April 2022, a total of 116 patients were recruited, with 96 patients completing the study. No technical difficulties, surgical case cancellations, or incidents of unanticipated difficult airways were reported. The majority of survey respondents (88%) expressed satisfaction with the video consultation and indicated a preference for it over physical consultations for future preoperative anesthesia evaluations. Conclusion Based on our findings, a telemedicine hybrid protocol for preoperative anesthetic assessment demonstrated both technical and medical feasibility while yielding high patient satisfaction. Future research could focus on expanding the protocol to encompass more complex surgeries and include patients with higher ASA status.
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Affiliation(s)
- Jia Xin Chai
- Department of Anesthesiology, Sengkang General Hospital, Singapore, SGP
- Division of Anaesthesiology and Perioperative Sciences, Singapore General Hospital, Singapore, SGP
| | - Wan Yen Lim
- Department of Anesthesiology, Sengkang General Hospital, Singapore, SGP
- Division of Anaesthesiology and Perioperative Sciences, Singapore General Hospital, Singapore, SGP
| | - Angie Phui Sze Au Yong
- Department of Anesthesiology, Sengkang General Hospital, Singapore, SGP
- Division of Anaesthesiology and Perioperative Sciences, Singapore General Hospital, Singapore, SGP
| | - Sharon Gek Kim Ong
- Department of Anesthesiology, Sengkang General Hospital, Singapore, SGP
- Division of Anaesthesiology and Perioperative Sciences, Singapore General Hospital, Singapore, SGP
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Assing Hvidt E, Atherton H, Keuper J, Kristiansen E, Lüchau EC, Lønnebakke Norberg B, Steinhäuser J, van den Heuvel J, van Tuyl L. Low Adoption of Video Consultations in Post-COVID-19 General Practice in Northern Europe: Barriers to Use and Potential Action Points. J Med Internet Res 2023; 25:e47173. [PMID: 37213196 DOI: 10.2196/47173] [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: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023] Open
Abstract
In the wake of the COVID-19 pandemic, video consultation was introduced in general practice in many countries around the world as a solution to provide remote health care to patients. It was assumed that video consultation would find widespread adoption in post-COVID-19 general practice. However, adoption rates remain low across countries in Northern Europe, suggesting that barriers to its use exist among general practitioners and other practice staff. In this viewpoint, we take a comparative approach, reflecting on similarities and differences in implementation conditions of video consultations in 5 Northern European countries' general practice settings that might have created barriers to its use within general practice. We convened at a cross-disciplinary seminar in May 2022 with researchers and clinicians from 5 Northern European countries with expertise in digital care in general practice, and this viewpoint emerged out of dialogues from that seminar. We have reflected on barriers across general practice settings in our countries, such as lacking technological and financial support for general practitioners, that we feel are critical for adoption of video consultation in the coming years. Furthermore, there is a need to further investigate the contribution of cultural elements, such as professional norms and values, to adoption. This viewpoint may inform policy work to ensure that a sustainable level of video consultation use can be reached in the future, one that reflects the reality of general practice settings rather than policy optimism.
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Affiliation(s)
- Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Helen Atherton
- Unit of Academic Primary Care, Warwick Medical School, Coventry, United Kingdom
| | - Jelle Keuper
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg Universit, Tilburg, Netherlands
| | - Eli Kristiansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Elle Christine Lüchau
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | | | - Lilian van Tuyl
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
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16
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Cheng J, Arora VM, Kappel N, Vollbrecht H, Meltzer DO, Press V. Assessing Disparities in Video-Telehealth Use and eHealth Literacy Among Hospitalized Patients: Cross-sectional Observational Study. JMIR Form Res 2023; 7:e44501. [PMID: 37171854 PMCID: PMC10221502 DOI: 10.2196/44501] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Medicare coverage for audio-only telehealth is slated to end this year after the public health emergency concludes. When the time comes, many patients may be unable to make the transition from audio-only to video telehealth due to digital inexperience. This study explores the second digital divide within video telehealth use, which is primarily characterized by skills and capabilities rather than access, by measuring eHealth literacy (eHL) and video capabilities in hospitalized patients. OBJECTIVE The aim of this study is to evaluate video capabilities, eHealth literacy, and engagement with video telehealth among hospitalized patients. METHODS The study design is a cross-sectional observational study of adult inpatients at the University of Chicago Medical Center. We assessed self-reported rates of audio versus video telehealth usage as well as the participants' self-reported willingness to use video telehealth for future health care visits. We used a multivariable binary logistic regression to determine the odds ratio for being unwilling to use video telehealth, adjusted for age, sex, race or ethnicity, educational level, eHL literacy scale (eHEALS), health literacy (brief health literacy screen), technology access, internet access, and video capability. RESULTS Of the 297 enrolled participants, median age was 58 years, most (n=185, 62%) identified as Black, half (n=149, 50%) were female, one-quarter (n=66, 22%) lacked home internet access, and one-third (n=102, 34%) had inadequate eHL. CONCLUSIONS Patients with low eHL reported greater participation in audio-only telehealth over video telehealth, of which the former may lose its flexible pandemic reimbursement policy. This may widen the existing health disparities as older adults and patients with low eHL face challenges in accessing video telehealth services. Low eHL is associated with lack of web-based skills, lower rates of video telehealth usage, and lower willingness to use video technology. The study results raise the question of how to improve video capability among patients who, despite having access to smartphones and laptops, face challenges in using telehealth optimally.
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Affiliation(s)
- Jessica Cheng
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Vineet M Arora
- General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Nicole Kappel
- General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Hanna Vollbrecht
- Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - David O Meltzer
- Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Valerie Press
- General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, United States
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17
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Renzoni E. Home sweet home… or is it? Respirology 2023; 28:401-402. [PMID: 36809857 DOI: 10.1111/resp.14476] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/12/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Elisabetta Renzoni
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Diseases, NHLI, Imperial College, London, UK
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18
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Antonio MG, Williamson A, Kameswaran V, Beals A, Ankrah E, Goulet S, Wang Y, Macias G, James-Gist J, Brown LK, Davis S, Pillai S, Buis L, Dillahunt T, Veinot TC. Targeting Patients' Cognitive Load for Telehealth Video Visits Through Student-Delivered Helping Sessions at a United States Federally Qualified Health Center: Equity-Focused, Mixed Methods Pilot Intervention Study. J Med Internet Res 2023; 25:e42586. [PMID: 36525332 PMCID: PMC9897309 DOI: 10.2196/42586] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/19/2022] [Accepted: 12/01/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The task complexity involved in connecting to telehealth video visits may disproportionately impact health care access in populations already experiencing inequities. Human intermediaries can be a strategy for addressing health care access disparities by acting as technology helpers to reduce the cognitive load demands required to learn and use patient-facing telehealth technologies. OBJECTIVE We conducted a cognitive load theory-informed pilot intervention involving warm accompaniment telehealth helping sessions with patients at a Federally Qualified Health Center (FQHC). We demonstrate how to design and report recruitment methods, reach, delivery process, and the preliminary impact of a novel equity-focused intervention. METHODS Early into the COVID-19 pandemic a telehealth helping session was offered to patients at FQHC via phone. Graduate students led the sessions on conducting a telehealth video test run or helping with patient portal log-in. They systematically recorded their recruitment efforts, intervention observations, and daily reflection notes. Following the intervention, we asked the intervention participants to participate in an interview and all patients who had telehealth visits during and 4 weeks before and after the intervention period to complete a survey. Electronic health records were reviewed to assess telehealth visit format changes. Descriptive and inferential statistical analyses of the recruitment records, electronic health record data, and surveys were performed. Through integrative analysis, we developed process-related themes and recommendations for future equity-focused telehealth interventions. RESULTS Of the 239 eligible patients, 34 (14.2%) completed the intervention and 3 (1.2%) completed subsequent interviews. The intervention participants who completed the survey (n=15) had lower education and less technological experience than the nonintervention survey participants (n=113). We identified 3 helping strategies for cognitive load reduction: providing step-by-step guidance for configuring and learning, building rapport to create confidence while problem-solving, and being on the same page to counter informational distractions. Intervention participants reported increased understanding but found that learning the video visit software was more difficult than nonintervention participants. A comparison of visit experiences did not find differences in difficulty (cognitive load measure) using telehealth-related technologies, changes to visit modality, or reported technical problems during the visit. However, the intervention participants were significantly less satisfied with the video visits. CONCLUSIONS Although a limited number of people participated in the intervention, it may have reached individuals more likely to need technology assistance. We postulate that significant differences between intervention and nonintervention participants were rooted in baseline differences between the groups' education level, technology experience, and technology use frequency; however, small sample sizes limit conclusions. The barriers encountered during the intervention suggest that patients at FQHC may require both improved access to web-based technologies and human intermediary support to make telehealth video visits feasible. Future large, randomized, equity-focused studies should investigate blended strategies to facilitate video visit access.
