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Arsenault M, Long S, D'Souza V, Ilie A, Todd KJ. Telemedicine visits requiring follow-up in-person visits at an urban academic family medicine centre. Fam Pract 2024; 41:105-113. [PMID: 38382045 DOI: 10.1093/fampra/cmae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND With the onset of the COVID-19 pandemic, telemedicine was rapidly implemented in care settings globally. To understand what factors affect the successful completion of telemedicine visits in our urban, academic family medicine clinic setting, we analysed telemedicine visits carried out during the pandemic. METHODS We conducted a retrospective chart review of telemedicine visits from 2 clinical units within a family medicine centre. To investigate the association between incomplete visits and various factors (age, gender, presenting complaints, physician level of training [resident or staff] and patient-physician relational continuity), we performed a multivariable logistic regression on data from August 2020, February 2021, and May 2021. An incomplete visit is one that requires a follow-up in-person visit with a physician within 3 days. RESULTS Of the 2,138 telemedicine patient visits we investigated, 9.6% were incomplete. Patients presenting with lumps and bumps (OR: 3.84, 95% CI: 1.44, 10.5), as well as those seen by resident physicians (OR: 1.77, 95% CI: 1.22, 2.56) had increased odds of incomplete visits. Telemedicine visits at the family medicine clinic (Site A) with registered patients had lower odds of incomplete visits (OR: 0.24, 95% CI: 0.15, 0.39) than those at the community clinic (Site B), which provides urgent/episodic care with no associated relational continuity between patients and physicians. CONCLUSION In our urban clinical setting, only a small minority of telemedicine visits required an in-person follow-up visit. This information may be useful in guiding approaches to triaging patients to telemedicine or standard in-person care.
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Affiliation(s)
- Mylène Arsenault
- Herzl Family Practice Centre, Jewish General Hospital, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Stephanie Long
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Vinita D'Souza
- Herzl Family Practice Centre, Jewish General Hospital, Montreal, Canada
| | - Alexandru Ilie
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Keith J Todd
- Herzl Family Practice Centre, Jewish General Hospital, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Canada
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2
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Finkelstein JB, Hauptman M, Acosta K, Flanagan S, Cahill D, Smith B, Bernstein A, Shah SH, Kaur R, Meyers H, Shah AS, Meara JG, Estrada CR. Environmental Impact of a Pediatric and Young Adult Virtual Medicine Program: A Lesson from the COVID-19 Pandemic. Acad Pediatr 2024; 24:408-416. [PMID: 37499794 PMCID: PMC10809144 DOI: 10.1016/j.acap.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/16/2023] [Accepted: 07/22/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES The Coronavirus Disease 2019 (COVID-19) pandemic led to the expansion of virtual medicine as a method to provide patient care. We aimed to determine the impact of pediatric and young adult virtual medicine use on fossil fuel consumption, greenhouse gas, and nongreenhouse traffic-related air pollutant emissions. METHODS We conducted a retrospective analysis of all virtual medicine patients at a single quaternary-care children's hospital with a geocoded address in the Commonwealth of Massachusetts prior to (March 16, 2019-March 15, 2020) and during the COVID-19 pandemic (March 16, 2020-March 15, 2021). Primary outcomes included patient travel distance, gasoline consumption, carbon dioxide and fine particulate matter emissions as well as savings in main hospital energy use. RESULTS There were 3,846 and 307,273 virtual visits performed with valid Massachusetts geocoded addresses prior to and during the COVID-19 pandemic, respectively. During 1 year of the pandemic, virtual medicine services resulted in a total reduction of 620,231 gallons of fossil fuel use and $1,620,002 avoided expenditure as well as 5,492.9 metric tons of carbon dioxide and 186.3 kg of fine particulate matter emitted. There were 3.1 million fewer kilowatt hours used by the hospital intrapandemic compared to the year prior. Accounting for equipment emissions, the combined intrapandemic emission reductions are equivalent to the electricity required by 1,234 homes for 1 year. CONCLUSIONS Widespread pediatric institutional use of virtual medicine provided environmental benefits. The true potential of virtual medicine for decreasing the environmental footprint of health care lies in scaling this mode of care to patient groups across the state and nation when medically feasible.
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Affiliation(s)
- Julia B Finkelstein
- Department of Urology (JB Finkelstein and CR Estrada), Boston Children's Hospital, Boston, Mass; Department of Surgery (JB Finkelstein, CR Estrada, and JG Meara), Harvard Medical School, Boston, Mass
| | - Marissa Hauptman
- Division of General Pediatrics (M Hauptman, K Acosta, S Flanagan, A Bernstein, and SH Shah), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (M Hauptman, S Flanagan, A Bernstein, and SH Shah), Harvard Medical School, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (M Hauptman, K Acosta, S Flanagan, A Bernstein, SH Shah), Boston, Mass.
