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Telemedicine and Telehealth: Principles, Policies, Performance and Pitfalls

Authors:

Abstract

Telemedicine and telehealth are changing the face of health care delivery and becoming a multi-billion dollar industry. Dr. Darkins and Dr. Cary share their knowledge and provide practical insights and advice on making telemedicine programs into successful clinical services and a productive business. The book gives background knowledge and useful tips on starting up and managing programs in an array of settings. Most importantly, the book is based on the recognition that patients are customers of health care and telemedicine companies developing new products vital to delivering care to rural or inaccessible clients is vital to health care's future.
... The clinical significance of this research will help shed light on what telemedicine and telehealth are and in which aspects they can be helpful for patients. Many articles attempt to explain the meaning and importance of telemedicine and telehealth [10,11], but most of them could not identify much difference between the two. We have reviewed all these articles. ...
... Many descriptions of telehealth and telemedicine are confusing. As these terms have become adopted in common use, they have lost their connection with the basic elements they set out to define [10]. Telehealth equipment is used as a tool for a specialist to investigate a patient with a disease condition and allows the patient to receive immediate expert advice [9]. ...
... Firstly, previous studies offered many definitions of telehealth and telemedicine [18,19]. However, the majority of articles stating that these two terms mean the same have limited the exact meaning of telehealth and telemedicine [9,10]. This study attempts to expand the current line of research, focusing first on all the given definitions of telehealth and telemedicine, and the comparison (Table 1) we have made shows the differences between them. ...
Article
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With the rapid progress in mobile healthcare and Internet medicine, the impact of telehealth and telemedicine on the satisfaction of patients and their willingness to travel has become a focus of the academic research community. This study analyses the differences between telehealth and telemedicine and their role in medical tourism. We examine how the information quality and communication quality of telehealth and telemedicine influence patient satisfaction, and their effects on patients’ willingness to undertake medical travel and on their medical travel behaviours. We conducted an empirical study on the use of telehealth and telemedicine and on medical travel behaviour in Azerbaijan using a survey for data collection. A total of 500 results were collected and analysed using SmartPLS 3.0. Results show that (1) the communication quality and information quality of telehealth and telemedicine and their effects on satisfaction have significantly positive influences on willingness to undertake medical travel; (2) the psychological expectations of value and cost (perceived value and perceived cost) have a positive influence on medical travel; and (3) willingness to participate in medical travel positively influences medical travel behaviour. Moreover, results of this study have implications for research on, and the practice of, using telehealth and telemedicine as they relate to medical tourism. This research may help improve knowledge about telehealth and telemedicine and understand the differences between them in detail. This empirical research model may also be useful for researchers from other countries who wish to measure medical travel behaviour.
... The role of telemedicine has become more apparent, with its ability to enhance access, particularly in underserved regions. However, disparities in technology access and digital literacy must be addressed to fully leverage telehealth's benefits [70]. The pandemic highlighted the crucial role of universal health coverage in providing equitable healthcare access, with countries that have universal systems generally performing better in terms of health outcomes and access during the crisis [71]. ...
... Future recommended research on healthcare access-related issues includes evaluating the impact of telehealth on health outcomes, understanding the effects of health coverage expansions, addressing disparities in digital health literacy, investigating social determinants of health, and examining the effectiveness of integrated care models. While telehealth has expanded access to care, its effectiveness in improving health outcomes and managing chronic conditions over time needs further evaluation [70,76]. Studies should focus on patient satisfaction, health outcomes, and disparities in technology access. ...
Chapter
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Preventive health care is essential in reducing the prevalence and impact of chronic diseases, which are major causes of death and illness worldwide. Chronic diseases like cardiovascular disease, diabetes, cancer, and respiratory conditions result from genetic, lifestyle, and environmental factors. This document explores these risk factors and highlights the importance of preventive strategies at primary, secondary, and tertiary levels. Primary prevention focuses on avoiding disease onset through lifestyle changes and policy measures, while secondary prevention emphasizes early detection and treatment. Tertiary prevention aims to manage and reduce complications in those with chronic conditions. Health care providers play a crucial role through patient education, early detection, and a multidisciplinary approach. Public policies, such as tobacco control and nutrition policies, are vital for fostering healthier communities. However, challenges like socioeconomic disparities and limited access to preventive services hinder effective implementation. Addressing these obstacles through targeted policy interventions, community involvement, and culturally sensitive care is crucial. Future research should focus on the impact of telehealth, health coverage expansions, digital health literacy, social determinants of health, and integrated care models.
... Indeed, although telemedicine and telehealth overlap greatly and many prefer to use such terms interchangeably, there is an often undervalued but key distinction between the 2 domains, which experts in the field and public health bodies such as the World Health Organization (WHO) also advocate. 6,7 TAXONOMY "Telehealth" is used in reference to the broad delivery of health care services via ICTs, including devices for health care self-management (i.e., with clinicians or health care providers [HCPs] out of the loop), whereas "telemedicine" is a subset of telehealth and refers to more clinicaloriented health care delivery via ICTs that include the intervention of a clinician in a synchronous way (e.g., teleconsultation) or in an asynchronous modality (e.g., store and forward telemedicine). 7 Indeed, "telehealth" also includes nonclinical services, such as virtual education, HCP and clinician training, and health self-management (e.g., fitness trackers). ...
... "Telemedicine" refers more specifically to ICTs used for delivering clinical-oriented services for medicine and health care at a distance, and it always requires interfacing between clinicians and patients (or patients' data) for clinical decisionmaking, which is based on evidence resulting from information obtained via patients' data or clinician-patient conversation (i.e., teleconsultation). 6 We sought to fill this gap by highlighting the first, to our knowledge, unified framework of ethical principles to consider, revise or expand, and operationalize to responsibly develop and deploy AI-based telemedicine for public health. ...
Article
The use of artificial intelligence (AI) in the field of telemedicine has grown exponentially over the past decade, along with the adoption of AI-based telemedicine to support public health systems. Although AI-based telemedicine can open up novel opportunities for the delivery of clinical health and care and become a strong aid to public health systems worldwide, it also comes with ethical risks that should be detected, prevented, or mitigated for the responsible use of AI-based telemedicine in and for public health. However, despite the current proliferation of AI ethics frameworks, thus far, none have been developed for the design of AI-based telemedicine, especially for the adoption of AI-based telemedicine in and for public health. We aimed to fill this gap by mapping the most relevant AI ethics principles for AI-based telemedicine for public health and by showing the need to revise them via major ethical themes emerging from bioethics, medical ethics, and public health ethics toward the definition of a unified set of 6 AI ethics principles for the implementation of AI-based telemedicine. (Am J Public Health. Published online ahead of print March 9, 2023:e1–e8. https://doi.org/10.2105/AJPH.2022.307225 )
... Teleradiology and telepsychiatry are among the earliest telemedicine applications (21). Although the origin of telemedicine goes back a long way, the modern era of telemedicine began in 1968 when Massachusetts General Hospital in America began to provide remote clinical examinations for travelers and airport staff at Logan International Airport (22). ...
... Although the origin of telemedicine goes back a long way, the modern era of telemedicine began in 1968 when Massachusetts General Hospital in America began to provide remote clinical examinations for travelers and airport staff at Logan International Airport (22). High technology costs, poor image quality, lack of usage services, and the inability to integrate Internet medical care with mainstream healthcare services, most of which disappeared by 1980, led to a decade of hiatus in telemedicine activities (21,22). It was not until the mid-1990s, due to the rapid growth of the Internet, that Internet-based medicine was once again seen as a relevant solution to the problems of licensing and quality of healthcare (23). ...