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Affiliation(s)
- Marcy G Antonio
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Alicia Williamson
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | | | - Ashley Beals
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Elizabeth Ankrah
- Department of Informatics, University of California Irvine, Irvine, CA, United States
| | - Shannon Goulet
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Yucen Wang
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Grecia Macias
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Jade James-Gist
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Lindsay K Brown
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Sage Davis
- Covenant Community Care, Detroit, MI, United States
| | | | - Lorraine Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Tawanna Dillahunt
- School of Information and College of Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Tiffany C Veinot
- Department of Health Behavior and Health Education, School of Information and School of Public Health, University of Michigan, Ann Arbor, MI, United States
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19
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Albayrak B, Cordier LJ, Greve S, Teschler U, Dathe AK, Felderhoff-Müser U, Hüning BM. Feasibility of Video Consultation for Preterm Neurodevelopmental Follow-up Care During the COVID-19 Pandemic: Cohort Study. JMIR Pediatr Parent 2023; 6:e40940. [PMID: 36409307 PMCID: PMC9879316 DOI: 10.2196/40940] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, parents of infants born very preterm or at risk were exceptionally worried about being infected. The only means of protection during the onset of the pandemic was social distancing. Video consultations for neurodevelopmental follow-up care were offered as an alternative way to stay in contact with patients and their families, to provide expert support, and to monitor and assess children's development. OBJECTIVE To assess the feasibility of and family satisfaction with video consultations, interviews were conducted after video and in-person consultations. METHODS An interview with 28 questions was created to evaluate parental satisfaction with the consultations (eg, their confidentiality and the children's behavior). A total of 93 interviews with parents were conducted between March 2020 and February 2021 and compared (58 after video consultations and 35 after in-person consultations). The interviews were conducted at the end of the consultations by a trained professional. The video consultations were conducted using a certified platform created by Zava Sprechstunde Online, maintaining data protection with end-to-end encryption. Follow-up consultations (video or in-person) were performed at corrected ages of 3, 6, and 12 months as well as 2, 3, 4, and 5 years. The rate of total follow-up appointments attended during the survey period was evaluated and compared with the previous year. RESULTS There were no significant differences between the video and in-person consultation groups in satisfaction, attitudes on the confidentiality of the consultation, or discussion of private and sensitive information. Following video consultations, parents were significantly more likely to report that they were avoiding contact with medical professionals during the pandemic (P=.045; Shapiro-Wilk W=1094.5, Cohen d=-0.1782146) than the in-person consultation group. Parents in the video-consultation group stated that performing a guided examination on their child was comfortable and helped them understand their child's development. In fact, they agreed to take advantage of future video consultations. The rate of total follow-up appointments increased compared to the previous year. Between March 2019 and February 2020, 782 of 984 (79.5%) children born at Essen University Hospital attended a follow-up appointment. During the survey period, between March 2020 and February 2021, a total of 788 of 1086 children (73%) attended a follow-up appointment, of which 117 (14.9%) were video consultations. CONCLUSIONS The feasibility of attending video consultations for follow-up care of very preterm or at-risk infants and parental satisfaction with these consultations were as high as for in-person consultations. Parents rated video consultations as being as confidential as in-person appointments. Telemedicine can be offered as an equivalent alternative to in-person consultations and is particularly useful under certain circumstances, such as for very sick children who require assistive devices or respiratory support and oxygen or for those living a long distance away.
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Affiliation(s)
- Bilge Albayrak
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Larissa Jane Cordier
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sandra Greve
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Uta Teschler
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anne-Kathrin Dathe
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Britta Maria Hüning
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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20
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Arndt EM, Jansen TR, Bojko J, Roos JJ, Babasiz M, Randau TM, Welle K, Burger C, Kabir K. COVID-19 measures as an opportunity to reduce the environmental footprint in orthopaedic and trauma surgery. Front Surg 2023; 10:959639. [PMID: 37123547 PMCID: PMC10130431 DOI: 10.3389/fsurg.2023.959639] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 03/22/2023] [Indexed: 05/02/2023] Open
Abstract
Background Climate change and its consequences on our everyday life have also tremendous impacts on public health and the health of each individual. The healthcare sector currently accounts for 4.4% of global greenhouse gas emissions. The share of the emissions in the health care system caused by the transportation sector is 7%. The study analyses the effect of video consultation on the CO2 emissions during the Covid-19 pandemic in an outpatient clinic of the department of orthopaedics and traumatology surgery at a German university hospital. Methods The study participants were patients who obtained a video consultation in the period from June to December 2020 and voluntarily completed a questionnaire after the consultation. The type of transport, travel time and waiting time as well as patient satisfaction were recorded by questionnaire. Results The study comprised 51 consultations. About 70% of respondents would have travelled to the clinic by car. The reduction in greenhouse gas emissions of video consultations compared to a face-to-face presentation was 97% in our model investigation. Conclusion The video consultation can be a very important part of the reduction of greenhouse gas emissions in the health care system. It also saves time for the doctor and patient and can form an essential part of individual patient care.
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Affiliation(s)
- Eva-Maria Arndt
- Department for Orthopedic and Traumatology Surgery, University Hospital Bonn, Bonn, Germany
- Correspondence: Eva-Maria Arndt
| | | | | | | | | | | | | | | | - Koroush Kabir
- Department for Orthopedic and Traumatology Surgery, University Hospital Wuppertal, Wuppertal, Germany
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21
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Dieperink KB, Vestergaard LV, Møller PK, Tolstrup LK. Using video consultations for clinical assessment and decision of treatment readiness before chemotherapy: A mixed-methods study among patients with gastrointestinal cancer and oncology nurses. Digit Health 2023; 9:20552076231197415. [PMID: 37675059 PMCID: PMC10478534 DOI: 10.1177/20552076231197415] [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: 12/12/2022] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
Objective To investigate the feasibility of clinical assessment and decision of treatment readiness before chemotherapy using video consultations, as perceived by gastrointestinal cancer patients and oncology nurses. In addition, to estimate reductions in travel time for patients and environmental carbon dioxide (CO2) emissions. Methods In a mixed-method study, patients with gastrointestinal cancer who participated in at least one video consultation during April-October 2019 completed a questionnaire on socioeconomic status, time and kilometers saved on travel. Kilometers saved were converted into reduced CO2 emissions. Descriptive statistics were used for analysis. Patients (n = 15) participated in semi-structured individual interviews, and five oncology nurses participated in a focus group interview. Results A total of 84/119 patients (71%) consented to video consultation and responded to the questionnaire. 69% were male, with a mean age of 66 years. For 46% of patients, a video consultation saved more than an hour of travel time. Avoiding a median travel distance of 120 km per patient (range, 2-450 km) reduced CO2 emissions by 7018 lb. Video consultations had other positive effects on patients, including avoiding waiting rooms, having more energy, and experiencing more focused interactions with nurses. Technical issues occurred rarely. Nurses found technical issues more troublesome, sometimes precluding complete assessments. They reported a need to rethink nursing practice to effectively provide care during video consultations. Conclusions Video consultations reduced CO2 emissions. In addition, they were beneficial for patients with gastrointestinal cancer. However, providing an optimal clinical assessment and decision of treatment readiness before chemotherapy requires testing patient equipment, technical skills and new oncology nursing competencies.
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Affiliation(s)
- Karin Brochstedt Dieperink
- Research Unit of Oncology, The Academy of Geriatric Cancer Research (www.agecare.org), Odense University Hospital, Odense C, Denmark
- Family Focused Healthcare Research Center (FaCe), Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Lene Vedel Vestergaard
- Research Unit of Oncology, The Academy of Geriatric Cancer Research (www.agecare.org), Odense University Hospital, Odense C, Denmark
| | - Pia Krause Møller
- Research Unit of Oncology, The Academy of Geriatric Cancer Research (www.agecare.org), Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Lærke Kjær Tolstrup
- Research Unit of Oncology, The Academy of Geriatric Cancer Research (www.agecare.org), Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
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22
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Ochieng L, Salehi M, Ochieng R, Nijhof D, Wong R, Gupta V, Prasad R, Ochieng B. Augmented video consultations in care homes during the COVID-19 pandemic: a qualitative study. BJGP Open 2022; 6:BJGPO. [PMID: 35764408 DOI: 10.3399/BJGPO.2022.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 05/15/2022] [Accepted: 06/16/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated an unprecedented implementation of remote consultations in UK primary care services. Specifically, older adults in care homes had a high need for infection prevention owing to their existing health conditions. GP practices in the East Midlands incorporated augmented video consultations (AVC) with the potential to support remote healthcare assessments for older adults at care homes. AIM To explore GPs' and care home staff's experiences of the use of AVC as a mechanism to perform remote examinations of older adults in care homes. DESIGN & SETTING Qualitative interviews were conducted with GPs and care home staff in the East Midlands, UK, during May-August 2020. METHOD A convenience sample of GPs (n = 5), nurses (n = 12), and senior healthcare assistants (n = 3) were recruited using a purposive approach. Data were collected through semi-structured telephone interviews and analysed using framework analysis. RESULTS Findings from participants indicated that AVC enabled real-time patient examinations to aid diagnosis and promoted person-centred care in meeting the needs of older adults. The participants also discussed the challenges of video consultations for patients with cognitive impairment and those receiving end-of-life care. CONCLUSION AVCs show great potential in terms of GPs providing primary care services for care homes. However, healthcare staff must be involved in the development of the technology, and consideration should be given to the needs of older adults with cognitive impairment and those receiving end-of-life care. It is also vital that training is available to encourage confidence and competency in implementing the technology.
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23
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Ward K, Vagholkar S, Sakur F, Khatri NN, Lau AYS. Visit Types in Primary Care With Telehealth Use During the COVID-19 Pandemic: Systematic Review. JMIR Med Inform 2022; 10:e40469. [PMID: 36265039 DOI: 10.2196/40469] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 06/22/2022] [Revised: 08/16/2022] [Accepted: 10/02/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Telehealth was rapidly incorporated into primary care during the COVID-19 pandemic. However, there is limited evidence on which primary care visits used telehealth. OBJECTIVE The objective of this study was to conduct a systematic review to assess what visit types in primary care with use of telehealth during the COVID-19 pandemic were reported; for each visit type identified in primary care, under what circumstances telehealth was suitable; and reported benefits and drawbacks of using telehealth in primary care during the COVID-19 pandemic. METHODS This study was a systematic review using narrative synthesis. Studies were obtained from four databases (Ovid [MEDLINE], CINAHL Complete, PDQ-Evidence, and ProQuest) and gray literature (NSW Health, Royal Australian College of General Practitioners guidelines, and World Health Organization guidelines). In total, 3 independent reviewers screened studies featuring telehealth use during the COVID-19 pandemic in primary care. Levels of evidence were assessed according to the Grading of Recommendations Assessment, Development, and Evaluation. Critical appraisal was conducted using the Mixed Methods Appraisal Tool. Benefits and drawbacks of telehealth were assessed according to the National Quality Forum Telehealth Framework. RESULTS A total of 19 studies, predominately cross-sectional surveys or interviews (13/19, 68%), were included. Seven primary care visit types were identified: chronic condition management (17/19, 89%), existing patients (17/19, 89%), medication management (17/19, 89%), new patients (16/19, 84%), mental health/behavioral management (15/19, 79%), post-test result follow-up (14/19, 74%), and postdischarge follow-up (7/19, 37%). Benefits and drawbacks of telehealth were reported across all visit types, with chronic condition management being one of the visits reporting the greatest use because of a pre-existing patient-provider relationship, established diagnosis, and lack of complex physical examinations. Both patients and clinicians reported benefits of telehealth, including improved convenience, focused discussions, and continuity of care despite social distancing. Reported drawbacks included technical barriers, impersonal interactions, and semi-established reimbursement models. CONCLUSIONS Telehealth was used for different visit types during the COVID-19 pandemic in primary care, with most visits for chronic condition management, existing patients, and medication management. Further research is required to validate our findings and explore the long-term impact of hybrid models of care for different visit types in primary care. TRIAL REGISTRATION PROSPERO CRD42022312202; https://tinyurl.com/5n82znf4.