| | - Keith Acosta
- Division of General Pediatrics (M Hauptman, K Acosta, S Flanagan, A Bernstein, and SH Shah), Boston Children's Hospital, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (M Hauptman, K Acosta, S Flanagan, A Bernstein, SH Shah), Boston, Mass
| | - Shelby Flanagan
- Division of General Pediatrics (M Hauptman, K Acosta, S Flanagan, A Bernstein, and SH Shah), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (M Hauptman, S Flanagan, A Bernstein, and SH Shah), Harvard Medical School, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (M Hauptman, K Acosta, S Flanagan, A Bernstein, SH Shah), Boston, Mass
| | | | - Brian Smith
- Department of Engineering (B Smith), Boston Children's Hospital, Boston, Mass
| | - Aaron Bernstein
- Division of General Pediatrics (M Hauptman, K Acosta, S Flanagan, A Bernstein, and SH Shah), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (M Hauptman, S Flanagan, A Bernstein, and SH Shah), Harvard Medical School, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (M Hauptman, K Acosta, S Flanagan, A Bernstein, SH Shah), Boston, Mass; Center for Climate, Health, and the Global Environment (C-CHANGE) (A Bernstein), Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Shalini H Shah
- Division of General Pediatrics (M Hauptman, K Acosta, S Flanagan, A Bernstein, and SH Shah), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (M Hauptman, S Flanagan, A Bernstein, and SH Shah), Harvard Medical School, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (M Hauptman, K Acosta, S Flanagan, A Bernstein, SH Shah), Boston, Mass
| | - Ravneet Kaur
- Innovation and Digital Health Accelerator (R Kaur and H Meyers), Boston Children's Hospital, Boston, Mass
| | - Heather Meyers
- Innovation and Digital Health Accelerator (R Kaur and H Meyers), Boston Children's Hospital, Boston, Mass
| | - Ankoor S Shah
- Department of Ophthalmology (AS Shah), Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - John G Meara
- Department of Surgery (JB Finkelstein, CR Estrada, and JG Meara), Harvard Medical School, Boston, Mass; Department of Plastic & Oral Surgery (JG Meara), Boston Children's Hospital, Boston, Mass
| | - Carlos R Estrada
- Department of Urology (JB Finkelstein and CR Estrada), Boston Children's Hospital, Boston, Mass; Department of Surgery (JB Finkelstein, CR Estrada, and JG Meara), Harvard Medical School, Boston, Mass
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3
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Davenport TE, Lee AC, Raja B, Stark ML, Reed C, Magnusson DM. Educational competencies for telehealth physical therapy: Results of a modified Delphi process. Work 2024:WOR230618. [PMID: 38393878 DOI: 10.3233/wor-230618] [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: 02/25/2024] Open
Abstract
BACKGROUND Telehealth is becoming more prevalent in physical therapy, involving a whole host of clinical services. These services are often provided without structured training in telehealth, and no formal curricula currently exist for this purpose. OBJECTIVE To develop a set of educational competencies (ECs) to guide instruction of telehealth-related skills in entry-level programs (i.e., Doctor of Physical Therapy), existing programs (i.e., residencies and fellowships), and potential future post-graduate programs specific to telehealth physical therapy. METHODS Physical therapists and physical therapist assistants from diverse geographic locations and practice areas were invited to participate on an expert panel. A modified Delphi process was then used to evaluate the acceptability of draft ECs gathered from the extant literature by a steering group. Draft ECs were presented to the expert panel on a questionnaire, which asked expert participants to rate each draft EC according to applicability and clarity. Draft ECs were accepted if they met a priori established criteria for acceptability and clarity. Unendorsed ECs were revised by the steering group according to open-ended comments from respondents and presented during a subsequent round. Three rounds of surveys were undertaken. RESULTS Thirty-eight participants formed the expert panel; 38 participants completed the Round 1 survey, 28 participants completed the Round 2 survey, and 24 participants completed the Round 3 survey. Delphi group members approved 48 ECs in the first round, 23 ECs in the second round, and 2 ECs in the third round. There were 4 ECs that remained unendorsed after the modified Delphi process. Endorsed ECs spanned 7 conceptual areas. Distinct sets of ECs characterized expected end points of first professional degree, existing residency and fellowship, and potential future telehealth physical therapy post-graduate program. CONCLUSIONS Consensus-based ECs identified in this study may guide instruction in knowledge and skills relevant to physical therapy telehealth.
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Affiliation(s)
- Todd E Davenport
- Department of Physical Therapy, University of the Pacific, Stockton, CA, USA
| | - Alan C Lee
- Mount Saint Mary's University, Los Angeles, CA, USA
| | - Bhavana Raja
- Department of Physical Therapy, University of the Pacific, Stockton, CA, USA
| | | | | | - Dawn M Magnusson
- Physical Therapy Program, University of Colorado - Anschutz Medical Campus, Aurora, CO, USA
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4
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Joseph AM, Alsalman RA, Almasoud WA, Almutairi R, Alammari RB, Deeban YAM, Mustafa MZ, Thakare AA. Predicting the employment of teledentistry in clinical practice by the Saudi dental community using a theoretical model. Digit Health 2024; 10:20552076241253739. [PMID: 38736733 PMCID: PMC11085021 DOI: 10.1177/20552076241253739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction There are very few scholastic studies applying a theory-driven methodology to analyse the employment of teledentistry in clinical practice by the Saudi dental community. The objective of this research was to predict the employment of teledentistry in clinical practice by the Saudi dental community using the UTAUT (Unified Theory of Acceptance and Use of Technology) model. Methods A countrywide survey was executed from November 2022 to April 2023 among the dental community (pre-graduate students, graduates, post-graduate students, general dentists, and specialist dentists) involved in clinical practice. The survey employed the UTAUT model, which has four fundamental constructs: performance expectancy (PE), effort expectancy (EE), social influence (SI) and facilitating conditions (FC). These constructs are known to impact the user's behavioural intention (BI). The four fundamental constructs were independent, and BI was the dependent variable. A Likert scale with five scores was used to record each variable. Descriptive statistics were used to describe all the constructs. Cronbach's alpha scores were used to measure the inner consistency of the Likert scale. Simple linear regression and multiple linear regression were used to determine the correlation between all the constructs and the overall model's prediction. The Statistical Package for the Social Sciences was applied for analysis. The study had 80% power and an alpha threshold of .05. Results The electronic survey was sent to 3000 participants, out of whom 2143 responded (response rate = 71.43%). PE (R2= 26%, p < .01) was the most significant predictor of the Saudi dental community BI to employ teledentistry in clinical practice, followed by SI (R2= 24%, p < .01), EE (R2= 19%, p < .01) and FC (R2= 6%, p < .01). With statistically significant predictive power, the UTAUT model explained 32% of the variance in the BI (R2= 0.32, p < .01). Conclusions Each UTAUT construct and the entire model were significantly correlated with the employment of teledentistry in clinical practice by the Saudi dental community. PE had the most salient correlation, followed by SI, EE and FC. The participants have perceived the benefits of teledentistry, increasing the future likelihood of its utilisation. The Saudi government could consider the UTAUT constructs to promote teledentistry in tandem with Vision 2030.