Article
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Introduction As a form of platform economy, telemedicine is not growing as fast as other digital platforms. The existing literature seldom pays attention to how licensing policy affects the development of telemedicine platform models. Methods This paper uses the method of multi-case study and the theory of policy implementation as mutual adaptation to research the influence mechanism of telemedicine platform licensing policy on the platform model in China. Results The findings of the current study are as follows: (1) three models can be classified in accordance with different platform providers in China: medical institution platform, Internet company platform and local government platform; (2) bargaining power, reputation mechanism and resource specificity are important dimensions in the analysis of platform models; (3) as an implementer in the process of licensing policy, the platform provider can not only directly determine the establishment and formation of platform model but also indirectly affect the sustainable development of platform model by affecting the supplier and the demander of platform; and (4) The impact between licensing policy and platform model is dynamic and bidirectional, mainly exerted via administrative orders, market-oriented mechanism and medical insurance. Conclusions The research enlightens practical exploration in telemedicine and enriches the theoretical innovation in platform.
... This precludes any telemedicine solutions, which are often used clinician to clinician to provide assistance with diagnostics or treatment. Using such a definition is in line with the WHO definition of telehealth which is "understood to mean the integration of ICT systems into the practice of protecting and promoting health, while telemedicine is the incorporation of these systems into curative medicine…" (Darkins & Cary, 2000;Kelly, 2021). ...
... There are concerns that certain patient groups do not benefit from virtual consultations. Certainly, in the literature, there is much evidence to suggest that whereas most patient groups can use telehealth well, there are outliers which need to be carefully considered and managed (Koonin, et al., 2020;Darkins & Cary, 2000;Fisk, et al., 2020;Aziz, et al., 2020), alongside ethical considerations (Kaplan & Litewka, 2008). ...
Article
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This paper seeks to understand the use of telehealth technologies post COVID-19. For many years, academics have sought to provide evidence that the use of telehealth can have positive effects on patient outcomes, increase access to healthcare for populations, and to ensure a better use of resources for all healthcare economies. Although a number of trials and implementations on local, regional and national scales have found positive outcomes, healthcare providers have resisted the drive to greater telehealth adoption. This paper does not examine the history of telehealth in any great detail, but examines the use of telehealth during the COVID-19 pandemic. The authors suggest that the increased use of telehealth is here to stay, and that health and care economies globally will need to adopt more telehealth solutions to continue to provide their services in a manner most appropriate for changing global populations. As part of the study, the authors identify that technology programmes alone cannot lead to better telehealth implementation. They suggest that telehealth needs to ensure and support safe healthcare; that it must be effective; that patient centricity is important; that timeliness is a major factor; that telehealth can increase efficiency; that it reduces health inequalities; and that big, bold, visionary change is required.
... 1 Telemedicine has been widely used since the 1990s, when healthcare providers used telephones whenever a patient felt sick, and later on, the development became accelerated in this modern era. 2 It is divided into three activities: teleconsultation involving telemonitoring, teleexpertise, and teleassistance. A further technological enhancement that also needs to be implemented in the health sector includes virtual and augmented reality, artificial intelligence, robotics, and gene writing. ...
... Based on these findings, it was concluded that this currative medicine is the part of telehealth which provided health services in various communities. 2 Primary physicians and nurses or midwives are the main people that mostly interact with patients. They either recommend patients to an expert or administer temporary medicine and observe the condition. ...
Article
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This article aimed to review the essence of telemedicine in current technology and innovation era especially in developing country and the regulation aspect as the main component for health care services. Global electronic health has two crucial components that are telehealth which is based on the e-commerce system and health informatics which is based on the e-learning system. There are five main categories to manage telemedicine, such as system management including revenue stream and technology literacy, health facilities, human resources, data authorization and security, and health protocol. A combination of telemedicine and wearable devices improves health care delivery opportunities by enhancing remote patient monitoring. World Health Organization (WHO) has been described telehealth services in developing country. Some issues related to telehealth are still must be well managed, such as patient’s data security of health services. Our community also should be encouraged to use telehealth. Regular training and evaluation for the people with poor educational background, low income, and stress are the main reasons why our community attend to healthcare service in spite of mild sickness.
... The Office of the National Coordinator for Health Information Technology defines telemedicine as "the use of electronic information and telecommunications technologies to support and pro-mote long-distance clinical health care, patient and professional health-related education, public health and health administration'' [14] telemedicine needs to give favorable outcomes with in person visits in a variety of objectives measures including clinical outcome [15], cost (both direct and indirect. In addition, patients and providers need to be at least as satisfied with their telehealth experience as they are with in-person visits. ...
... By this measure remote consultation does not always imply long distances between parties [3][4][5][6][7][8]. ...
Article
Full-text available
The concept of providing healthcare remotely for patients is not new. It is a part of everyday medical practice and complements the traditional face-to-face encounters between doctors and patients on a regular basis. However, with the disruption of traditional healthcare delivery between 2020 and 2022 due to the COVID 19 pandemic telemedicine has become the focus as a method of healthcare delivery that could in some cases replace the traditional time-tested method of physical doctor patient encounters. This paper aims to look at the advantages and disadvantages of telemedicine, in the provision of quality healthcare without compromising patient safety and guaranteeing good outcomes via a review of the literature. This reviews the aspects of good practice that must be adhered to in the implementation of telemedicine.
... The World Health Organisation defines rehabilitation as "a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment" [7]. Telehealth is the umbrella term used to describe the provision of health care at a distance using information and communication technology [8]. Thereby, telerehabilitation is the delivery of rehabilitation services via information and communication technology [9]. ...
Article
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Background Telerehabilitation is a term to describe rehabilitation services delivered via information and communication technology. Such services are an increasingly important component for the management of rheumatic and musculoskeletal diseases (RMDs). Telerehabilitation has the potential to expand the long-term self-management options for individuals with RMDs, improve symptoms, and relieve pressures on health care services. Yet, little is known about the variety of interventions implemented, and how they are being evaluated. Thus, this scoping review aims to identify and describe existing rehabilitation interventions delivered via telehealth for RMDs. Specifically, we aim to identify and summarize the key components of rehabilitation, the technology used, the level of health care professional interaction, and how the effectiveness of interventions is evaluated. Methods We will conduct this review following the latest JBI scoping review methodology and the PRISMA guidelines for Scoping Reviews (PRISMA-ScR). The ‘Population-Concept-Context (PCC)’ framework will be used, whereby the ‘Population’ is RMDs (≥18 years); the ‘Concept’ is rehabilitation; and the ‘Context’ is telehealth. Developed in collaboration with a subject Librarian, refined PCC key terms will be utilized to search (from 2011–2021) three electronic databases (i.e., Embase, Scopus, Web of Science) for articles published in English. Search results will be exported to the citation management software (EndNote), duplicates removed, and eligibility criteria applied to title/abstract and full-text review. Relevant information pertaining to the PCC framework will be extracted. Data will be summarized qualitatively, and if appropriate, quantitatively via frequency counts of the components comprising the ‘Concept’ and ‘Context’ categories of the PCC framework. Discussion Findings from the proposed scoping review will identify how telehealth is currently used in the delivery of rehabilitation interventions for RMDs. The findings will develop our understanding of such interventions and provide a platform from which to inform future research directions.