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Affiliation(s)
- Kanesha Ward
- Centre for Health Informatics, Australian Institute for Health Innovation, Macquarie University, North Ryde, Australia
| | - Sanjyot Vagholkar
- Primary Care, Faculty of Medicine, Health & Human Sciences, Macquarie University, North Ryde, Australia
| | - Fareeya Sakur
- Centre for Health Informatics, Australian Institute for Health Innovation, Macquarie University, North Ryde, Australia
| | - Neha Nafees Khatri
- Centre for Health Informatics, Australian Institute for Health Innovation, Macquarie University, North Ryde, Australia
| | - Annie Y S Lau
- Centre for Health Informatics, Australian Institute for Health Innovation, Macquarie University, North Ryde, Australia
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24
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Johnson D, Barradas R, Newington L. Inter-rater and intra-rater reliability of finger goniometry measured from screenshots taken via video consultation. J Hand Surg Eur Vol 2022; 48:459-465. [PMID: 36324231 DOI: 10.1177/17531934221132690] [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: 11/06/2022]
Abstract
The purpose of this study was to assess the intra- and inter-rater reliability of using screenshots and handheld manual goniometers to assess range of finger movements during video consultations. Twenty-seven hand therapists measured finger joint angles from four different screenshots using two different goniometers. Results were compared within and between participants using the intraclass correlation coefficient (ICC). The ICC grading for both intra- and inter-rater reliability was moderate to excellent for all joints and both goniometers. Clinicians can measure finger joint angles from a screenshot with good reliability. The protocol used in this study can be used in remote video consultations as a no-cost substitute for in-person goniometry.Level of evidence: II.
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Affiliation(s)
- Dane Johnson
- Hand Therapy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Melbourne Hand Therapy, Melbourne, Australia
| | - Rodrigo Barradas
- Hand Therapy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lisa Newington
- Hand Therapy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.,MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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25
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Zimbile F, David S, Daemen M, Goossens A, Creemers J, Crutzen R. Introducing video consultations at public sexual health clinics in the Netherlands: a mixed-methods study. Health Promot Int 2022; 37:6730776. [PMID: 36173604 PMCID: PMC9521338 DOI: 10.1093/heapro/daac135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 11/23/2022] Open
Abstract
Video consultations (in combination with remote STI testing) can benefit both public sexual health clinics (SHCs) and their clients. The Dutch public SHCs explored the extent to which video consultations are accepted and appreciated—compared to face-to-face consultations—by both young clients (under 25 years) and nurses who normally carry out consultations. A mixed-methods study, using online questionnaires and telephone interviews with both young clients (aged under 25 years) and nurses (focus groups), was conducted to evaluate acceptance and appreciation of video and face-to-face consultations of the SHCs. Young clients evaluated 333 video consultations and 100 face-to-face consultations. Clients rated the VCs and F2F consultations as being of equal high level on five evaluation criteria (e.g. how it feels to talk about sex with a nurse, contact with the nurse). These positive results were confirmed in the interviews. Most important perceived advantages of VCs were time saving, ease, and feelings of comfort and safety. The nurses evaluated 422 VCs and 120 F2F consultations, rating the VCs and F2F consultations on an equal high level on three evaluation criteria (e.g., contact with the client, possibility to continue asking questions). Increasing accessibility of SHC consultations, getting faster to the point and saving time were mentioned as advantages of VCs during the focus group sessions with nurses. Video consultations are accepted and appreciated by young clients and nurses. They can be used for standard STI consultations that do not require a physical examination.
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Affiliation(s)
- Filippo Zimbile
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands.,National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Aidsfonds - Soa Aids Nederland, Amsterdam, The Netherlands
| | - Silke David
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Maud Daemen
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands
| | - Anne Goossens
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands
| | - Josien Creemers
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands
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26
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van Steenbergen G, van Veghel D, van Lieshout D, Sperwer M, Ter Woorst J, Dekker L. Effects of Video-Based Patient Education and Consultation on Unplanned Health Care Utilization and Early Recovery After Coronary Artery Bypass Surgery (IMPROV-ED): Randomized Controlled Trial. J Med Internet Res 2022; 24:e37728. [PMID: 36018625 PMCID: PMC9463622 DOI: 10.2196/37728] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/04/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Health care utilization after coronary artery bypass graft (CABG) surgery is high and is partly of an unplanned nature. eHealth applications have been proposed to reduce care consumption, which involve and assist patients in their recovery. In this way, health care expenses could be reduced and quality of care could be improved. OBJECTIVE The aim of this study was to evaluate if an eHealth program can reduce unplanned health care utilization and improve mental and physical health in the first 6 weeks after CABG surgery. METHODS A single-blind randomized controlled trial was performed, in which patients scheduled for nonacute CABG surgery were included from a single center in the Netherlands between February 2020 and October 2021. Participants in the intervention group had, alongside standard care, access to an eHealth program consisting of online education videos and video consultations developed in conjunction with the Dutch Heart Foundation. The control group received standard care. The primary outcome was the volume and costs of a composite of unplanned health care utilization, including emergency department visits, outpatient clinic visits, rehospitalization, patient-initiated telephone consultations, and visits to a general practitioner, measured using the Medical Technology Assessment Medical Consumption Questionnaire. Patient-reported anxiety and recovery were also assessed. Intention-to-treat and "users-only" analyses were used. RESULTS During the study period, 280 patients were enrolled and randomly allocated at a 1:1 ratio to the intervention or control group. The intention-to-treat analysis consisted of 136 and 135 patients in the intervention and control group, respectively. At 6 weeks, the primary endpoint had occurred in 43 of 136 (31.6%) patients in the intervention group and in 61 of 135 (45.2%) patients in the control group (hazard ratio 0.56, 95% CI 0.34-0.92). Recovery was faster in the intervention group, whereas anxiety was similar between study groups. "Users-only" analysis yielded similar results. CONCLUSIONS An eHealth strategy comprising educational videos and video consultations can reduce unplanned health care utilization and can aid in faster patient-reported recovery in patients following CABG surgery. TRIAL REGISTRATION Netherlands Trial Registry NL8510; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8510. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1007/s12471-020-01508-9.
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Affiliation(s)
- Gijs van Steenbergen
- Cardiothoracic Surgery Department, Catharina Heart Centre, Catharina Hospital, Eindhoven, Netherlands
| | - Dennis van Veghel
- Cardiothoracic Surgery Department, Catharina Heart Centre, Catharina Hospital, Eindhoven, Netherlands
| | | | | | - Joost Ter Woorst
- Cardiothoracic Surgery Department, Catharina Heart Centre, Catharina Hospital, Eindhoven, Netherlands
| | - Lukas Dekker
- Cardiothoracic Surgery Department, Catharina Heart Centre, Catharina Hospital, Eindhoven, Netherlands.,Department of Biomedical Technology, Eindhoven University of Technology, Eindhoven, Netherlands
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27
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von Weinrich P, Kong Q, Liu Y. Would you zoom with your doctor? A discrete choice experiment to identify patient preferences for video and in-clinic consultations in German primary care. J Telemed Telecare 2022:1357633X221111975. [PMID: 35915997 DOI: 10.1177/1357633x221111975] [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: 11/15/2022]
Abstract
INTRODUCTION The popularity of video consultations in healthcare has accelerated during the COVID-19 pandemic. Despite increased availability and obvious benefits, many patients remain hesitant to use video consultations. This study investigates the relative importance of the consultation mode compared to other attributes in patients' appointment choices in Germany. METHODS A discrete choice experiment was conducted to examine the influence of appointment attributes on preferences for video over in-clinic consultations. A total of 350 participants were included in the analysis. RESULTS The level of continuity of care (46%) and the waiting time until the next available appointment (22%) were shown to have higher relative importance than consultation mode (18%) and other attributes. Participants with fewer data privacy concerns, higher technology proficiency, and more fear of COVID-19 tended to prefer video over in-clinic consultations. The predicted choice probability of a video over a typical in-clinic consultation and opting out increased from <1% to 40% when the video consultation was improved from the worst-case to the best-case scenario. CONCLUSION This study provides insight into the effect of the consultation mode on appointment choice at a time when telemedicine gains momentum. The results suggest that participants preferred in-clinic over video consultations. Policymakers and service providers should focus on increasing the level of continuity of care and decreasing the time until the next available appointment to prompt the adoption of video consultations. Although participants preferred to talk to their physician in person over consulting via video per se, the demand for video consultations can be increased significantly by improving the other appointment attributes of video consultations such as the level of continuity of care.
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Affiliation(s)
- Philipp von Weinrich
- Rotterdam School of Management, 6984Erasmus University Rotterdam, The Netherlands
| | - Qingxia Kong
- Rotterdam School of Management, 6984Erasmus University Rotterdam, The Netherlands
| | - Yun Liu
- Erasmus School of Health Policy and Management, 84857Erasmus University Rotterdam, The Netherlands
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28
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Altinisik Ergur G, Nuhoglu S, Cobanoglu C, Sengul M, Eryildiz N, Ergur A. The Patient Perspective of Telemedicine in the Context of COVID-19 Pandemic. Bull Sci Technol Soc 2022; 42:39-53. [PMID: 38603115 PMCID: PMC9008468 DOI: 10.1177/02704676221094735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
COVID-19 Pandemic might be considered as a catalyst for transformation in healthcare experience via the use of video consultation as a method for telemedicine. The aim of our qualitative study is to understand the patient perception of video consultations in telemedicine, which has been used by a single pulmonologist in only one university hospital in Turkey since the first three months of the pandemic. Research findings are essential when it comes to a more effective and widespread future use of telemedicine, as it focuses on patient experience about a medical technology that is newly introduced. Totally 30 patients were randomly chosen and interviewed who get healthcare support via telemedicine. A semi-structured questionnaire was used to learn the experiences and opinions of the interviewees. The expressions of the patients highlight some advantages of using telemedicine such as being free from risk of contagion caused by exposure in the hospital, being able to save time and money while reaching to the physician online whenever needed, and success in technical details even though they were experiencing it for the first time. A very few of the patients are feeling discomfort to be in front of the screen. Almost all patients are applicants to suggest to other individuals the system they used, in conditions to be appropriate, and continuity after the pandemic period. Since the pandemic has propagated from one patient, the worldwide implementation of telemedicine might be catalyzed by following in the footsteps of the sporadic examples of decisiveness nourished from patient experiences.