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Affiliation(s)
- Angel M Joseph
- Department of Dental Restoration and Prosthodontics, College of Dentistry, Majmaah University, Al- Majmaah, Saudi Arabia
| | - Rasha A Alsalman
- Intern, College of Dentistry, Majmaah University, Al- Majmaah, Saudi Arabia
| | - Wjoud A Almasoud
- Intern, College of Dentistry, Majmaah University, Al- Majmaah, Saudi Arabia
| | - Reem Almutairi
- Department of Dental Restoration and Prosthodontics, College of Dentistry, Majmaah University, Al- Majmaah, Saudi Arabia
| | - Rawan B Alammari
- Department of Dental Restoration and Prosthodontics, College of Dentistry, Majmaah University, Al- Majmaah, Saudi Arabia
| | - Yahya AM Deeban
- Department of Dental Restoration and Prosthodontics, College of Dentistry, Majmaah University, Al- Majmaah, Saudi Arabia
| | - Mohammed Z Mustafa
- Department of Dental Restoration and Prosthodontics, College of Dentistry, Majmaah University, Al- Majmaah, Saudi Arabia
| | - Amar A Thakare
- Department of Dental Restoration and Prosthodontics, College of Dentistry, Majmaah University, Al- Majmaah, Saudi Arabia
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5
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Neufeld A, Babenko O, Bhella V. Family Physician Motivation and Well-Being in the Digital Era. Ann Fam Med 2023; 21:496-501. [PMID: 38012032 PMCID: PMC10681703 DOI: 10.1370/afm.3031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 06/05/2023] [Accepted: 07/25/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE Family physicians rapidly shifted to using virtual care during the COVID-19 pandemic, yet it is largely unknown if this change has impacted their workplace motivation. A better understanding of this matter is essential for optimizing the integration of virtual care into standard practice and for supporting family physician well-being. Using a self-determination theory lens, we examined if family physicians experienced autonomous (vs controlled) motivation toward using virtual care, how this related to their subjective well-being, and whether satisfaction (vs frustration) of their basic psychological needs at work mediated that relationship. METHODS Using cross-sectional survey methodology, quantitative data was collected from 156 family physicians in Alberta, Canada. The questionnaire contained validated scales for measuring motivational quality, workplace need fulfillment, and subjective well-being. Descriptive, correlational, and mediation analyses were performed. RESULTS Family physicians varied significantly in their quality of motivation towards using virtual care. Controlled motivation toward using virtual care was associated with lower well-being, and workplace need frustration fully mediated that relationship. Conversely, workplace need satisfaction, but not autonomous motivation toward using virtual care, was associated with higher well-being. CONCLUSIONS In line with self-determination theory, findings suggest that when family physicians' motivation toward using virtual care is less self-determined, it will lead to poorer subjective well-being, because of basic psychological need frustration. Potential implications of the findings are discussed within the contexts of virtual health and primary care.
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Affiliation(s)
- Adam Neufeld
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Oksana Babenko
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Vishal Bhella
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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6
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Appukumran R, Shyamsundar K, Agrawal M, Khurana R, Pannu A, Kumar P. Eight years' experience in mobile teleophthalmology for diabetic retinopathy screening. Med Hypothesis Discov Innov Ophthalmol 2023; 11:162-170. [PMID: 37641607 PMCID: PMC10460246 DOI: 10.51329/mehdiophthal1460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/04/2023] [Indexed: 08/31/2023]
Abstract
Background Screening for diabetic retinopathy in the community without compromising the routine work of ophthalmologists at hospitals is the essence of teleophthalmology. This study was aimed at investigating the efficacy of teleophthalmology practice for screening diabetic retinopathy from 2012 to 2020. It was also aimed at comparing the 2-year prevalence of camps organized by a district hospital in South India, as well as the footfall, reporting, follow-up, patient response, and diagnostic efficacy at these camps. Methods All patients with diabetes and unexplained vision deterioration attending the mobile camp units underwent non-dilated fundus photography. Patients underwent teleconsultation with the ophthalmologist at the district hospital, and those requiring intervention were called to the district hospital. Trends were studied for the number of patients reporting to the hospital. Patient satisfaction was recorded based on a questionnaire. Results A total of 682 camps were held over 8 years, and 30 230 patients were examined. Teleconsultation was done for 12 157 (40.21%) patients. Patients requiring further investigations, intervention for diabetic retinopathy, or further management of other ocular pathologies were urgently referred to the district hospital (n= 3293 [10.89%] of 30 230 examined patients). The severity and presence of clinically significant macular edema increased significantly with an increased duration of diabetes mellitus (P < 0.001). The percentage of teleconsultations showed an increasing trend over the years (P = 0.001). Similarly, considering trends of patients reporting to the hospital, the attrition rate decreased over the years (P < 0.05). A total of 10 974 of 12 157 (90.27%) patients who underwent teleophthalmic consultation were satisfied with the service. Conclusions Teleconsultations over the years showed an increasing trend, and the attrition rate decreased over the years. Teleophthalmology is achieving success in providing high-quality service, easy access to care, and in increasing patient satisfaction. Future studies on the role of teleophthalmology for other leading preventable causes of blindness seem possible and necessary.