... Telehealth has been widely adopted as an effective way to provide health care and continue access to a vast range of clinical specialties since the beginning of the COVID-19 pandemic [1][2][3][4]. Before this, telehealth, that is, the provision of health care at a distance using information and communication technology [5], was not widely used, despite being in existence for several decades [4,6]. Although the sudden and widespread adoption of telehealth in 2020 enabled the continued provision of health care, it also fueled an investment in digital infrastructure, regulatory changes, and innovations in care, creating an ideal environment for its continued growth [7][8][9]. ...
... We used the Guidance on Conducting and Reporting Delphi Studies (CREDES) [19] and followed the proposed guidelines for developing surveys using the Delphi method [17]. We used the term "telehealth" to describe the context of this e-Delphi survey because it is considered an umbrella term [1,20]. and provides a common understanding between all interested parties (See Supplementary file 1 A for operational definitions in this study). ...
Article
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Background Telehealth has emerged as an alternative model for treatment delivery and has become an important component of health service delivery. However, there is inconsistency in the use of terminologies and a lack of research priorities in telehealth in musculoskeletal pain. The purpose of this international, multidisciplinary expert panel assembled in a modified three-round e-Delphi survey is to achieve a consensus on research priorities and for the standard terminology for musculoskeletal pain telehealth practice. Methods In this international modified e-Delphi survey, we invited an expert panel consisting of researchers, clinicians, consumer representatives, industry partners, healthcare managers, and policymakers to participate in a three-round e-Delphi. Expert panels were identified through the Expertscape website, PubMed database, social media, and a snowball approach. In Round 1, potential research priorities and terminologies were presented to panel members. Panel members rated the agreement of each research priority on a 5-point Likert scale and an 11-point numerical scale, and each terminology on a 5-point Likert scale for the "telehealth in musculoskeletal pain " field over rounds. At least 80% of the panel members were required to agree to be deemed a consensus. We analyzed the data descriptively and assessed the stability of the results using the Wilcoxon matched-pairs signed rank test. Results We performed an international e-Delphi survey from February to August 2022. Of 694 invited people, 160 panel members participated in the first round, 133 in the second round (83% retention), and 134 in the third round (84% retention). Most of the panel members were researchers 76 (47%), clinicians 57 (36%), and consumer representatives 9 (6%) of both genders especially from Brazil 31 (19%), India 22 (14%), and Australia 19 (12%) in the first round. The panel identified fourteen telehealth research priorities spanned topics including the development of strategies using information and communication technology, telehealth implementation services, the effectiveness and cost-effectiveness of telehealth interventions, equity of telehealth interventions, qualitative research and eHealth literacy in musculoskeletal pain conditions from an initial list of 20 research priorities. The consensus was reached for "digital health" and "telehealth" as standard terminologies from an initial list of 37 terminologies. Conclusion An international, multidisciplinary expert consensus recommends that future research should consider the 14 research priorities for telehealth musculoskeletal pain reached. Additionally, the terms digital health and telehealth as the most appropriate terminologies to be used in musculoskeletal telehealth research. Register Open Science Framework (https://osf.io/tqmz2/).
... Telehealth has been widely adopted as an effective way to provide health care and continue access to a vast range of clinical specialties since the beginning of the COVID-19 pandemic [1][2][3][4]. Before this, telehealth, that is, the provision of health care at a distance using information and communication technology [5], was not widely used, despite being in existence for several decades [4,6]. Although the sudden and widespread adoption of telehealth in 2020 enabled the continued provision of health care, it also fueled an investment in digital infrastructure, regulatory changes, and innovations in care, creating an ideal environment for its continued growth [7][8][9]. ...
Article
Full-text available
Background The COVID-19 pandemic accelerated the use of telehealth in cancer care and highlighted the potential of telehealth as a means of delivering the much-needed rehabilitation services for patients living with the side effects of cancer and its treatments. Objective This mixed methods study aims to explore patients’ experiences of telehealth and their preferences regarding the use of telehealth for cancer rehabilitation to inform service development. Methods The study was completed in 2 phases from October 2020 to November 2021. In phase 1, an anonymous survey (web- and paper-based) exploring the need, benefits, barriers, facilitators, and preferences for telehealth cancer rehabilitation was distributed to survivors of cancer in Ireland. In phase 2, survivors of cancer were invited to participate in semistructured interviews exploring their experiences of telehealth and its role in cancer rehabilitation. Interviews were conducted via telephone or video call following an interview guide informed by the results of the survey and transcribed verbatim, and reflexive thematic analysis was performed using a qualitative descriptive approach. Results A total of 48 valid responses were received. The respondents were at a median of 26 (range 3-256) months after diagnosis, and 23 (48%) of the 48 participants had completed treatment. Of the 48 respondents, 31 (65%) reported using telehealth since the start of the pandemic, 15 (31%) reported having experience with web-based cancer rehabilitation, and 43 (90%) reported a willingness for web-based cancer rehabilitation. A total of 26 (54%) of the 48 respondents reported that their views on telehealth had changed positively since the start of the pandemic. Semistructured interviews were held with 18 survivors of cancer. The mean age of the participants was 58.9 (SD 8.24) years, 56% (10/18) of the participants were female, and 44% (8/18) of the participants were male. Reflexive thematic analysis identified 5 key themes: telehealth improves accessibility to cancer rehabilitation for some but is a barrier for others, lived experiences of the benefits of telehealth in survivorship, the value of in-person health care, telehealth in cancer care and COVID-19 (from novelty to normality), and the future of telehealth in cancer rehabilitation. Conclusions Telehealth is broadly welcomed as a mode of cancer rehabilitation for patients living with and beyond cancer in Ireland. However, issues regarding accessibility and the importance of in-person care must be acknowledged. Factors of convenience, time savings, and cost savings indicate that telehealth interventions are a desirable patient-centered method of delivering care when performed in suitable clinical contexts and with appropriate populations.
... 2,3 New digital solutions have been introduced annually, including remote sensors and wearables, telemedicine and health information, data analytics and artificial intelligence approaches, evidence-based medical posts on social media, and clinical decision support systems. [4][5][6][7] Multiple health-related institutions and stakeholders, including WHO, are promoting the adoption and scale-up of DHT innovations worldwide. 8,9 These promotional initiatives aim to translate scientific research into action and enhance knowledge through scientific engagement assessing and linking geographical needs with innovation pipelines, and implementing practical approaches that balance benefits and risks of DHTs. ...