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Affiliation(s)
- G Altinisik Ergur
- Faculty of Medicine Pulmonology
Department, Pamukkale
University, Denizli, Turkey
| | - S Nuhoglu
- Center for Sociological Research,
Galatasaray
University, Istanbul, Turkey
| | - C Cobanoglu
- Center for Sociological Research,
Galatasaray
University, Istanbul, Turkey
| | - M Sengul
- Center for Sociological Research,
Galatasaray
University, Istanbul, Turkey
| | - N Eryildiz
- Center for Sociological Research,
Galatasaray
University, Istanbul, Turkey
| | - A Ergur
- Sociology Department,
Galatasaray
University, Istanbul, Turkey
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29
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Walthall H, Schutz S, Snowball J, Vagner R, Fernandez N, Bartram E. Patients' and clinicians' experiences of remote consultation? A narrative synthesis. J Adv Nurs 2022; 78:1954-1967. [PMID: 35362191 PMCID: PMC9321562 DOI: 10.1111/jan.15230] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 09/16/2021] [Revised: 02/09/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022]
Abstract
Aims To identify, evaluate and summarize evidence of patient and clinician experiences of being involved in video or telephone consultations as a replacement for in‐person consultations. Design Narrative synthesis. Data sources Medline; EMBASE; EMCARE; CINAHL and BNI. Searching took place from January 2021 to April 2021. Papers included were published between 2013 and 2020. Review Methods Papers were appraised by two independent reviewers for methodological quality. Data extraction was conducted according to the standardized tool from Joanna Briggs Institute. Results Seven qualitative studies were included, from five countries and from the perspective of patients, relatives, administrators, nurses, physiotherapists and physicians. We developed two main themes: Pragmatic Concerns and Therapeutic Concerns. Each theme contained two categories: Pragmatic Concerns: (a) the convenience of non‐face to face consultations; (b) using technology and equipment in a consultation; Therapeutic Concerns (c) building therapeutic relationships; and (d) embracing benefits and addressing challenges. Conclusion This narrative synthesis presents the existing evidence on clinician and patient experience of participating in non‐face to face consultations. Experiences are varied but largely focus on communication and forming relationships, using the technology successfully and the ability for patients to self‐manage with support from clinicians who are not in‐person. More high‐quality studies are required to explore the experiences of patients and clinicians accessing remote consultations as a result of global implementation post‐SARS‐CoV‐2 pandemic to identify any learning and education opportunities. Impact Health care staff can provide high‐quality care through video or telephone appointments as well as face to face appointments. This review has, however, identified that the evidence is limited and weak in this area and recommends there is research further to inform practice and influence future care.
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Affiliation(s)
- Helen Walthall
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Sue Schutz
- Oxford Brookes University and Oxford Biomedical Research Centre, Oxford, UK
| | - Joanne Snowball
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Raluca Vagner
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Nicola Fernandez
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Emilia Bartram
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
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Higgs P, McElwee J. 'In the circumstances I think we've all managed really well' an exploration of the impact of the COVID-19 restrictions on a Child Development Advisor (Portage) Service. Br J Learn Disabil 2022; 51:BLD12455. [PMID: 35602321 PMCID: PMC9111847 DOI: 10.1111/bld.12455] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 12/23/2021] [Accepted: 12/31/2021] [Indexed: 06/15/2023]
Abstract
Background The Child Development Advisor (CDA) (Portage) service provides developmental support to children with significant developmental delays and emotional support for their families through fortnightly home visits. However, the onset of the COVID-19 pandemic and subsequent restrictions imposed to control its spread prevented services from providing face-to-face sessions with families and caregivers, thus removing the CDA (Portage) service's primary means of supporting children and their families. This article aims to explore the impact of those changes on a team of CDAs. Methods Semi-structured interviews were conducted with six CDAs representing the CDA (Portage) service within one NHS Health Board. Findings The CDAs expressed feeling an initial negative impact of the COVID-19 restrictions on the service, but in the longer term they noticed a number of positive impacts, including caregiver empowerment and improved working with other professionals. Conclusion Despite having their primary means of providing support removed as part of the COVID-19 restrictions, the service has been able to adapt to continuously support families and promote child development throughout the pandemic and inadvertently developed a service offer that may be more beneficial for both families and professionals in the future.
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Affiliation(s)
- Pippa Higgs
- Department of EducationUniversity of BathBathUK
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Moeller AM, Hansen JP, Andersen PT. Factors that determine mental health professionals' decision to support home-based video consultations - A qualitative study. Front Psychiatry 2022; 13:984026. [PMID: 36245860 PMCID: PMC9553986 DOI: 10.3389/fpsyt.2022.984026] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Using videoconferencing for consulting with patients in the mental health services has been shown in interventions to be similarly effective as when meeting in person. In practice, it often makes more sense to use video consultations with patients in a more flexible way than interventions permit. The aim of this study was to investigate what constitutes a professional video consultation from the perspectives of mental health professionals and explore what is of importance for the establishment and realization of video consultations in practice. MATERIALS AND METHODS A Grounded Theory methodology approach based on Corbin and Strauss was used. Data collection consisted of participant observations of introductory events followed by individual interviews with mental health professionals who had used video consultations with patients. FINDINGS Mental health professionals believed that a professional video consultation was one that was not inferior to an in-person consultation but offered something else, such as more and easier access, accommodating patients' needs and wishes. At the same time, it should not interfere with the treatment quality, e.g., by hampering communication and therapeutic tasks. The expected treatment quality was based on an individual assessment of the patient and varied from clinician to clinician. The implementation process and support which the organization provided affected the clinicians' attitudes as well as the clinicians' experiences and hence how the clinicians assessed the quality of the service. CONCLUSION Perceived usefulness, patient demands, and close IT support will positively impact the establishment and realization of video consultations whereas high workload and technical problems would hamper it.
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Affiliation(s)
- Anne Marie Moeller
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Research Unit for Telepsychiatry and E-Mental Health, Centre for Telepsychiatry, The Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Jens Peter Hansen
- Psychiatric Research Unit Esbjerg, The Mental Health Services in the Region of Southern Denmark, Esbjerg, Denmark.,Department of Clinical Research, Center for Clinical Nursing Research, University of Southern Denmark, Odense, Denmark
| | - Pernille Tanggaard Andersen
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Pronk Y, Pilot P, van der Weegen W, Brinkman JM, Schreurs BW. A Patient-Reported Outcome Tool to Triage Total Hip Arthroplasty Patients to Hospital or Video Consultation: Pilot Study With Expert Panels and a Cohort of 1228 Patients. JMIR Form Res 2021; 5:e31232. [PMID: 34931989 PMCID: PMC8726038 DOI: 10.2196/31232] [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: 06/14/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The digital transformation in health care has been accelerated by the COVID-19 pandemic. Video consultation has become the alternative for hospital consultation. It remains unknown how to select patients suitable for video consultation. OBJECTIVE This study aimed to develop a tool based on patient-reported outcomes (PROs) to triage total hip arthroplasty (THA) patients to hospital or video consultation. METHODS A pilot study with expert panels and a retrospective cohort with prospectively collected data from 1228 THA patients was executed. The primary outcome was a PRO triage tool to allocate THA patients to hospital or video consultation 6 weeks postoperatively. Expert panels defined the criteria and selected the patient-reported outcome measure (PROM) questions including thresholds. Data were divided into training and test cohorts. Distribution, floor effect, correlation, responsiveness, PRO patient journey, and homogeneity of the selected questions were investigated in the training cohort. The test cohort was used to provide an unbiased evaluation of the final triage tool. RESULTS The expert panels selected moderate or severe pain and using 2 crutches as the triage tool criteria. PROM questions included in the final triage tool were numeric rating scale (NRS) pain during activity, 3-level version of the EuroQol 5 dimensions (EQ-5D-3L) questions 1 and 4, and Oxford Hip Score (OHS) questions 6, 8, and 12. Of the training cohort, 201 (201/703, 28.6%) patients needed a hospital consultation, which was statistically equal to the 150 (150/463, 32.4%) patients in the test cohort who needed a hospital consultation (P=.19). CONCLUSIONS A PRO triage tool based on moderate or severe pain and using 2 crutches was developed. Around 70% of THA patients could safely have a video consultation, and 30% needed a hospital consultation 6 weeks postoperatively. This tool is promising for selecting patients for video consultation while using an existing PROM infrastructure.