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Affiliation(s)
| | | | - Mohini Agrawal
- Department of Ophthalmology, Military Hospital, Jalandhar, Punjab, India
| | - Rolli Khurana
- Department of Ophthalmology, Military Hospital, Ahmedabad, India
| | - Anju Pannu
- Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Praveen Kumar
- Department of Community Medicine, Armed Forces Medical College, Pune, India
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7
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Desai P, Kazmi SH, Schneider S, Angert R. Virtual Care Across the Neonatal Intensive Care Continuum. Cureus 2023; 15:e35183. [PMID: 36960267 PMCID: PMC10029832 DOI: 10.7759/cureus.35183] [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] [Accepted: 02/19/2023] [Indexed: 02/21/2023] Open
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for establishing effective parent and family engagement throughout all aspects of medicine. Though there has been some discussion in the literature regarding the transition from typical outpatient visits to telehealth visits, there has been less written about the inpatient approach to family inclusion. Here, we seek to describe our institution's experience with implementing virtual medicine across the full continuum of the neonatal intensive care unit (NICU) experience, including inpatient rounding, child life family visits, and outpatient high-risk developmental follow-up after discharge.
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Affiliation(s)
- Purnahamsi Desai
- Pediatrics, New York University (NYU) Grossman School of Medicine, New York, USA
| | - Sadaf H Kazmi
- Pediatrics, New York University (NYU) Grossman School of Medicine, New York, USA
| | - Stacey Schneider
- Child Life, New York University (NYU) Langone Health, New York, USA
| | - Robert Angert
- Pediatrics, New York University (NYU) Grossman School of Medicine, New York, USA
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8
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Olufunlayo TF, Ojo OO, Ozoh OB, Agabi OP, Opara CR, Taiwo FT, Fasanmade OA, Okubadejo NU. Telemedicine ready or not? A cross-sectional assessment of telemedicine maturity of federally funded tertiary health institutions in Nigeria. Digit Health 2023; 9:20552076221150072. [PMID: 36636728 PMCID: PMC9829877 DOI: 10.1177/20552076221150072] [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: 12/17/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction and objective Telemedicine has reinforced its position as a means for the continuity of healthcare services and a cost-effective approach to improving health equity as demonstrated during the COVID-19 pandemic. The preparedness of health systems for telemedicine is an indicator of the scalability of their services, especially during catastrophes. We aimed to assess the maturity and preparedness of federally funded tertiary health institutions in Nigeria, to deploy telemedicine as such data are currently lacking and are required to drive improvements in health services delivery. Methods We conducted a cross-sectional survey of thirty randomly selected federally funded tertiary health institutions in Nigeria using the Pan American Health Organization's tool for assessing the maturity level of health institutions to implement telemedicine between 17 September 2020 and 1 September 2021. Descriptive statistics were used for overall maturity levels and non-parametric tests to compare scores for overall maturity and specific Pan American Health Organization domains per region. The level of significance was set at p-value <0.05. Results The response rate was 77.4% (24 of 30 randomly polled federally funded tertiary health institutions responded). Overall, the median telemedicine maturity level was 2.0 (1.75) indicating a beginner level. No significant inter-zonal difference in the median overall maturity level (p = 0.87). The median maturity levels for telemedicine readiness in specific domains were organizational readiness - 2.0 (2.0), processes 1.0 (1.0), digital environment 2.0 (3.0), human resources 2.0 (1.0), regulatory issues - 1.5 (1.0) and expertise 2.0 (2.0); mostly at beginner level, with no inter-zonal differences. Most participating institutions had no initiatives in place for domains of processes and regulatory issues. Conclusions The current telemedicine maturity level of federally funded tertiary health institutions in Nigeria is at the beginner level. This behoves policy-makers to advance the implementation and deployment of telemedicine nationwide as part of digital quality healthcare, to improve health equity and to ensure continuity of healthcare services in the event of another pandemic.