Article
Full-text available
Systematic reviews have quantified the effectiveness, feasibility, acceptability, and cost-effectiveness of digital health technologies (DHTs) used by health-care workers. We aimed to collate available evidence on technologies’ effect on health-care workers’ competencies and performance. We searched the Cochrane Database of Systematic Reviews, Embase, MEDLINE, Epistemonikos, and Scopus for reviews published from database inception to March 1, 2023. Studies assessing the effects of DHTs on the organisational, socioeconomic, clinical, and epidemiological levels within the workplace, and on health-care workers’ performance parameters, were included. Data were extracted and clustered into 25 domains using vote counting based on the direction of effect. The relative frequency of occurrence (RFO) of each domain was estimated using R software. AMSTAR-2 tool was used to appraise the quality of reporting, and the Confidence in the Evidence from Reviews of Qualitative research approach developed by Grading of Recommendations Assessment, Development and Evaluation was used to analyse the certainty of evidence among included studies. The 12 794 screened reviews generated 132 eligible records for assessment. Top-ranked RFO identifiers showed associations of DHT with the enhancement of health-care workers’ performance (10·9% [95% CI 5·3–22·5]), improvement of clinical practice and management (9·8% [3·9–24·2]), and improvement of care delivery and access to care (9·2% [4·1–20·9]). Our overview found that DHTs positively influence the daily practice of health-care workers in various medical specialties. However, poor reporting in crucial domains is widely prevalent in reviews of DHT, hindering our findings’ generalisability and interpretation. Likewise, most of the included reviews reported substantially more data from high-income countries. Improving the reporting of future studies and focusing on low-income and middle-income countries might elucidate and answer current knowledge gaps.
... Bu sayede, insanlar günlük yaşantılarında teknolojiyi kullanarak ihtiyaçlarını daha kolay karşılamaya başlamışlardır. Günlük yaşamda sıkça kullanılan 'tele', bir diğer deyişle, "uzaktan iletişim" yöntemleri de bu ilerlemelerin bir sonucu olarak ortaya çıkmış ve sıkça kullanıldığı alanlardan en önemlileri de eğitim-öğretim ve sağlık alanı olmuştur (Darkins & Cary, 2000). Tele-terapi, mesafe, terapist yetersizliği, uygun olmayan sağlık koşulları gibi çeşitli nedenlerle dil ve konuşma terapisi hizmetlerine erişim sıkıntısı yaşayan danışanların değerlendirme, müdahale veya danışmanlık gibi profesyonel hizmetlere uzaktan erişimini sağlamak için telekomünikasyon teknolojisinin kullanılmasıdır (ASHA, 2020). ...
... Telehealth is an additional alternative to in vivo BST that uses video and teleconferencing technology to share information and provide clinical care, education, and administrative services from a distance (Darkins & Cary, 2000). Telehealth allows for service delivery when inperson services are unavailable but is not considered asynchronous because it often involves a trainer providing live training via video conferencing software. ...
Chapter
As more staff enter the field of applied behavior analysis, trainers must ensure that staff are trained to accurately perform a variety of behavioral technologies. The purpose of this chapter is to describe best practices in staff training. An overview of behavioral skills training is provided, including a discussion of each component of the training procedure, and suggestions for modifying training when in vivo training is not an option. Then, pyramidal training is described, along with relevant research. Finally, recommendations for providing ongoing support and resolving problems related to non-proficient staff performance are described.
... We also identified rural/urban differences in how more frequent chronic conditions affected telehealth use, such that residents in rural areas were more likely to use telehealth as the number of conditions increased. Telehealth has long been posited as one solution to deteriorating health systems in rural areas 45 and most telehealth programs in the 21st century have focused on rural populations. 46 In this light, our finding of higher telehealth utilization in rural areas is consistent with the overall national trends. ...
Article
Introduction: The COVID-19 pandemic brought about renewed interest and investment in telehealth, while also highlighting persistent health disparities in the Southern states. Little is known about the characteristics of those utilizing telehealth services in Arkansas, a rural Southern state. We sought to compare the characteristics of telehealth utilizers and nonutilizers among Medicare beneficiaries in Arkansas before the COVID-19 public health emergency to provide a baseline for future research investigating disparities in telehealth utilization. Methods: We used Arkansas Medicare beneficiary data (2018-2019) to model telehealth use. We included interactions to assess how the association between the number of chronic conditions and telehealth was moderated by race/ethnicity and rurality, adjusted for covariates. Results: Overall telehealth utilization in 2019 was low (n = 4,463; 1.1%). The adjusted odds of utilizing telehealth was higher for non-Hispanic Black/African Americans (vs. white, adjusted odds ratio [aOR] = 1.34, 95% confidence interval [CI] = 1.17-1.52), rural beneficiaries (aOR = 1.99, 95% CI = 1.79-2.21), and those with more chronic conditions (aOR = 1.23, 95% CI = 1.21-1.25). Race/ethnicity and rurality were significant moderators, such that the association between the number of chronic conditions and telehealth was strongest among white and among rural beneficiaries. Discussion: Among the 2019 Arkansas Medicare beneficiaries, having more chronic conditions was most strongly associated with telehealth use among white and rural individuals, while the effect was not as pronounced for Black/African American and urban individuals. Our findings suggest that advances in telehealth are not benefiting all Americans equally, with aging minoritized communities continuing to engage with more strained and underresourced health systems. Future research should investigate how upstream factors such as structural racism perpetuate poor health outcomes.
... Department of Health & Human Services, 2020). Telehealth has been in existence since at least the 1960s (e.g., Darkins & Cary, 2000) and has many advantages, including convenience, reaching people with mobility limitations, and improving access in rural area. We have witnessed the increase in telehealth usage in recent decades, particularly during the COVID-19 pandemic. ...
Article
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The use of telehealth has increased significantly over the last decade and has become even more popular and essential during the COVID-19 pandemic due to social distancing requirements. Telehealth has many advantages including potentially improving access to healthcare in rural areas and achieving healthcare equality. However, there is still limited research in the literature on how to accurately evaluate telehealth accessibility. Here we present the Enhanced Two-Step Virtual Catchment Area (E2SVCA) model, which replaces the binary broadband strength joint function of the previous Two-Step Virtual Catchment Area (2SVCA) with a step-wise function that more accurately reflects the requirements of telehealth video conferencing. We also examined different metrics for representing broadband speed at the Census Block level and compared the results of 2SVCA and E2VCA. Our study suggests that using the minimum available Internet speed in a Census Block can reveal the worst-case scenario of telehealth care accessibility. On the other hand, using the maximum of the most frequent available speeds reveals optimal accessibility, while the minimum of the most frequent reflects a more common case. All three indicators showed that the 2SVCA model generally overestimates accessibility results. The E2SVCA model addresses this limitation of the 2SVCA model, more accurately reflects reality, and more appropriately reveals low accessibility regions. This new method can help policymakers in making better decisions about healthcare resource allocations aiming to improve healthcare equality and patient outcomes.
... Telehealth is considered an umbrella term for all healthcare services [3,[7][8][9], defined by the World Health Organization as "the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities" [10,11]. Telemedicine restricts telehealth use to physicians [12] and, telerehabilitation refers to the services provided by any healthcare professionals for rehabilitation services [8]. ...