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Affiliation(s)
- Yvette Pronk
- Research Department, Kliniek ViaSana, Mill, Netherlands
| | | | | | | | - Berend Willem Schreurs
- Department of Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
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Bekkelund SI, Müller KI. One-Year Remission Rate of Chronic Headache Comparing Video and Face-to-Face Consultations by Neurologist: Randomized Controlled Trial. J Med Internet Res 2021; 23:e30151. [PMID: 34898455 PMCID: PMC8713100 DOI: 10.2196/30151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/04/2021] [Accepted: 09/12/2021] [Indexed: 01/03/2023] Open
Abstract
Background Chronic headache causing severe headache-related disability for those affected by the disease is under- or misdiagnosed in many cases and therefore requires easy access to a specialist for optimal health care management. Objective The goal of the research is to determine whether video consultations are noninferior to face-to-face consultations in treating chronic headache patients referred to a specialist in Northern Norway. Methods Patients included in the study were recruited from general practice referrals to a specialist at a neurological department in Northern Norway (Tromsø) and diagnosed according to the International Headache Society classification system. In a randomized controlled design, the 1-year remission rate of chronic headache (change from ≥15 to <15 headache days per month during the last 3 months), patient satisfaction with a specialist consultation, and need for follow-up consultations by general practitioners were compared between groups consulted by video and face-to-face in a post hoc analysis. Data were collected by interview (baseline) and questionnaire (follow-up). Results From a baseline cohort of 402 headache patients consecutively referred from general practice to a specialist over 2.5 years, 58.0% (233/402) were classified as chronic headache and included in this study. Response rates were 71.7% (86/120) in the video group and 67.3% (76/113) in the face-to-face group. One-year remission from chronic headache was achieved in 43.0% (37/86) in the video group and 39.5% (30/76) in the face-to-face group (P=.38). Patient satisfaction with consultations were 86.5% (32/37; video) and 93.3% (28/30; face-to-face; P=.25). A total of 30% (11/37) in the video group and 53% (16/30) in the face-to-face group consulted general practitioners during the follow-up period (P=.03), and median number of consultations was 1 (IQR 0-13) and 1.5 (IQR 0-15), respectively (P=.19). Conclusions One-year remission rate from chronic headache was about 40% regardless of consultation form. Likewise, patient satisfaction with consultation and need for follow-up visits in general practice post consultation was similar. Treating chronic headache patients by using video consultations is not inferior to face-to-face consultations and may be used in clinical neurological practice. Trial Registration ClinicalTrials.gov NCT02270177; https://clinicaltrials.gov/ct2/show/NCT02270177
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Affiliation(s)
- Svein Ivar Bekkelund
- Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Kai Ivar Müller
- Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
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Salvador Vergès À, Cusí Sánchez MV, Bossio Grigera P, Fàbrega Agulló C, Gomes da Costa F, Serra Trullas A, García Abejas A. Determinants in Stakeholder Opinions About Telemedicine in Palliative Care: A Scoping Review. Telemed J E Health 2021; 28:932-941. [PMID: 34871034 DOI: 10.1089/tmj.2021.0441] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/26/2022] Open
Abstract
Background: The use of Telemedicine is growing, and its application in palliative medicine may facilitate patient care and be a solution to the growing pressures on hospital services in these pandemic times. Aim: The main objective of this review is to describe the current use of telemedicine in palliative care and assess stakeholders' views on the initiatives that have been implemented worldwide regarding digital service standards. Materials and Methods: Articles published between 2010 and 2020 were identified through PubMed, SCOPUS, Web of Science, and Google Scholar searches. We used Arksey and O'Malley's five-step framework to delimit and guide the initial search results. Results: The search identified 291 articles, of which 16 are included in this review. The selected studies were sufficiently detailed to allow their evaluation and answer our research questions. In addition, Telemedicine was used for patient and caregiver support and professional education. Conclusions: The use of Telemedicine for patient and caregiver support and professional education. Telemedicine empowers patients and increases their functional capacity. The imperative need to dictate implementation policies and ethical issues are some of the pending questions. In countries where a Telemedicine project has been initiated, it is valued as a good option for continuity of care, but all those involved would like face-to-face contact first, even if it is not mandatory.
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Affiliation(s)
- Àngels Salvador Vergès
- Iberian Society of Telemedicine and Telehealth, Madrid, Spain.,Digital Care Research Group, UVIC-UCC, Barcelona, Spain
| | | | - Paz Bossio Grigera
- Digital Health, School of Health, The National University of Jujuy, San Salvador de Jujuy, Argentina
| | - Carles Fàbrega Agulló
- Iberian Society of Telemedicine and Telehealth, Madrid, Spain.,Digital Health, School of Health, The National University of Jujuy, San Salvador de Jujuy, Argentina
| | - Fernando Gomes da Costa
- Iberian Society of Telemedicine and Telehealth, Madrid, Spain.,Portuguese Ministry of Health, Lisbon, Portugal
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Oelmeier K, Schmitz R, Möllers M, Braun J, Deharde D, Sourouni M, Köster HA, Apsite G, Eveslage M, Fischhuber K, Storck M, Emming F, Wohlmann J, Juhra C. Satisfaction with and Feasibility of Prenatal Counseling via Telemedicine: A Prospective Cohort Study. Telemed J E Health 2021; 28:1193-1198. [PMID: 34861131 DOI: 10.1089/tmj.2021.0309] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/12/2022] Open
Abstract
Introduction: Telemedicine has become increasingly important over the past decade. With the pressure of the COVID-19 pandemic, demands for remote health care solutions have seen an unprecedented rise. However, many questions regarding the feasibility and benefits of telemedicine remain. The aim of our study was to evaluate both the technical feasibility and patient satisfaction with video consultations in a tertiary center for obstetric care. Materials and Methods: This prospective single-center trial was part of the larger open Video Service project on telemedicine at the Department of Gynecology and Obstetrics at the University of Münster. Patients requiring prenatal or prepregnancy counseling were included. A questionnaire was designed for the evaluation of patient satisfaction and filled in by both patient and health care provider at the end of the video consultation. Results: Of 80 eligible cases, 75 video consultations were carried out and data from the questionnaire were collected. Overall patient satisfaction was high (95%, 71/75) although technical problems occurred in 37% (29/75) of the appointments. Health care providers' satisfaction was equally high and in 88% (66/75) of cases, remote consultations avoided an in-house visit without effect on health care quality. Conclusions: Remote consultations are feasible and yield high satisfaction rates even in a medical field as sensitive as perinatal medicine. Further research is necessary to determine the cost-effectiveness and effects on perinatal outcome. Health care systems should be offered clear guidance on medicolegal issues and funding of remote consultations to integrate telemedicine into routine health care.
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Affiliation(s)
- Kathrin Oelmeier
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Ralf Schmitz
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Mareike Möllers
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Janina Braun
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Daniela Deharde
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Marina Sourouni
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Helen Ann Köster
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Gunita Apsite
- Centre for Clinical Trials Münster, University of Münster, Münster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Karen Fischhuber
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Franziska Emming
- Office for eHealth, University Hospital Münster, Münster, Germany
| | - Jan Wohlmann
- Office for eHealth, University Hospital Münster, Münster, Germany
| | - Christian Juhra
- Office for eHealth, University Hospital Münster, Münster, Germany
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Kröncke S, Lund LK, Buchholz A, Lang M, Briem‐Richter A, Grabhorn EF, Sterneck M. Psychosocial situation, adherence, and utilization of video consultation in young adult long-term pediatric liver transplant recipients during COVID-19 pandemic. Pediatr Transplant 2021; 25:e14121. [PMID: 34428322 PMCID: PMC8646625 DOI: 10.1111/petr.14121] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/13/2021] [Accepted: 08/04/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Young adults who underwent liver transplantation in childhood (YALTs) are highly vulnerable to non-adherent behavior and psychosocial problems. During the COVID-19 pandemic, special efforts may be necessary to maintain contact with these patients and offer support. This can be achieved through the use of telemedicine. The study's objective was to assess adherence and the psychosocial situation of YALTs during the COVID-19 pandemic in Germany and to evaluate the utilization of video consultations. METHODS In May 2020, a questionnaire was sent to YALTs treated at the Hamburg University Transplant Center, accompanied by the offer of video appointments with the attending physician. The questionnaire included the Generalized Anxiety Disorder Scale 7, the Patient Health Questionnaire 2, and questions compiled by the authors. RESULTS Of 98 YALTs, 12% used the video consultation, while 65% had an in-person appointment. The 56 patients who completed the questionnaire did not report reduced medication adherence during the pandemic, but 40% missed follow-up visits with their primary care physician or check-up laboratory tests. About 70% of YALTs were afraid to visit their physician and the transplant center, and 34% were afraid of a SARS-CoV-2 infection. Mental health and well-being were unimpaired. CONCLUSIONS During the COVID-19 pandemic, YALTs in our study did not show an increased need for psychosocial support, but a majority were afraid to attend medical appointments, and 40% reported lower appointment adherence. Acceptance of video consultations was lower than expected. The reasons for this need to be further investigated in order to optimize care.
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Affiliation(s)
- Sylvia Kröncke
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Louisa Katharina Lund
- Department of GastroenterologyUniversity Transplant CenterUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Angela Buchholz
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Melanie Lang
- Department of GastroenterologyUniversity Transplant CenterUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Andrea Briem‐Richter
- Department of PediatricsUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Enke Freya Grabhorn
- Department of PediatricsUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Martina Sterneck
- Department of GastroenterologyUniversity Transplant CenterUniversity Medical Center Hamburg‐EppendorfHamburgGermany
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Gunner CK, Eisner E, Watson AJM, Duncan JL. Teaching webside manner: development and initial evaluation of a video consultation skills training module for undergraduate medical students. Med Educ Online 2021; 26:1954492. [PMID: 34313579 PMCID: PMC8317946 DOI: 10.1080/10872981.2021.1954492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/17/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Video consultations are increasingly used to communicate with patients, particularly during the current COVID-19 pandemic. However, training in video consultation skills receives scant attention in the literature. We sought to introduce this important topic to our undergraduate medical school curriculum. OBJECTIVE To increase final year medical students' video consultation skills and knowledge. METHODS We used Plan, Do, Study, Act (PDSA) quality improvement methodology with a pre-post study design to develop a teaching session for 5th year medical students, informed by a literature review and online clinician survey. The 2 hour session comprised an introduction and three practical stations: patient selection and ethics, technology and example videos, and simulation. Subjective pre- and post-session confidence was reported by students across seven domains using 5-point scales (1: not at all confident; 5: extremely confident). Students and facilitators completed post-session feedback forms. RESULTS The 40 students and 3 facilitators who attended, over two separate teaching sessions, provided unanimously positive feedback. All students considered the session relevant. Subjective confidence ratings (n = 34) significantly increased from pre- to post-session (mean increase 1.78, p < 0.001). CONCLUSIONS The inaugural teaching session was well-received and subjective assessment measures showed improvement in taught skills. This pilot has informed a UK-wide multi-centre study with subjective and objective data collection.