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Affiliation(s)
- Tolulope F Olufunlayo
- Department of Community Health and Primary Care, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria,Department of Community Health, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Oluwadamilola O Ojo
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba,
Lagos, Nigeria,Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria,Oluwadamilola O Ojo, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria; Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
| | - Obianuju B Ozoh
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba,
Lagos, Nigeria,Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Osigwe P Agabi
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba,
Lagos, Nigeria,Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Chuks R Opara
- Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Funmilola T Taiwo
- Department of Medicine, University College Hospital, Ibadan, Oyo, Nigeria
| | - Olufemi A Fasanmade
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba,
Lagos, Nigeria,Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Njideka U Okubadejo
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba,
Lagos, Nigeria,Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
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9
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Wahezi SE, Duarte R, Kim C, Sehgal N, Argoff C, Michaud K, Luu M, Gonnella J, Kohan L. An Algorithmic Approach to the Physical Exam for the Pain Medicine Practitioner; A Review of the Literature with Multidisciplinary Consensus. Pain Med 2022; 23:1489-1528. [PMID: 35179576 PMCID: PMC9383455 DOI: 10.1093/pm/pnac031] [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] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/10/2022] [Accepted: 02/05/2022] [Indexed: 11/16/2022]
Abstract
Background Increased utilization of telemedicine has created a need for supplemental pain medicine education, especially for the virtual physical assessment of the pain patient. Traditional clinical training utilizes manual and tactile approaches to the physical examination. Telemedicine limits this approach and thus alternative adaptations are necessary to acquire information needed for sound clinical judgement and development of a treatment plan. Clinical assessment of pain is often challenging given the myriad of underlying etiologies contributing to the sensory experience. The COVID-19 pandemic has led to a dramatic increase in the use of virtual and telemedicine visits, further complicating the ease of assessing patients in pain. The increased reliance on telemedicine visits requires clinicians to develop skills to obtain objective information from afar. While eliciting a comprehensive history and medication assessment are performed in a standard fashion via telemedicine, a virtual targeted physical examination is a new endeavor in our current times. In order to appropriately diagnose and treat patients not directly in front of you, a pivot in education adaptations are necessary. Objective To summarize best care practices in the telemedicine physical exam while presenting an algorithmic approach towards virtual assessment for the pain practitioner. Design Review of the literature and expert multidisciplinary panel opinion. Setting Nationally recognized academic tertiary care centers. Subjects Multidisciplinary academic experts in pain medicine. Methods Expert consensus opinion from the literature review. Results An algorithm for the virtual physical exam for pain physicians was created using literature review and multidisciplinary expert opinion. Conclusions The authors here present simple, comprehensive algorithms for physical exam evaluations for the pain physician stemming from a review of the literature.
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Affiliation(s)
| | | | | | | | | | | | - Michael Luu
- University of Virginia Health System, Charlottesville, VA
| | | | - Lynn Kohan
- University of Virginia Health System, Charlottesville, VA
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10
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Le Pichon JB, Horton S, Abdelmoity O, Hoffman MA, Cramer E, Kishk N, Hamada S, Abdelmoity A. The use of virtual tools in narrowing the impact of health disparities in neurology. Front Pediatr 2022; 10:1028833. [PMID: 36313873 PMCID: PMC9614345 DOI: 10.3389/fped.2022.1028833] [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: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
The concept of Epilepsy Treatment Gap (ETG) refers to the proportion of people with epilepsy who are not being appropriately treated. The ETG in the USA approaches 10%, with historically underserved populations and rural populations disproportionately affected. The ETG in Low-and Middle-Income Countries (LMIC) is reported to be 5-10 times higher than in high-income countries. The growing availability of reliable internet access offers a unique opportunity to provide better care to children and adults with epilepsy. In this paper we explore various telehealth (TH) initiatives that have leveraged the availability of easy and free access to an internet connection in reducing the ETG in underserved regions of the world. We describe several interventions targeted to reach patients and providers in rural areas of the United States and in LMIC. First, we examine initiatives that were developed to improve patient access to coordinated care and education regarding epilepsy and seizures. Next, we describe an intervention designed to improve knowledge of epilepsy diagnosis and treatment for providers in LMIC. We conclude with a brief overview of the use of virtual tools in diminishing the ETG.
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Affiliation(s)
- Jean-Baptiste Le Pichon
- Division of Neurology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, United States
| | - Stephanie Horton
- Division of Neurology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, United States
| | - Omar Abdelmoity
- Washington University at St. Louis, Saint Louis, MO, United States
| | - Mark A Hoffman
- Department of Pediatrics, Children's Mercy Research Institute, Kansas City, MO, United States
| | - Emily Cramer
- Division of Health Services / Outcomes Research, Children's Mercy Research Institute, Kansas City, MO, United States
| | - Nirmeen Kishk
- Department of Neurology, Cairo University, Giza, Egypt
| | - Salah Hamada
- Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Ahmed Abdelmoity
- Division of Neurology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, United States
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11
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Ball E, Rivas C, Khan R. If virtual gynecology clinics are here to stay, we need to include everyone. AJOG Glob Rep 2021;:100043. [PMID: 34909705 DOI: 10.1016/j.xagr.2021.100043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022] Open
Abstract
Before the COVID-19 pandemic virtual clinics in gynecology were not commonplace in the United Kingdom or most other countries. Owing to the need to reconfigure health provision to caring for COVID-19 patients, reducing footfall in hospitals and restricted movement, telemedicine was rapidly introduced at scale in hospitals thought the United Kingdom. This happened without much consultation with service users and healthcare professionals. It is anticipated that after the pandemic, telemedicine will remain to some extent. The authors report how their hospital how their place of work, a large London teaching hospital, adopted virtual phone consultations in gynecology, along with a countrywide survey of 200 service users and healthcare professionals. Now it is important carry out a robust evaluation of outcomes (both clinician and patient experience) and also to take care that service users from disadvantaged backgrounds do not lose out.