Article
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Background Given the rapid advances in communication technology and the need that emerged from the COVID-19 pandemic, telehealth initiatives have been widely used worldwide. This masterclass aims to provide an overview of telerehabilitation for musculoskeletal conditions, synthesizing the different terminologies used to describe telehealth and telerehabilitation, its effectiveness and how to use it in clinical practice, barriers and facilitators for the implementation in health services, and discuss the need of a curriculum education for the near future. Main body Telerehabilitation refers to the use of information and communication technologies provided by any healthcare professionals for rehabilitation services. Telerehabilitation is a safe and effective option in the management of musculoskeletal conditions in different models of delivery. There are many technologies, with different costs and benefits, synchronous and asynchronous, that can be used for telerehabilitation: telephone, email, mobile health, messaging, web-based systems and videoconferences applications. To ensure a better practice of telerehabilitation, the clinician should certify safety and access, and appropriateness of environment, communication, technology, assessment, and therapeutic prescription. Despite the positive effect of telerehabilitation in musculoskeletal disorders, a suboptimal telerehabilitation implementation may have happened due to the COVID-19 pandemic, especially in countries where telehealth was not a reality, and clinicians lacked training and guidance. This emphasizes the need to identify the necessary curriculum content to guide future clinicians in their skills and knowledge for telerehabilitation. There are some challenges and barriers that must be carefully accounted for to contribute to a health service that is inclusive and relevant to health professionals and end users. Conclusions Telerehabilitation can promote patient engagement in health care and plays an important role in improving health outcomes in patients with musculoskeletal conditions. Digital health technologies can also offer new opportunities to educate patients and facilitate the process of behavior change to a healthy lifestyle. Currently, the main needs in telerehabilitation are the inclusion of it in health curriculums in higher education and the development of cost-effectiveness and implementation trials, especially in low- and middle-income countries where access, investments and digital health literacy are limited.
... Although face-to-face rehabilitation can improve postoperative complications in breast cancer patients, patients who have difficulty visiting a rehabilitation facility, including those in remote areas, may experience barriers to exercise. Therefore, interest in telehealth, which is defined as health care provided remotely via information and communication technology, 7 has been increasing. Telehealth can be provided via telephone, email, and videoconferencing, as well as relatively novel technologies such as virtual reality (VR) and augmented reality (AR). ...
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Introduction: Limited range of motion (ROM) of the shoulder occurs commonly after breast cancer surgery, resulting in reduced quality of life and difficulty with activities of daily living. Physical exercise is effective in postoperative breast cancer patients, but no study has assessed the effects of augmented reality (AR)-based telerehabilitation. Therefore, this study aimed to investigate the effect of hospital-home linked rehabilitation therapy using an AR-based digital health care system (UINCARE Home+) in postoperative patients with breast cancer. Methods: This study was a prospective, multicenter, assessor-blinded, randomized controlled trial. Patients who underwent breast cancer surgery were assigned to either the UINCARE Home+ (intervention) group or the brochure-based home rehabilitation (control) group for an 8-week intervention. The study outcomes were the change in ROM of the affected shoulder, pain in the affected shoulder (Numerical Rating Scale [NRS]), functional outcomes (Disabilities of the Arm, Shoulder, and Hand questionnaire [QuickDASH] score), and quality of life (Functional Assessment of Cancer Therapy-Breast [FACT-B] and EuroQoL 5-Dimension 5-Level [EQ-5D-5L] scores), all of which were measured at enrollment and at 4, 8, and 12 weeks thereafter. Results: A total of 100 participants were enrolled in the study (n = 50 in each groups). In both groups, active and passive ROM, NRS, and the QuickDASH, FACT-B, and EQ-5D-5L scores showed significant improvements from baseline to 12 weeks (p < 0.001), but no group differences were detected. Discussion: A home-based exercise program with an AR system improved shoulder dysfunction in breast cancer patients and could be used in conjunction with a traditional hospital-based rehabilitation program. Trial Registration: ClinicalTrials.gov ID: NCT04316156.
... Telemedicine, the use electronic technologies to provide remote healthcare, has long been heralded as a solution to numerous healthcare barriers, including those regarding access and engagement. Despite technological advances, adoption of telemedicine lagged behind for a variety of reasons, including provider and patient skepticism, inability to integrate with traditional healthcare, ethical concerns, licensing issues, reimbursement, and policy [27,28]. Further, a 2019 report on telemedicine reviewing seven state Medicaid programs noted that technology barriers, such as unreliable internet services, prevent telemedicine from reaching the very populations considered to benefit the most from such services (e.g., rural individuals) [29]. ...
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Purpose of Review The purpose of this review is to summarize advances in behavioral treatments for pain and headache disorders, as well as recent innovations in telemedicine for behavioral treatments. Recent Findings Research for behavioral treatments continues to support their use as part of a multidisciplinary approach to comprehensive management for pain and headache conditions. Behavioral treatments incorporate both behavioral change and cognitive interventions and have been shown to improve outcomes beyond that of medical management alone. The onset of the COVID-19 public health emergency necessitated the rapid uptake of nontraditional modalities for behavioral treatments, particularly telemedicine. Telemedicine has long been considered the answer to several barriers to accessing behavioral treatments, and as a result of COVID-19 significant progress has been made evaluating a variety of telemedicine modalities including synchronous, asynchronous, and mobile health applications. Researchers are encouraged to continue investigating how best to leverage these modalities to improve access to behavioral treatments and to continue evaluating the efficacy of telemedicine compared to traditional in-person care. Summary Comprehensive pain and headache management should include behavioral treatments to address a variety of behavior change and cognitive targets. Policy changes and advances in telemedicine for behavioral treatments provide the opportunity to address historical barriers limiting access.
... As a consequence of the COVID-19 crisis, organizations had to rethink how to deliver healthcare services, and an alternative care model has thus emerged, leveraging information and communication technologies (ICT) to guarantee the continuance of such services. Health services delivered via digital means are referred to using terms such as "telehealth", "eHealth" or "mHealth" [3,4]; with specific regard to physiotherapy, the term "telerehabilitation" has been widely used in the literature to describe rehabilitation services delivered via ICT [5,6], and this is the term we will also use from this point on in the present review. Telerehabilitation can be Int. ...
Article
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COVID-19 has abruptly disrupted healthcare services; however, the continuity of rehabilitation could be guaranteed using mobile technologies. This review aims to analyze the feasibility and effectiveness of telehealth solutions proposed to guarantee the continuity of rehabilitation during the COVID-19 pandemic. The PubMed, Cochrane Library, Web of Science and PEDro databases were searched; the search was limited to randomized controlled trials, observational and explorative studies published up to 31 May 2022, assessing the feasibility and effectiveness of telerehabilitation during the COVID-19 pandemic. Twenty studies were included, for a total of 224,806 subjects: 93.1% with orthopedic complaints and 6.9% with non-orthopedic ones. The main strategies used were video and audio calls via commonly available technologies and free videoconferencing tools. Based on the current evidence, it is suggested that telerehabilitation is a feasible and effective solution, allowing the continuity of rehabilitation while reducing the risk of infection and the burden of travel. However, it is not widely used in clinical settings, and definitive conclusions cannot be currently drawn. Telerehabilitation seems a feasible and safe option to remotely deliver rehabilitation using commonly available mobile technologies, guaranteeing the continuity of care while respecting social distancing. Further research is, however, needed to strengthen and confirm these findings.
... Because of this increased emphasis on remote patient care, telecare and telehealth are becoming increasingly integral aspects of global health care. Briefly, telecare can be defined as the provision of remote care using telecommunication to enable equitable access to health care services (6). Within MSK health care, telerehabilitation can be further defined as the delivery of rehabilitation services via information and communication technologies (7). ...
Article
Musculoskeletal conditions are a major contributor to global morbidity. During the COVID-19 pandemic, clinicians needed to rapidly meet the evolving requirements of their patients, which resulted in an increased adoption of telehealth services. This area needs more research, as there is currently a paucity of studies, and telehealth practices are continuing to advance and evolve. This study subsequently aims to evaluate the ethics, health economics, and accuracy of current musculoskeletal telehealth services. This article combines three original studies; a telehealth accuracy systematic review; a cost-effectiveness scoping review; and a biopsychosocial narrative review. These studies were combined into one article. This article concludes that telehealth services achieve an average agreement with in-person assessments of 62% for the knee and 31% for the shoulder and that telerehabilitation services incur average cost savings per patient of £38.57 but that these savings are primarily a result of a reduced need to travel.