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Affiliation(s)
| | - Emily Eisner
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK AND Research and Innovation Department, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Angus JM Watson
- Department of Colorectal Surgery, NHS Highland, Inverness, UK
| | - John L. Duncan
- Highlands Medical Education Centre, University of Aberdeen, Inverness, UK
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Sandbæk A, Christensen LD, Larsen LL, Primholdt Christensen N, Kofod FG, Guassora AD, Merrild CH, Assing Hvidt E. Guidance for Implementing Video Consultations in Danish General Practice: Rapid Cycle Coproduction Study. JMIR Form Res 2021; 5:e27323. [PMID: 34821560 PMCID: PMC8663649 DOI: 10.2196/27323] [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: 05/27/2021] [Revised: 09/06/2021] [Accepted: 10/05/2021] [Indexed: 12/05/2022] Open
Abstract
Background The COVID-19 pandemic has changed various spheres of health care. General practitioners (GPs) have widely replaced face-to-face consultations with telephone or video consultations (VCs) to reduce the risk of COVID-19 transmission. Using VCs for health service delivery is an entirely new way of practicing for many GPs. However, this transition process has largely been conducted with no formal guidelines, which may have caused implementation barriers. This study presents a rapid cycle coproduction approach for developing a guide to assist VC implementation in general practice. Objective The aim of this paper is to describe the developmental phases of the VC guide to assist general practices in implementing VCs and summarize the evaluation made by general practice users. Methods The development of a guide for VC in general practice was structured as a stepped process based on the coproduction and prototyping processes. We used an iterative framework based on rapid qualitative analyses and interdisciplinary collaborations. Thus, the guide was developed in small, repeated cycles of development, implementation, evaluation, and adaptation, with a continuous exchange between research and practice. The data collection process was structured in 3 main phases. First, we conducted a literature review, recorded observations, and held informal and semistructured interviews. Second, we facilitated coproduction with stakeholders through 4 workshops with GPs, a group interview with patient representatives, and individual revisions by GPs. Third, nationwide testing was conducted in 5 general practice clinics and was followed by an evaluation of the guide through interviews with GPs. Results A rapid cycle coproduction approach was used to explore the needs of general practice in connection with the implementation of VC and to develop useful, relevant, and easily understandable guiding materials. Our findings suggest that a guide for VCs should include advice and recommendations regarding the organization of VCs, the technical setup, the appropriate target groups, patients’ use of VCs, the performance of VCs, and the arrangements for booking a VC. Conclusions The combination of coproduction, prototyping, small iterations, and rapid data analysis is a suitable approach when contextually rich, hands-on guide materials are urgently needed. Moreover, this method could provide an efficient way of developing relevant guide materials for general practice to aid the implementation of new technology beyond the pandemic period.
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Affiliation(s)
- Amanda Sandbæk
- Research Unit for General Practice, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | | | - Nina Primholdt Christensen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Frida Greek Kofod
- The Research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ann Dorrit Guassora
- The Research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Arnold JL, Anderson E, Roeder L. Rural patients highly satisfied with gynaecological oncology care via telehealth. Aust N Z J Obstet Gynaecol 2021; 62:280-285. [PMID: 34713445 DOI: 10.1111/ajo.13452] [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: 04/16/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Introduction of telehealth for gynaecological oncology consultations aims to improve access to specialised care for rural and remote Queensland women with gynaecological malignancies. AIMS This survey examines patient satisfaction with gynaecological oncology consultations via telehealth after introduction of the service in Far North Queensland in 2017. MATERIALS AND METHODS Patients who accessed the gynaecological oncology telehealth service at Cairns Hospital from January 2019 to June 2020 were invited to participate in the study. Demographic details and results of a satisfaction survey were investigated. The questionnaire included 16 statements measured on a five-point Likert scale and three open-ended questions, which were coded into related responses and predominant themes developed. RESULTS Fifty-three patients completed the study. The mean satisfaction score across all questions was 90.5% (standard deviation 8.7%). The lowest overall patient score was 77.5% and the highest was 100%. Themes emerging from the open questions were emotions experienced by women, communication, relationship building and acceptability of the service. CONCLUSIONS Patients were highly satisfied with the telehealth service. Our findings encourage further development and research into telehealth care models for surgical disciplines such as gynaecological oncology.
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Affiliation(s)
- Joanna L Arnold
- Department of Women's Health, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - Emma Anderson
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Luisa Roeder
- College of Medicine and Dentistry, James Cook University, Cairns, Australia.,School of Exercise Nutrition Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Department of Sport and Health Sciences, Chair of Human Movement Science, Technical University Munich, Germany
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Ainley E, Witwicki C, Tallett A, Graham C. Using Twitter Comments to Understand People's Experiences of UK Health Care During the COVID-19 Pandemic: Thematic and Sentiment Analysis. J Med Internet Res 2021; 23:e31101. [PMID: 34469327 PMCID: PMC8547412 DOI: 10.2196/31101] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/12/2021] [Accepted: 08/30/2021] [Indexed: 12/26/2022] Open
Abstract
Background The COVID-19 pandemic has led to changes in health service utilization patterns and a rapid rise in care being delivered remotely. However, there has been little published research examining patients’ experiences of accessing remote consultations since COVID-19. Such research is important as remote methods for delivering some care may be maintained in the future. Objective The aim of this study was to use content from Twitter to understand discourse around health and care delivery in the United Kingdom as a result of COVID-19, focusing on Twitter users’ views on and attitudes toward care being delivered remotely. Methods Tweets posted from the United Kingdom between January 2018 and October 2020 were extracted using the Twitter application programming interface. A total of 1408 tweets across three search terms were extracted into Excel; 161 tweets were removed following deduplication and 610 were identified as irrelevant to the research question. The remaining relevant tweets (N=637) were coded into categories using NVivo software, and assigned a positive, neutral, or negative sentiment. To examine views of remote care over time, the coded data were imported back into Excel so that each tweet was associated with both a theme and sentiment. Results The volume of tweets on remote care delivery increased markedly following the COVID-19 outbreak. Five main themes were identified in the tweets: access to remote care (n=267), quality of remote care (n=130), anticipation of remote care (n=39), online booking and asynchronous communication (n=85), and publicizing changes to services or care delivery (n=160). Mixed public attitudes and experiences to the changes in service delivery were found. The proportion of positive tweets regarding access to, and quality of, remote care was higher in the immediate period following the COVID-19 outbreak (March-May 2020) when compared to the time before COVID-19 onset and the time when restrictions from the first lockdown eased (June-October 2020). Conclusions Using Twitter data to address our research questions proved beneficial for providing rapid access to Twitter users’ attitudes to remote care delivery at a time when it would have been difficult to conduct primary research due to COVID-19. This approach allowed us to examine the discourse on remote care over a relatively long period and to explore shifting attitudes of Twitter users at a time of rapid changes in care delivery. The mixed attitudes toward remote care highlight the importance for patients to have a choice over the type of consultation that best suits their needs, and to ensure that the increased use of technology for delivering care does not become a barrier for some. The finding that overall sentiment about remote care was more positive in the early stages of the pandemic but has since declined emphasizes the need for a continued examination of people’s preference, particularly if remote appointments are likely to remain central to health care delivery.
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Affiliation(s)
| | | | - Amy Tallett
- Picker Institute Europe, Oxford, United Kingdom
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Dutta A, Mahendru S, Sharma R, Singh A, Jain A, Jevalikar G, Mithal A. Video Consultation Versus In-Person Clinic Visit for Glycemic Control in Type 2 Diabetes during COVID-19 Pandemic (VIP-CD Study). Indian J Endocrinol Metab 2021; 25:427-431. [PMID: 35300446 PMCID: PMC8923318 DOI: 10.4103/ijem.ijem_347_21] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/04/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To compare the efficacy of video consultation (VC) for prospective glycemic control against that of in-person clinic visit (IPV) in individuals with type 2 diabetes. MATERIALS AND METHODS This is a retrospective, cohort study of 96 individuals with type 2 diabetes followed up for a period of ≤6 months. The cohort was divided into two groups depending on the mode of consultation, namely IPV (n = 48) and VC (n = 48). Baseline and follow-up characteristics including glycemic profile and lipid profile were compared. RESULTS The cohort had a mean age of 55.4 ± 13.8 years, median diabetes duration of 8 (0.3-70) years, a mean body mass index (BMI) of 28.8 ± 5.8 kg/m2, 44 (46.3%) females, and uncontrolled hyperglycemia (HbA1c 8.7% ± 1.9%). Both groups were adequately matched at baseline. At the time of first visit, cessation of previous medications was more frequent in the IPV group (37.5% vs 8.3%; P = 0.001) than in the VC group. Follow-up was earlier in the VC group as compared to the IPV group (43.2 vs 87.9 days; P = 0.000). During the follow-up period, both groups had similar and adequate glycemic (mean HbA1c 7% ± 1%) and lipid profile control. Cox regression model showed that the VC group achieved glycemic control quicker as compared to the IPV group. CONCLUSIONS Telemedicine is an effective mode of consultation for attaining glycemic control during COVID-19 pandemic, possibly owing to the quicker follow-up without the risk of potential in-clinic/hospital exposure to COVID-19.
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Affiliation(s)
- Aditya Dutta
- Institute of Endocrinology and Diabetes, Max Healthcare, New Delhi, India
| | - Shama Mahendru
- Institute of Endocrinology and Diabetes, Max Healthcare, New Delhi, India
| | - Rutuja Sharma
- Institute of Endocrinology and Diabetes, Max Healthcare, New Delhi, India
| | - Anshu Singh
- Institute of Endocrinology and Diabetes, Max Healthcare, New Delhi, India
| | - Anjali Jain
- Institute of Endocrinology and Diabetes, Max Healthcare, New Delhi, India
| | - Ganesh Jevalikar
- Institute of Endocrinology and Diabetes, Max Healthcare, New Delhi, India
| | - Ambrish Mithal
- Institute of Endocrinology and Diabetes, Max Healthcare, New Delhi, India
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Primholdt Christensen N, Skou KE, Boe Danbjørg D. Health Care Professionals' Experiences With the Use of Video Consultation: Qualitative Study. JMIR Form Res 2021; 5:e27094. [PMID: 34287207 PMCID: PMC8339982 DOI: 10.2196/27094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/15/2021] [Revised: 04/08/2021] [Accepted: 05/31/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The number of remote video consultations between doctors and patients has increased during the last few years and especially during the COVID-19 pandemic. The health care service is faced with rising rates of chronic illness and many patients who are more confident in self-management of their illnesses. In addition, there is an improved long-term outlook for serious conditions, such as cancer, that might require flexibility in everyday life. OBJECTIVE This study aimed to investigate how medical doctors in the outpatient clinic use and experience the use of video consultations with hematological patients, with a focus on relational and organizational aspects. METHODS The study was designed as an explorative and qualitative study. Data were collected via participant observations and focus group interviews with medical doctors. RESULTS The study identified possibilities and barriers in relation to adapting to the alternative way of meeting patients in the clinical setting. One of the main findings in this study is that the medical doctors were afraid that they missed important observations, as they were not able to perform a physical examination, if needed. They also emphasized that handshake and eye contact were important in order to get an overall impression of the patient's situation. It also became clear that the medical doctors used body language a lot more during video consultation compared with consultation in a physical setting. The medical doctors found the contact with the patients via the screen to be good, and the fact that the technology was working well made them feel comfortable with the video consultation. CONCLUSIONS In this study, we found that the medical doctors were able to maintain good contact with the patients despite the screen and were able to assess the patients in a satisfying manner. However, there were still uncertainties among some doctors about the fact that they could not examine the patients physically. New knowledge about how to use gestures and body language during video consultation was obtained.