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12
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Schiller T, Zornitzki T, Ostrovsky V, Sapojnik D, Cohen L, Kunyavski T, Knobler H, Kirzhner A. Following the COVID-19 Experience, Many Patients with Type 1 Diabetes Wish to Use Telemedicine in a Hybrid Format. Int J Environ Res Public Health 2021; 18:11309. [PMID: 34769826 DOI: 10.3390/ijerph182111309] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 12/22/2022]
Abstract
Background: The COVID-19 pandemic has brought to light both challenges and unique opportunities regarding type 1 diabetes (T1D) management, including the usage of telemedicine platforms. Methods: This study was conducted in a tertiary hospital diabetes clinic. All consecutive T1D patients during March and June 2021 were asked to fill out a structured anonymous questionnaire that aimed to determine their preference regarding continuous use of a virtual platform. Results: In total, 126 T1D patients answered the questionnaire, of whom 51% were under the age of 40, half were men, half used insulin pumps, and 69% used continuous glucose monitoring. During the pandemic, the exposure of patients to virtual visits has grown about twofold, from 29% to 53%. Of the respondents, 49% expressed an interest in future usage of a virtual platform, but most of them preferred use in a hybrid manner. We found an association between preference to use telemedicine in the future and younger age, previous virtual platform experience, and confidence in being able to download data. Conclusions: Our data demonstrate that the COVID-19 experience has led to a growing interest of T1D patients in using the hybrid format of telemedicine. However, we still need to better understand who will benefit most from this platform and assess its cost-effectiveness and organization.
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13
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Grimsrud A, Ehrenkranz P, Sikazwe I. Silver linings: how COVID-19 expedited differentiated service delivery for HIV. J Int AIDS Soc 2021; 24 Suppl 6:e25807. [PMID: 34713575 PMCID: PMC8554212 DOI: 10.1002/jia2.25807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/19/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Anna Grimsrud
- HIV Programmes and AdvocacyInternational AIDS SocietyCape TownSouth Africa
| | | | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia (CIDRZ)LusakaZambia
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14
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Hannan TA, Umar SY, Rob Z, Choudhury RR. Designing and running an online Objective Structured Clinical Examination (OSCE) on Zoom: A peer-led example. Med Teach 2021; 43:651-655. [PMID: 33626286 DOI: 10.1080/0142159x.2021.1887836] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
INTRODUCTION The COVID-19 pandemic threatened medical teaching and progression secondary to the 'lockdown' measures which limit physical interactions. Consequently, there was a necessity to shift medical teaching and assessment online. Our challenge was to logistically organise and conduct an Objective Structured Clinical Examination (OSCE) using a virtual, socially distanced approach. METHODS We found that Zoom offered the most suitable functionality in mimicking a physical OSCE online and its breakout rooms were used to represent different stations. One organiser manually transferred candidates between stations, allowing for the OSCE to operate punctually. Examiners screen shared to display an automated slideshow with station vignettes, investigation results, and viva questions. RESULTS Participants found the use of Zoom's features to be extremely beneficial with one candidate describing the experience as 'brilliant, very efficient and smooth'. Numerous aspects of the OSCE from decision making, to verbal communication, to medical knowledge were assessed, equivalent to a physical OSCE. DISCUSSION As the transformation of medical education is catalysed by the pandemic, it is important to ensure that peer to peer teaching and assessments are revolutionised with a quality similar to that of physical teaching. We have displayed how this may be achieved in an OSCE setting using Zoom teleconferencing.
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Affiliation(s)
- Tufayl A Hannan
- Barts and The London School of Medicine & Dentistry, Turner St, Whitechapel, London, UK
| | - Safwan Y Umar
- Barts and The London School of Medicine & Dentistry, Turner St, Whitechapel, London, UK
| | - Zakaria Rob
- Barts and The London School of Medicine & Dentistry, Turner St, Whitechapel, London, UK
| | - Rakin R Choudhury
- Barts and The London School of Medicine & Dentistry, Turner St, Whitechapel, London, UK
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15
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Abstract
BACKGROUND/OBJECTIVES Other medical specialties have studied how their practices influence the environment, but environmental impact studies in the field of dermatology remain limited. With respect to dermatology, vehicle emissions by patients traveling to and from appointments are an important factor influencing climate change. This study was undertaken to determine the greenhouse gas emissions avoided by managing isotretinoin virtually at West Virginia University Hospital. METHODS A retrospective cross-sectional study was conducted during the COVID-19 outbreak from March 25 to December 1, 2020, where travel data were acquired and converted to emission data. RESULTS 5,137 kg of GHG emissions in CO2 equivalents were prevented by managing isotretinoin virtually during the study period. 49 400 kg of GHG emissions in CO2 equivalents would be prevented annually. This is the emission load released when 24 690 kg of coal are burned. CONCLUSIONS Environmental impact studies in the field of dermatology remain limited. GHG emissions were significantly reduced by virtually managing isotretinoin at a single institution. The practice of dermatology could reduce its carbon footprint by managing isotretinoin virtually, even in non-pandemic periods. Given that isotretinoin management represents a small percentage of the overall carbon footprint associated with dermatology, dermatologists should identify other conditions amenable to virtual medicine to produce greater environmental impact.
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Affiliation(s)
- Justin Lee
- Department of Dermatology, West Virginia University, Morgantown, WV, USA
| | - Ahmed Yousaf
- Department of Dermatology, West Virginia University, Morgantown, WV, USA
| | - Samantha Jenkins
- Department of Dermatology, West Virginia University, Morgantown, WV, USA
| | - Mohammed Tamim Zaki
- Department of Civil and Environmental Engineering, West Virginia University, Morgantown, WV, USA
| | - Cecelia Napier
- Department of Dermatology, West Virginia University, Morgantown, WV, USA
| | - Omar I Abdul-Aziz
- Department of Civil and Environmental Engineering, West Virginia University, Morgantown, WV, USA
| | - Zachary Zinn
- Department of Dermatology, West Virginia University, Morgantown, WV, USA
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16
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Jarratt L. A Viral Connection. J Med Educ Curric Dev 2021; 8:2382120520968071. [PMID: 33681465 PMCID: PMC7897817 DOI: 10.1177/2382120520968071] [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] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/22/2020] [Indexed: 06/12/2023]
Abstract
A heartfelt commentary on the rise of virtual medicine and medical education as told from the perspective of a 3rd year medical student during the COVID-19 pandemic.