... Telecommunications is the main highlight of this era changing the way of communication and way of thinking of society. Telehealth is a piece of this huge change in telecommunication technologies 1 . The main purpose of telehealth is to support health services through health promotion, remote education, and preventive services via applications and electronic communications 2 . ...
Article
Background: Telehealth is delivering health care services remotely from healthcare facilities using telecommunications and virtual technology. Egypt is aiming to reach Universal Health Coverage; this increases the demand for telehealth in routine health services. Telehealth helps in increasing access to areas with no available medical services as patients can be monitored remotely. Objective: To measure the awareness of telehealth among attendees of primary health care units and their acceptance of applying telehealth. Methodology: This was a cross-sectional study among attendees of primary health units. Ethical issues were considered. Results: A sample size was calculated to be 162 and 170 valid Arabic interview questionnaires were filled by attendees. The awareness percentage of telehealth among attendees was 64.7% while the willingness to implement telehealth was 78%. Both awareness and willingness were significantly associated with age groups, residence, socioeconomic status, and presence of computer with internet access. Age, residence, and possession of a PC were the only adjusted predictive factors for knowledge about telehealth among patients in the multivariable analysis. Conclusion: Large percentages of attendees to primary health care centers are aware of telehealth and are willing to implement it. The major cause of refusal to implement telehealth was ignorance of using telecommunication devices and the desire to be in close contact with the physicians.
... Henceforth, telehealth interventions may serve as a commendable follow-up to personal healthcare delivery, and a decent solution to augment unequal access to healthcare in rural regions. Literature also suggests that developing countries are the potential benefactors of telehealth programs due to its cost efficient operating cost (Darkins & Cary, 2000;Hjelm, 2005;Sorrells, Tschirch & Liong, 2006;Miller, 2007;Maeder, 2010). ...
Article
Background/Objectives: Telehealth through videoconferencing has the potential to improve the lives of the elderly. Unfortunately, little is known on its health benefits in the physical and quality of life dimensions among seniors. The aim of this paper is to compare videoconferencing as a mode of telehealth with traditional healthcare delivery in the contexts of functional independence and Quality of Life (QoL) measures using a non-equivalent control group before-after quasi experimental design. Methods/Statistical analysis: One-hundred forty seniors from a rural area were purposively selected and distributed to the telehealth (n=82) and traditional (n=58) groups. SF-8 and Functional Independence Measure (FIM) were used to gather the needed data from the participants before and after exposure to the interventions. Findings: Results of t-tests indicate significant improvement in QoL of the two groups of subjects on both telehealth and traditional groups, while FIM measures exhibited no significant change among the telehealth group. Improvements/Applications: On the whole, study findings promote a more personal delivery of healthcare among the elderly, and challenges the health practitioners and policy makers to recognize the pragmatic worth of and improve telehealth as a complementary healthcare tool for traditional consultation in enhancing QoL among seniors. Impliedly, more researches with extended number of subjects and locale is needed to come up with a more generalizable result.
... Taking into account that using e-health may help tailor interventions to the caregivers' support needs [33], telemedicine approaches have been adapted to remotely manage ALS patients improving the efficiency of healthcare [34,35]. In particular, due to Coronavirus disease 2019 (COVID-19) pandemic, containment measures led to necessary restrictions in personal movement and reduced access to traditional healthcare resources. ...
Article
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Family caregivers of people with amyotrophic lateral sclerosis (ALS), a severely disabling neurodegenerative disease due to the degeneration of both upper and lower motor neurons, have a very demanding role in managing their relatives, thereby often experiencing heavy care burden. Previous literature has widely highlighted that this situation reduces caregivers’ quality of life and increases their psychological distress and risk of health problems, but there are relatively few studies that focus on psychological interventions for these situations. Family support is more—not less—important during crisis. However, during the COVID-19 pandemic, maintaining public safety has required restricting the physical presence of families for hospitalized patients. Caregivers of ALS patients felt increased sense of loneliness and experienced greater difficulties in the access to both hospital and home assistance. In response, health systems rapidly adapted family-centric procedures and tools to circumvent restrictions on physical presence. In this regard, internet-based and telehealth solutions have been adopted to facilitate the routine, predictable, and structured communication, crucial to family-centered care. This narrative review aims at addressing more current matters on support needs and interventions for improving wellbeing of caregivers of ALS patients. In particular, we aimed at highlighting several gaps related to the complex needs of caregivers of ALS patients, to the interventions carried out in order to respond to these needs, and to the changes that COVID-19 pandemic caused from 2020 to nowadays in clinical managing of ALS patients. Finally, we report ongoing experiences of psychological support for family caregivers of ALS patients through telehealth solutions, which have been reinforced in case of needing of physical distancing during the COVID-19 pandemic.
... However, telemedicine can be applied to health promotion, prevention, and public health and should not be limited to curative health care. The distinction could become unnecessary in the long term [35]. Especially, stemming from the rapid penetration of mobile phones, mobile health or m-health has emerged in the recent two decades. ...
Article
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Health services provided through the telecommunications system aim to improve the population’s health and well-being. This research aims to explore what digital, economic, and health factors are associated with the provision of telehealth services, especially in ageing communities. Applying Organization for Economic Cooperation and Development (OECD) countries’ experiences, this research tries to construct a logistic regression model between adopting a telehealth system or not, a binary outcome variable, and a group of potentially explanatory variables. Estimation results showed that there were thresholds for telehealth provision: The demand for telehealth service usually began when the provision of telecommunication accessibility reached 50%, the proportion of elders exceeded 10%, or the proportion of health spending occupied more than 3–5% of the gross domestic product (GDP); the slope of each variable seemed to correspond with an increase in demand for such a provision. A growing number of individuals in OECD countries are now readily served by telehealth systems under the COVID-19 pandemic. These findings could be regarded as a model for other countries for implementing the necessary infrastructure early on when any of these parameters reaches its threshold. Moreover, telehealth applied in developing countries could be elevated for wider populations to access basic health services and for the remote delivery of health care. A rational decision could be made to appropriately use additional resources in telehealth provision. With accessible e-health services, the population’s health could be improved, which in turn would possibly increase productivity and social welfare.
... During the first lockdown due to the SARS CoV-2 pandemic in spring 2020 in CH, there was a moratorium on health professionals (HPs) carrying out non-urgent medical examinations, treatments, and interventions [9,10]. Consequently, the number of physiotherapy sessions per week in outpatient practices fell by 84% [11] and a high proportion of PTs submitted requests for an indemnity due to reduced working hours [12]. Swiss PTs, however, were still able to provide and invoice remote therapy to COVID-19 survivors or other patients with an urgent need of continuous therapy [13,14]. ...