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Affiliation(s)
| | | | - Dorthe Boe Danbjørg
- Centre for Innovative Medical Technology, Department of Hematology, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
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Gullslett MK, Kristiansen E, Nilsen ER. Therapists' Experience of Video Consultation in Specialized Mental Health Services During the COVID-19 Pandemic: Qualitative Interview Study. JMIR Hum Factors 2021; 8:e23150. [PMID: 34096505 PMCID: PMC8284340 DOI: 10.2196/23150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/05/2020] [Revised: 10/27/2020] [Accepted: 06/06/2021] [Indexed: 01/20/2023] Open
Abstract
Background As part of political and professional development with increased focus on including service users within mental health services, these services are being transformed. Specifically, they are shifting from institutional to noninstitutional care provision with increased integration of the use of electronic health and digitalization. In the period from March to May 2020, COVID-19 restrictions forced rapid changes in the organization and provision of mental health services through the increased use of digital solutions in therapy. Objective The aim of this study was to develop and advance comprehensive knowledge about how therapists experience the use of video consultation (VC). To reach this objective, we evaluated therapists’ experiences of using VC in specialized mental health services in the early phase of COVID-19 restrictions. The following questions were explored through interviews: Which opportunities and challenges appeared when using VC during the period of COVID-19 restrictions? In a short-term care pathway, for whom does VC work and for whom does it not work? Methods This study employed a qualitative approach based on an abductive strategy and hermeneutic-phenomenological methodology. Therapists and managers in mental health departments in a hospital were interviewed via Skype for Business from March to May 2020, using a thematic interview guide that aimed to encourage reflections on the use of VC during COVID-19 restrictions. Results Therapists included in this study experienced advantages in using VC under circumstances that did not permit face-to-face consultations. The continuity that VC offered the service users was seen as a valuable asset. Various negative aspects concerning the therapeutic environment such as lack of safety for the most vulnerable service users and topics deemed unsuitable for VC lowered the therapists’ overall impression of the service. The themes that arose in the data analysis have been categorized in the following main topics: (1) VC—“it’s better than nothing”; (2) VC affects therapists’ work situation—opportunities and challenges in working conditions; and (3) challenges of VC when performing professional assessment and therapy on the screen. Conclusions Experiences with VC in a mental health hospital during COVID-19 restrictions indicate that there are overall advantages to using VC when circumstances do not permit face-to-face consultations. Nevertheless, various negative aspects in the use of VC lowered the therapists’ overall impression of VC. Further qualitative research is needed, and future studies should focus on service users’ experiences, cocreation between different stakeholders, and how to scale up the use of VC while ensuring that the service provided is appropriate, safe, and available.
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Affiliation(s)
- Monika K Gullslett
- Norwegian Center for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Eli Kristiansen
- Norwegian Center for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Etty R Nilsen
- School of Business and Economics, University of Tromsø (UiT), Alta, Norway
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Alhajri N, Simsekler MCE, Alfalasi B, Alhashmi M, AlGhatrif M, Balalaa N, Al Ali M, Almaashari R, Al Memari S, Al Hosani F, Al Zaabi Y, Almazroui S, Alhashemi H, Baltatu OC. Physicians' Attitudes Toward Telemedicine Consultations During the COVID-19 Pandemic: Cross-sectional Study. JMIR Med Inform 2021; 9:e29251. [PMID: 34001497 PMCID: PMC8171285 DOI: 10.2196/29251] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 03/31/2021] [Revised: 05/04/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
Background To mitigate the effect of the COVID-19 pandemic, health care systems worldwide have implemented telemedicine technologies to respond to the growing need for health care services during these unprecedented times. In the United Arab Emirates, video and audio consultations have been implemented to deliver health services during the pandemic. Objective This study aimed to evaluate whether differences exist in physicians’ attitudes and perceptions of video and audio consultations when delivering telemedicine services during the COVID-19 pandemic. Methods This survey was conducted on a cohort of 880 physicians from outpatient facilities in Abu Dhabi, which delivered telemedicine services during the COVID-19 pandemic between November and December 2020. In total, 623 physicians responded (response rate=70.8%). The survey included a 5-point Likert scale to measure physician’s attitudes and perceptions of video and audio consultations with reference to the quality of the clinical consultation and the professional productivity. Descriptive statistics were used to describe physicians’ sociodemographic characteristics (age, sex, designation, clinical specialty, duration of practice, and previous experience with telemedicine) and telemedicine modality (video vs audio consultations). Regression models were used to assess the association between telemedicine modality and physicians’ characteristics with the perceived outcomes of the web-based consultation. Results Compared to audio consultations, video consultations were significantly associated with physicians’ confidence toward managing acute consultations (odds ratio [OR] 1.62, 95% CI 1.2-2.21; P=.002) and an increased ability to provide patient education during the web-based consultation (OR 2.21, 95% CI 1.04-4.33; P=.04). There was no significant difference in physicians’ confidence toward managing long-term and follow-up consultations through video or audio consultations (OR 1.35, 95% CI 0.88-2.08; P=.17). Video consultations were less likely to be associated with a reduced overall consultation time (OR 0.69, 95% CI 0.51-0.93; P=.02) and reduced time for patient note-taking compared to face-to-face visits (OR 0.48, 95% CI 0.36-0.65; P<.001). Previous experience with telemedicine was significantly associated with a lower perceived risk of misdiagnosis (OR 0.46, 95% CI 0.3-0.71; P<.001) and an enhanced physician-patient rapport (OR 2.49, 95% CI 1.26-4.9; P=.008). Conclusions These results indicate that video consultations should be adopted frequently in the new remote clinical consultations. Previous experience with telemedicine was associated with a 2-fold confidence in treating acute conditions, less than a half of the perceived risk of misdiagnosis, and an increased ability to provide patients with health education and enhance the physician-patient rapport. Additionally, these results show that audio consultations are equivalent to video consultations in providing remote follow-up care to patients with chronic conditions. These findings may be beneficial to policymakers of e-health programs in low- and middle-income countries, where audio consultations may significantly increase access to geographically remote health services.
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Affiliation(s)
- Noora Alhajri
- Khalifa University College of Medicine and Health Science, Abu Dhabi, United Arab Emirates
| | | | - Buthaina Alfalasi
- Department of Family Medicine, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Mohamed Alhashmi
- Khalifa University College of Medicine and Health Science, Abu Dhabi, United Arab Emirates
| | - Majd AlGhatrif
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nahed Balalaa
- Department of General Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Maryam Al Ali
- Ambulatory Health Services, Zafarana Clinic, Abu Dhabi Healthcare Company, Abu Dhabi, United Arab Emirates
| | - Raghda Almaashari
- Department of Dermatology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Shammah Al Memari
- Abu Dhabi Public Health Center, Department of Health, Abu Dhabi, United Arab Emirates
| | - Farida Al Hosani
- Abu Dhabi Public Health Center, Department of Health, Abu Dhabi, United Arab Emirates
| | - Yousif Al Zaabi
- Abu Dhabi Public Health Center, Department of Health, Abu Dhabi, United Arab Emirates
| | - Shereena Almazroui
- Abu Dhabi Public Health Center, Department of Health, Abu Dhabi, United Arab Emirates
| | | | - Ovidiu C Baltatu
- Khalifa University College of Medicine and Health Science, Abu Dhabi, United Arab Emirates
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Kooij L, Vos PJ, Dijkstra A, Roovers EA, van Harten WH. Video Consultation as an Adequate Alternative to Face-to-Face Consultation in Continuous Positive Airway Pressure Use for Newly Diagnosed Patients With Obstructive Sleep Apnea: Randomized Controlled Trial. JMIR Form Res 2021; 5:e20779. [PMID: 33973866 PMCID: PMC8150406 DOI: 10.2196/20779] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/28/2020] [Revised: 10/25/2020] [Accepted: 04/13/2021] [Indexed: 01/29/2023] Open
Abstract
Background The effectiveness of continuous positive airway pressure (CPAP) is dependent on the degree of use, so adherence is essential. Cognitive components (eg, self-efficacy) and support during treatment have been found to be important in CPAP use. Video consultation may be useful to support patients during treatment. So far, video consultation has rarely been evaluated in thorough controlled research, with only a limited number of outcomes assessed. Objective The aim of the study was to evaluate the superiority of video consultation over face-to-face consultation for patients with obstructive sleep apnea (OSA) on CPAP use (minutes per night), adherence, self-efficacy, risk outcomes, outcome expectancies, expectations and experiences with video consultation, and satisfaction of patients and nurses. Methods A randomized controlled trial was conducted with an intervention (video consultation) and a usual care group (face-to-face consultation). Patients with confirmed OSA (apnea-hypopnea index >15), requiring CPAP treatment, no history of CPAP treatment, having access to a tablet or smartphone, and proficient in the Dutch language were recruited from a large teaching hospital. CPAP use was monitored remotely, with short-term (weeks 1 to 4) and long-term (week 4, week 12, and week 24) assessments. Questionnaires were completed at baseline and after 4 weeks on self-efficacy, risk perception, outcome expectancies (Self-Efficacy Measure for Sleep Apnea), expectations and experiences with video consultation (covering constructs of the unified theory of acceptance and use of technology), and satisfaction. Nurse satisfaction was evaluated using questionnaires. Results A total of 140 patients were randomized (1:1 allocation). The use of video consultation for OSA patients does not lead to superior results on CPAP use and adherence compared with face-to-face consultation. A significant difference in change over time was found between groups for short-term (P-interaction=.008) but not long-term (P-interaction=.68) CPAP use. CPAP use decreased in the long term (P=.008), but no significant difference was found between groups (P=.09). Change over time for adherence was not significantly different in the short term (P-interaction=.17) or long term (P-interaction=.51). A relation was found between CPAP use and self-efficacy (P=.001), regardless of the intervention arm (P=.25). No significant difference between groups was found for outcome expectancies (P=.64), self-efficacy (P=.41), and risk perception (P=.30). The experiences were positive, and 95% (60/63) intended to keep using video consultation. Patients in both groups rated the consultations on average with an 8.4. Overall, nurses (n=3) were satisfied with the video consultation system. Conclusions Support of OSA patients with video consultation does not lead to superior results on CPAP use and adherence compared with face-to-face consultation. The findings of this research suggest that self-efficacy is an important factor in improving CPAP use and that video consultation may be a feasible way to support patients starting CPAP. Future research should focus on blended care approaches in which self-efficacy receives greater emphasis. Trial Registration Clinicaltrials.gov NCT04563169; https://clinicaltrials.gov/show/NCT04563169
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Affiliation(s)
- Laura Kooij
- Rijnstate, Arnhem, Netherlands.,Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands
| | - Petra Je Vos
- Pulmonary Department, Rijnstate, Arnhem, Netherlands
| | | | | | - Wim H van Harten
- Rijnstate, Arnhem, Netherlands.,Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
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Abstract
Telemedicine use has expanded rapidly to cope with increasing demand on services by delivering remote clinical review and monitoring of long-term conditions. Triaging individual patients to determine their suitability for telephone, video or face-to-face consultations is necessary. This is crucial in the context of COVID-19 to ensure doctor-patient safety. Telemedicine was shown to be safe and feasible in managing certain chronic diseases and providing patient education. When reviewing newly referred or long-term patients, different specialty clinics have different requirements for physical examination. Clinicians prefer face-to-face consultations at the initial visit to establish a doctor-patient relationship; telephone or video consultations are reasonable options for long-term patients where physical examination may not be needed. Video consultations, often aided by sophisticated devices and apps or medical assistants, are useful to facilitate remote physical examination. Most patients prefer telemedicine as it saves time and travel cost and provides better access to appointments.