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Affiliation(s)
- LynnMarie Jarratt
- LynnMarie Jarratt, University of New Mexico School of Medicine, 915 Camino de Salud NE Albuquerque, NM 87106, USA.
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17
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Itamura K, Tang DM, Higgins TS, Rimell FL, Illing EA, Ting JY, Lee MK, Wu A. Comparison of Patient Satisfaction Between Virtual Visits During the COVID-19 Pandemic and In-person Visits Pre-pandemic. Ann Otol Rhinol Laryngol 2020; 130:810-817. [PMID: 33251849 PMCID: PMC8174012 DOI: 10.1177/0003489420977766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To compare the patient experience of a virtual otolaryngology clinic visit to an in-person visit, especially with its significantly increased implementation during the COVID-19 pandemic. Methods: Patient satisfaction (PS) metrics from the Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey were queried from March 1, 2020 to May 1, 2020 for telehealth visits and January 1, 2020 to March 1, 2020 for in-person visits. Overlapping and comparable questions were analyzed using Mann-Whitney U test, Chi-square test for independence, and Student’s t-test. Results: There were 1284 partial or complete PS surveys from in-person visits and 221 partial or complete virtual PS surveys. There were statistically significantly worse virtual visit evaluations of provider listening, conveyance of information, likelihood to recommend, and overall provider ratings compared to in-person visits. Conclusion: Telehealth has become the new norm for most healthcare providers in the United States. This study demonstrates some of the initial shortcomings of telehealth in an otolaryngology practice and identifies challenges with interpersonal communication that may need to be addressed as telehealth becomes increasingly prevalent. Level of Evidence: 3.
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Affiliation(s)
- Kyohei Itamura
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dennis M Tang
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, Louisville University, Louisville, KY, USA
| | - Franklin L Rimell
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Elisa A Illing
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Matthew K Lee
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Arthur Wu
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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18
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Prasad A, Brewster R, Rajasekaran D, Rajasekaran K. Preparing for Telemedicine Visits: Guidelines and Setup. Front Med (Lausanne) 2020; 7:600794. [PMID: 33324665 PMCID: PMC7724018 DOI: 10.3389/fmed.2020.600794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/26/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Aman Prasad
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Ryan Brewster
- Stanford University School of Medicine, Stanford University, Stanford, CA, United States
| | - Divya Rajasekaran
- Department of Endocrinology, Summit Medical Group, Berkeley Heights, NJ, United States
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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19
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Garcia-Huidobro D, Rivera S, Valderrama Chang S, Bravo P, Capurro D. System-Wide Accelerated Implementation of Telemedicine in Response to COVID-19: Mixed Methods Evaluation. J Med Internet Res 2020; 22:e22146. [PMID: 32903195 PMCID: PMC7541041 DOI: 10.2196/22146] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 07/04/2020] [Revised: 07/20/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background As the COVID-19 pandemic disrupted medical practice, telemedicine emerged as an alternative to outpatient visits. However, it is not known how patients and physicians responded to an accelerated implementation of this model of medical care. Objective The aim of this study is to report the system-wide accelerated implementation of telemedicine, compare patient satisfaction between telemedicine and in-person visits, and report provider perceptions. Methods This study was conducted at the UC Christus Health Network, a large private academic health network in Santiago, Chile. The satisfaction of patients receiving telemedicine care in March and April 2020 was compared to those receiving in-person care during the same period (concurrent control group) as well as in March and April 2019 (retrospective control group). Patient satisfaction with in-person care was measured using the Net Promoter Score (NPS) survey. Patient satisfaction with telemedicine was assessed with an online survey assessing similar domains. Providers rated their satisfaction and responded to open-ended questions assessing challenges, strategies used to address challenges, the diagnostic process, treatment, and the patient-provider relationship. Results A total of 3962 patients receiving telemedicine, 1187 patients from the concurrent control group, and 1848 patients from the retrospective control group completed the surveys. Satisfaction was very high with both telemedicine and in-person services. Overall, 263 physicians from over 41 specialties responded to the survey. During telemedicine visits, most providers felt their clinical skills were challenged (61.8%). Female providers felt more challenged than male providers (70.7% versus 50.9%, P=.002). Surgeons, obstetricians, and gynecologists felt their clinical skills were challenged the least, compared to providers from nonsurgical specialties (P<.001). Challenges related to the delivery modality, diagnostic process, and patient-provider relationship differed by provider specialty (P=.046, P<.001, and P=.02, respectively). Conclusions Telemedicine implemented in response to the COVID-19 pandemic produced high patient and provider satisfaction. Specialty groups perceived the impact of this new mode of clinical practice differently.