Article
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Background The Swiss containment strategy for the COVID-19 pandemic during the first wave in spring 2020 resulted in a moratorium on non-urgent physiotherapy via regular direct patient contact. Consequently, such physiotherapy sessions declined by 84%. This study investigates the impact of this moratorium on the use of digital remote physiotherapy in Switzerland during this period and the perceptions of its use by Swiss physiotherapists (PTs). Methods A cross-sectional online questionnaire was distributed between June and August of 2020 via the Swiss Physiotherapy Association (physioswiss) and various associations of physiotherapy specialists (e.g., sport, pediatric) working in both inpatient and outpatient settings. The questionnaire was designed to capture the demographics of participants and the perceptions of PTs using 33 questions in the following domains: Demography; Attitudes towards digital technology; Private and professional use of digital technology; Use of digital technology during therapy; and, Support requirements. Closed and open-ended questions were included and the frequency of answers was analyzed. Non-parametric inferential statistics were used to identify differences, where appropriate. The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) was adopted. Results Participants in the survey were 742 PTs (23.5% male, mean age of 43 years, mean working experience of 18 years) from the German-speaking (75.5%), French-speaking (15.1%), and Italian-speaking (9.4%) regions of Switzerland. The percentage of PTs using digital remote therapy increased from 4.9% prior to the lockdown to 44.6% during the lockdown period. The majority of PTs did not consider that digital remote therapy could complement usual physiotherapy practice and did not plan to continue with digital remote therapy after the pandemic. Conclusions During the lockdown, Swiss PTs adopted various low-cost and easily accessible digital technologies. However, several barriers hampered further implementation of this modality. Specific education and training programs need to be provided among PTs, appropriate digital technologies should be introduced, and a correct reimbursement scheme should be developed. Trial registration COVIDPhysio Registry of World Physiotherapy, registered 15th June 2020 ( https://world.physio/covid-19-information-hub/covid-19-covidphysio-registry ).
... Tele-health, i.e., the provision of health care at a distance (HCD), might be suitable for continuing therapy under these circumstances [7]. The use of HCD has been described in a number of areas of work, including the outpatient area, the inpatient sector, the home environment, and school settings [8]. ...
Article
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Background The COVID-19 pandemic impedes therapy and care activities. Tele-health, i.e., the provision of health care at a distance (HCD), is a promising way to fill the supply gap. However, facilitators and barriers influence the use and experience of HCD for occupational therapists (OTs) and midwives. We identified use of services and appraisal of experiences of Switzerland-based OTs and midwives regarding the provision of HCD during the lockdown as it pertains to the COVID-19 pandemic in spring 2020. 1. Hypothesis: Profession, age in years, and area of work have a significant and meaningful influence over whether HCD is provided. 2. Hypothesis: Profession, age in years, area of work, possibility of reimbursement by health insurance, and application used have a significant and meaningful influence on the experience of HCD. Methods In a cross-sectional survey, 5755 OTs and midwives were contacted to fill out an online questionnaire with 13 questions regarding demographic information, use of HCD, and experiences while providing the service. Eleven potential facilitators and barriers and areas where there was desire for support were identified. Results The questionnaire was completed by 1269 health professionals (response rate 22.5%). 73.4% of responding OTs ( n = 431) and midwives ( n = 501) provided HCD during the COVID-19 pandemic lockdown. Profession and area of work had a significant influence on whether HCD was provided. Age only had a significant influence on the use of videotelephony, SMS, and chat services. OTs experienced HCD significantly more positively than midwives (log odds = 1.3; p ≤ .01). Video-telephony (log odds = 1.1; p ≤ .01) and use of phone (log odds = 0.8; p = .01) were positive predictors for positive experience, while use of SMS (log odds = − 0.33; p = .02) was a negative predictor. Among OTs, 67.5% experienced HCD as positive or mostly positive, while 27.0% experienced it as negative or mostly negative. Among midwives, 39.5% experienced it as positive or mostly positive, while 57.5% experienced it as negative or mostly negative. Most respondents desired support concerning reimbursement by health insurance (70.8%), followed by law and data protection (60.4%). Conclusions HCD during the early COVID-19 pandemic was generally perceived as positive by OTs and midwives. There is need for training opportunities in connection with HCD during the COVID-19 pandemic.
... To provide mental healthcare to those who need it most, while simultaneously limiting exposure to COVID-19, many healthcare providers turned to telehealth as an effective way to abridge physical distance between patients and healthcare providers. Telehealth is defined as the use of technology via audio and video telecommunications in order to provide healthcare across geographical distances, to facilitate the exchange of information between healthcare providers, or provide healthcare when it is not possible to have face-to-face contact [3,4]. When applied to mental health, these methods are known as telepsychiatry, which includes teleconsultation, teletherapy, telepsychology, telepsychotherapy, or telemental health via videoconferencing, phone conversations, and real-time chat [5]. ...
Article
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Due to COVID-19, face-to-face mental health service delivery has been interrupted by social distancing and stay-at-home orders. To abridge physical distance between patients and healthcare providers, while limiting exposure to COVID-19, telepsychiatry has been widely adopted to provide services to patients with pre-existing mental health disorders. Though telepsychiatry has become more mainstream in delivering mental health services during COVID-19, evaluation studies of the rapid conversion of care delivery from face-to-face to telepsychiatry have been limited. The aim of this study was to review the literature on the transition of mental health service delivery to telepsychiatry during COVID-19. The findings of the current review showed that a majority of patients and healthcare providers were satisfied with telepsychiatry services, and suggest that telepsychiatry is feasible and appropriate for supporting patients and healthcare providers during COVID-19.
... The term telehealth is broad and includes many narrower terms like telemedicine, telepsychiatry, and telepsychology (Darkins & Cary, 2000). The prefix tele-is added to many terms to suggest distance (American Psychological Association, 2013). ...
Article
Due to the state of the COVID-19 in Florida, a community-based agency serving children and families had to transition abruptly to teletherapy. This agency adapted to pandemic-related challenges by transitioning from in-person to virtual therapy, which played a key role in safely serving community members. This article explores the unique benefits and difficulties of the transition to teletherapy under those circumstances. The agency clinical staff utilized their brief therapy skills and strengths-oriented perspective to aid in this abrupt transition, as illustrated by a case study. Ultimately, the agency's transition was a successful one as evidenced by a survey of both agency clinicians and clients, and by uninterrupted services at the same volume of cases and level of care. Suggestions are made for other providers seeking to cope with similar transitions.
... Telehealth care is according to WHO defined as the integration of tele communications systems into the practice of protecting and promoting health, and telemedicine is the incorporation of these systems into curative medicine (Darkin & Cary, 2000). ...
Chapter
This chapter describes a case study of the poor access to healthcare in the developing the countries with more focus on the rural areas and presents an adapted remote care delivery system approach for improving and increasing the access to healthcare services by overcoming certain cultural, social, financial, and linguistic barriers. The remote care delivery system integrates traditional practitioners because most people are more confident with the traditional medicine. The chapter presents the results of a practical on-site test of the proposed system. The test has shown the potentiality of the proposed system to improve the quality and effectiveness of healthcare and increase the accessibility of healthcare systems. The chapter also discusses the obstacles for applying standard telemedicine systems and e-health solutions in the developing world.
... The term "Telemedicine" was introduced to the world in the 1960s (12) . The term "Telemedicine" was introduced by Bird and his colleagues in 1969 to describe the delivery of medical care without the usual patient-physician confrontation (15) . Later, Bannet and associates introduced the word "Telehealth" in 1978 to broaden the scope of Telemedicine with the incorporation of patient/clinician education (16) . ...