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Affiliation(s)
| | - Sara Koo
- South Tyneside and Sunderland NHS Foundation Trust
| | - Simon Panter
- South Tyneside and Sunderland NHS Foundation Trust
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Painter J, Turner J, Procter P. If There's Something Strange in Your Neighbourhood, Who You Gonna Call? Perceived Mental Health Service User Suitability for Video Consultations. Healthcare (Basel) 2021; 9:healthcare9050517. [PMID: 33946641 PMCID: PMC8146145 DOI: 10.3390/healthcare9050517] [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: 03/09/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022] Open
Abstract
COVID-19 has placed additional challenges on mental health services. Video consultations (VCs) have provided a short-term solution to lockdown restrictions but could also increase long-term capacity to meet the anticipated rising demand. A total of 7752 VCs were conducted over six weeks. Thematic analysis of 474 online survey responses identified twenty patient attributes that influenced staffs’ decisions to offer VCs. Their opinions were diverse, at times contradictory, and not always evidence based. There was reasonable consensus (and published evidence to support) of the probable suitability of VC for patients who: are IT savvy and suitably equipped; are teenagers; live in remote/rural locations; have caring responsibilities; have anxiety disorders or express a preference. No consensus was reached regarding eight attributes and there was a corresponding paucity of evidence, indicating the need for further research. Conversely, old age; paranoia, sensory impairment/communication difficulties; high risk and trauma/PTSD (posttraumatic stress disorder) were generally seen as contraindicated by staff, despite published evidence of success elsewhere. It may be possible to overcome staff’s reticence to offer these groups VCs. As staff are effectively the gatekeepers to VC interventions, it is important to understand and support them to overcome reservations that are contrary to the empirical evidence base. This will ensure that their initial anxieties do not become unnecessary barriers to services for those most in need. As with all mental healthcare, such decisions should be made collaboratively, and on an individual basis.
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Abstract
OBJECTIVE To describe physicians' experiences of video consultation with new patients visiting a publicly owned virtual primary care clinic. DESIGN In this qualitative study, data were collected from semi-structured individual interviews and analysed by systematic text condensation. SETTING A publicly owned virtual primary care clinic in Region Västra Götaland, Sweden. SUBJECTS Ten primary care physicians working at the clinic. RESULTS Connecting with a patient over video could be either straightforward or deficient, depending on communication and the patient's condition. Clinical experience, communication skills, and involving patients throughout the consultation and examination were crucial for assessments over video where patients were guided to perform self-examination. The flexibility of work and the regulated assignment online were positive for the physicians' work situation and wellbeing. Providing video consultation within the same organisation as the patient's regular health centre was considered to facilitate patient care and safety. Video consultation was considered suitable for some diagnoses and for some patients not able to reach a primary healthcare centre, though doubts were expressed about the healthcare and social benefits of this virtual care service. CONCLUSION For the physicians, video consultation induced changes in the basis for assessment of primary care patients. The limitations on informational exchange demanded an extended form of patient involvement founded upon consultation skills, clinical experience and new skills for virtual examination. Combining virtual care with traditional general practice has the potential to reduce the workload for the individual physician and ensure medical competence in virtual primary care. Video consultation experienced suitable in some situations, but easy access to it expressed problematic in terms of medical prioritisation in healthcare.KEY POINTSVideo consultation is suitable for primary care visits for some patients, but physicians' experiences of this are rarely studied. •Clinical experience and consultation skills are important for video assessment of primary care patients which involves physician-guided patient self-examination.•Video consultation facilitates care in some situations and could benefit from the provider being connected to patient's regular health centre.•Virtual care offers a flexible way of working but challenges healthcare prioritisation from the primary care physician's perspective.
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Affiliation(s)
- Cajsa Björndell
- Närhälsan Brämaregården Health Centre, Gothenburg, Sweden
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research and Development Primary Health Care, Research and Development Centre Gothenburg and Södra Bohuslän, Gothenburg, Sweden
| | - Åsa Premberg
- Research and Development Primary Health Care, Research and Development Centre Gothenburg and Södra Bohuslän, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Dinakaran D, Manjunatha N, Kumar CN, Math SB. Telemedicine practice guidelines of India, 2020: Implications and challenges. Indian J Psychiatry 2021; 63:97-101. [PMID: 34083829 PMCID: PMC8106416 DOI: 10.4103/psychiatry.indianjpsychiatry_476_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/11/2020] [Revised: 06/06/2020] [Accepted: 07/06/2020] [Indexed: 11/24/2022] Open
Abstract
Telemedicine Guidelines of India, 2020 promises to pave a road map for regularization and diversification of teleconsultation services across the country. This guideline is the need of the hour, especially during the current coronavirus disease pandemic. All modes of communications (text, audio, video, etc.) between the service provider and user are included in the broad rubric of the guidelines. Scope, inclusions, exclusions, and restrictions are clearly specified in the guideline. Medications are grouped and listed for the specific type of consultation, and restricted drugs are notified. This guideline especially helps mitigate the gaps in legislation and reduces the uncertainty while providing a practical, safe, and cost-effective framework to improve healthcare service delivery in this article; the authors discuss the implications of this new guideline and the challenges during the implementation of teleconsultation services across the country.
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Affiliation(s)
- Damodharan Dinakaran
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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von Sengbusch S, Eisemann N, Mueller-Godeffroy E, Lange K, Doerdelmann J, Erdem A, Menrath I, Bokelmann J, Krasmann M, Kaczmarczyk P, Bertram B, Hiort O, Katalinic A, Frielitz FS. Outcomes of monthly video consultations as an add-on to regular care for children with type 1 diabetes: A 6-month quasi-randomized clinical trial followed by an extension phase. Pediatr Diabetes 2020; 21:1502-1515. [PMID: 33009690 DOI: 10.1111/pedi.13133] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 06/02/2020] [Revised: 09/05/2020] [Accepted: 09/24/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To explore the outcomes of monthly video consultations for children with diabetes. METHODS The Virtual Outpatient Diabetes Clinic for Children and Youth (VIDIKI) was a 6-month multicenter controlled clinical trial followed by an extension phase. The 240 participants (1-16 years), all using a CGM, were quasi-randomized by residence location to the intervention group (IG) or the waitlist-control group (WG). The IG started immediately after enrollment with monthly video consultations as an add-on to regular care, while the WG received regular care for 6 months before starting the intervention. The extension phase lasted between 12 months and 2 years, depending on the enrollment date. Linear regression was applied to model the primary outcome of HbA1c after 6 months and other metabolic and psychosocial outcomes. RESULTS After covariate adjustments, the HbA1c at 6 months-corresponding to the controlled treatment phase-was 0.11% lower in the IG than that in the WG (95% CI -0.31 to 0.09, P = .277). For the total study sample, a significant HbA1c improvement was found after 12 months of video consultations, which increased further until month 15. The diabetes burden of the main caregivers was lower, and parental treatment satisfaction was significantly higher in the IG than that in the WG. CONCLUSIONS The VIDIKI study found no significant HbA1c difference between IG and WG after 6 months in the controlled phase, but there was a decreased diabetes burden and increased treatment satisfaction for the parents. In the longitudinal perspective, a significant HbA1c improvement was found after 12 and 15 months.
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Affiliation(s)
- Simone von Sengbusch
- Division of Pediatric Endocrinology and Diabetology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Nora Eisemann
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Esther Mueller-Godeffroy
- Division of Pediatric Endocrinology and Diabetology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Karin Lange
- Hannover Medical School, Medical Psychology, Hannover, Germany
| | - Jana Doerdelmann
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Alev Erdem
- Division of Pediatric Endocrinology and Diabetology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Ingo Menrath
- Division of Pediatric Endocrinology and Diabetology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Jessica Bokelmann
- Department of Pediatrics Kiel, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Miriam Krasmann
- Department of Pediatrics Kiel, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | | | - Bettina Bertram
- Department of Pediatrics, General Hospital Kiel, Kiel, Germany
| | - Olaf Hiort
- Division of Pediatric Endocrinology and Diabetology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Alexander Katalinic
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Fabian S Frielitz
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
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