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Affiliation(s)
- Diego Garcia-Huidobro
- Department of Family Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Solange Rivera
- Department of Family Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Sebastián Valderrama Chang
- Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.,Office of Innovation and Digital Transformation, UC Christus Health Network, Santiago, Chile
| | - Paula Bravo
- Office of Innovation and Digital Transformation, UC Christus Health Network, Santiago, Chile
| | - Daniel Capurro
- Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.,School of Computing and Information Systems, University of Melbourne, Melbourne, Australia.,Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
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20
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Zara A, Fleming P, Lynde C. A Call for Critical Analysis of Teledermatology. J Cutan Med Surg 2020; 24:648. [PMID: 32912009 DOI: 10.1177/1203475420957627] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Anthony Zara
- Lynde Institute for Dermatology, Markham, Ontario, Canada
| | - Patrick Fleming
- Lynde Institute for Dermatology, Markham, Ontario, Canada.,210484 Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Charles Lynde
- Lynde Institute for Dermatology, Markham, Ontario, Canada.,210484 Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
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21
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Ohlstein JF, Garner J, Takashima M. Telemedicine in Otolaryngology in the COVID-19 Era: Initial Lessons Learned. Laryngoscope 2020; 130:2568-2573. [PMID: 32740925 PMCID: PMC7435539 DOI: 10.1002/lary.29030] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/07/2020] [Accepted: 07/28/2020] [Indexed: 12/14/2022]
Abstract
Objectives/Hypothesis The COVID‐19 pandemic has led to unprecedented global changes in the delivery of healthcare over a short period of time. With the implementation of shelter‐in‐place orders, otolaryngology clinic visits at our institution were transitioned to telemedicine. This change enabled the rapid characterization of the patients who accepted and declined telemedicine. Study Design Cross‐sectional analysis. Methods A review was conducted of 525 otolaryngology patients at a tertiary‐care referral center with scheduled visits requiring rescheduling to a future date or a telemedicine visit. Visit, demographic information, and reason for deferring telemedicine were collected for analysis. Results Seventy‐two percent of patients declined a telemedicine visit, with the most common reason being the lack of a physical exam (97%). There was an even distribution of demographics between those who accepted and declined visits. There was an association between declining telemedicine with older age (P = .0004) and otology visits (P = .0003), whereas facial plastics patients were more likely to accept (P < .0001). Patients scheduled earlier during the pandemic were more likely to accept a visit with a median of 28 days from onset of shelter‐in‐place orders versus 35 for those who declined (P < .0001). Conclusions We describe our initial experience with a transition to telemedicine, where the majority of patients would decline a virtual visit due to the lack of a physical exam. Although the future remains uncertain, telemedicine will continue to play a vital role in healthcare delivery. We believe that understanding our patient base gives critical insights that will help guide and improve virtual care to meet patients' needs. Level of Evidence 4 Laryngoscope, 130:2568–2573, 2020
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Affiliation(s)
- Jason F Ohlstein
- Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, Texas, U.S.A
| | - Jordan Garner
- Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Masayoshi Takashima
- Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, U.S.A
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22
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Itamura K, Rimell FL, Illing EA, Higgins TS, Ting JY, Lee MK, Wu AW. Assessment of Patient Experiences in Otolaryngology Virtual Visits During the COVID-19 Pandemic. OTO Open 2020; 4:2473974X20933573. [PMID: 32551407 PMCID: PMC7281887 DOI: 10.1177/2473974x20933573] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/20/2022] Open
Abstract
This study evaluates the patient experience during virtual otolaryngology clinic
visits implemented during the coronavirus disease 2019 (COVID-19) pandemic.
Patient satisfaction surveys were queried from January 1, 2020, to May 1, 2020,
for both telehealth and in-person visits. A descriptive analysis of the question
responses was performed. There were 195 virtual and 4013 in-person visits with
surveys completed in this time period. Ratings related to provider-patient
communication were poor for virtual visits. Telehealth has become the new norm
for most health care providers in the United States. This study demonstrates
some of the initial shortcomings of telehealth in an otolaryngology practice and
identifies challenges with interpersonal communication that may need to be
addressed as telehealth becomes increasingly prevalent.
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Affiliation(s)
- Kyohei Itamura
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Franklin L Rimell
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Elisa A Illing
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, Louisville University, Louisville, Kentucky, USA
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Matthew K Lee
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Arthur W Wu
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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23
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J Morrice D, F Bard J, M Koenig K. Designing and scheduling a multi-disciplinary integrated practice unit for patient-centred care. Health Syst (Basingstoke) 2019; 9:293-316. [PMID: 33354322 DOI: 10.1080/20476965.2019.1569481] [Citation(s) in RCA: 5] [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] [Indexed: 10/27/2022] Open
Abstract
This paper presents the design and analysis of a newly proposed form of care delivery called an integrated practice unit (IPU) in which a multi-disciplinary team of providers and staff work together to cover the full care cycle for a given condition. In an IPU, the different providers circulate among the patients, according to the need for their expertise, while patients remain in a single location once they check-in. From the patient's perspective, the benefits of such an arrangement should be self-evident. For payers and providers there will also be benefits as the fee-for-service market gives way to structured payments for each episode of care. Before setting up an IPU, it is necessary to gain an understanding of how available resources will limit patient flow and system performance. Treating resources such as providers, imaging equipment, and rooms parametrically, the primary goal of our work is to determine the number of patients that can be seen per day in an IPU while trying to constrain overtime, length of stay, and waiting time to best practice targets. Discrete-event simulation serves as our analytic tool. While we are involved in the design of a comprehensive suite of musculoskeletal IPUs, we illustrate our approach with an extensive computational study of one: a Lower Extremity Joint Pain IPU. Using the simulation methodology, we are not only able to determine the number of patients that can be scheduled for an in-clinic visit each day, but also the daily number of follow-up patients that can be served virtually through telemedicine with no additional resources and minimal impact on IPU performance. These results assisted the Department of Surgery at the Dell Medical School at The University of Texas in the optimal design of its first IPU, which opened in the fall of 2017.
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Affiliation(s)
| | - Jonathan F Bard
- Cockrell School of Engineering, The University of Texas, Austin, Texas
| | - Karl M Koenig
- Medical Director of the Integrated Practice Unit for Musculoskeletal Care Dell Medical School, The University of Texas, Austin, Texas
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