... The concept of digital health is not a new or revolutionary one. For example, technologies, such as medical images and telemedicine date back over 100 years (1,2), while prototype wearable devices have been used to tackle obesity since the 1940s (3). Digital health, however, has had continually transforming effects in an industry that is notoriously resistant to change (4). ...
... Tele-health, i.e., the provision of health care at a distance (HCD), might be suitable for continuing therapy under these circumstances (8). The use of HCD has been described in a number of areas of work, including the outpatient area, the inpatient sector, the home environment and school settings (9). ...
Preprint
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Background: The COVID-19 pandemic impedes therapy and care activities. Health care at a distance (HCD) is a promising way to fill the supply gap. However, facilitators and barriers influence the use and experience of HCD in occupational therapists (OTs) and midwives. We identified use of services and appraisal of experiences of Switzerland-based OTs and midwives regarding the provision of HCD during the lockdown as it pertains to the COVID-19 pandemic in spring 2020. 1. Hypothesis: Profession, age in years, and area of work have a significant and meaningful influence over whether HCD is provided. 2. Hypothesis: Profession, age in years, area of work, possibility of reimbursement by health insurance, and application used have a significant and meaningful influence on the experience of HCD. Methods: In a cross-sectional survey, 5755 OTs and midwives were contacted to fill out an online questionnaire with 13 questions regarding demographic information, use of HCD and experiences while providing the service. Eleven potential facilitators and barriers and areas where there was desire for support were identified. Results: The questionnaire was completed by 1269 health professionals (response rate 22.5%). 73.4% of responding OTs (n=431) and midwives (n=501) provided HCD during the COVID-19 pandemic lockdown. Profession and area of work had a significant influence on whether HCD was provided. Age had only a significant influence on the use of videotelephony, SMS and chat services. OTs experienced HCD significantly more positively than midwives (log odds=1.3; p≤.01). Video-telephony (log odds=1.1; p≤.01) and use of phone (log odds=1.1; p=.01) were positive predictors for positive experience, while use of SMS (log odds=-0.33; p=.02) was a negative predictor. Among OTs, 75.7% experienced HCD as positive or mostly positive, while 13.9% experienced it as negative or mostly negative. Among midwives, 53.7% experienced it as positive or mostly positive, while 36.1% experienced it as negative or mostly negative. Most respondents desired support concerning reimbursement by health insurance (70.8%), followed by law and data protection (60.4%). Conclusions: HCD during the early COVID-19 pandemic was generally perceived as positive by OTs and midwives. There is need for training opportunities in connection with HCD during the COVID-19 pandemic.
Article
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Background Around 463 million people globally have diabetes, of which over 90% have type 2 diabetes (T2D). Projections indicate an expected increase to 700 million by 2045. The COVID-19 pandemic accelerated digital health uptake, establishing virtual consultations as a feasible alternative to traditional in-person care. Despite promising preliminary evidence, a comprehensive review is needed to fully assess the impact of virtual consultations on diabetes care. This review aims to systematically evaluate the impact of remote consultations on the quality of care provided to persons with T2D, by mapping impacts against the six quality domains outlined by the National Academy of Medicine (NAM) (ie, patient-centeredness, effectiveness, efficiency, timeliness, equity and safety). Methods and analysis PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online), COCHRANE Library, EMBASE (Excerpta Medica Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Web of Science will be searched for studies published between 2010 and 2024. Primary outcomes will include any quality measures pertaining to the NAM domains for adult patients accessing virtual consultations. The Cochrane Collaboration’s tool will be used to assess the quality of the randomised studies, and the Risk of Bias in Non-Randomised Studies of Interventions will be used for non-randomised studies. The findings will be summarised as a narrative synthesis. This systematic review protocol was registered with the International Prospective Register of Systematic Reviews on 15 November 2023 (registration number: CRD42023474219). Ethics and dissemination This review will not include primary data and therefore does not require ethical approval. This protocol complies with the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols guidelines. Findings will be disseminated as academic publications and conference presentations and summarised into patient-led lay summaries.
Article
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When implemented in practice, digital technologies have shown improvements in morbidity and mortality outcomes in patients with cardiovascular disease (CVD). For scholars, research into digital technologies in cardiovascular care has been relatively recent, thus it is important to understand the history of digital health technology in cardiovascular research—its emergence, rate of growth, hot topics, and its temporal evolution. The aim of this study was to analyse more than 16,000 articles in this domain based on their scientometric indicators. Web of Science (WoS) Core Collection was accessed and searched at several levels, including titles, abstracts, keywords, authors, sources and individual articles. Analysis examined the temporal shifts in research and scholarly focus based on keywords, networks of collaboration, topical divisions in relation to digital technologies, and influential publications. Findings showed this research area is growing exponentially. Co-citation analysis revealed twenty prominent research streams and identified variation in the magnitude of activities in each stream. A recent emergence of research activities in digital technology in cardiovascular rehabilitation (CR), out-of-hospital cardiac arrest (OHCA), and arrythmia research was also demonstrated. Conversely, wearable technologies, activity tracking and electronic medical records research are now past their peak of reported research activity. With increasing amounts of novel technologies becoming available and more patients taking part in remote health care monitoring, further evaluation and research into digital technologies, including their long-term effectiveness, is needed. Furthermore, emerging technologies, which are evaluated and/or validated should be considered for implementation into clinical practice as treatment and prevention modalities for CVD.
Article
Aims: Evaluate reproducibility of hypermobility assessments using in-person versus telehealth modes. Methods: Hypermobility of 20 children (7-12 years) was evaluated using the Beighton Score, Upper Limb Hypermobility Assessment Tool (ULHAT), and Lower Limb Assessment Score (LLAS) via in-person and telehealth modes. Agreement between the two modes was examined using percentage of exact agreement (%EA and %EA ± 2), Limits of Agreement (LoA) and Smallest detectable change (SDC). Reliability was calculated using intra-class correlation coefficients (ICCs). Results: Agreement between modes for total Scores was best for the Beighton (%EA = fair, %EA ± 2 = good), then the ULHAT (%EA = poor, %EA ± 2 = excellent), and LLAS (%EA = poor, %EA ± 2 = fair). Total scores for all scales showed wide LoA, large SDC (25-31%), and fair to good reliability (ICC = 0.54-0.61). Exact agreement for Generalized Joint Hypermobility classification was excellent for the Beighton (≥7/9 threshold) and fair for the ULHAT and LLAS (≥7/12 threshold). Percentage of individual test items with good/excellent agreement was highest for the Beighton (78%, 7/9 items), then the ULHAT (58%, 14/24) and LLAS (42%, 10/24). Conclusion: Total Scores of hypermobility scales showed low exact agreement between in-person and telehealth, but fair-excellent agreement within two points. Classification using the Beighton ≥7/9 threshold was excellent. Research is recommended to increase accuracy of online assessments.
Article
Background: Occupational self-efficacy is a stable predictor for professionals' motivation to engage with new methods and tasks. Yet, the delivery of tele-physiotherapy (Tele-PT) by physiotherapists (PTs) during the coronavirus disease of 2019 (COVID-19) outbreak without advance training may have had the potential to increase work stress and damage their motivation, regardless of their occupational self-efficacy. Objectives: The present study examined whether the relations between PTs' overall occupational self-efficacy and motivation to provide Tele-PT was mediated by role stress (i.e. role conflict and ambiguity). Design and method: Between February 4 and April 23, 2021, 150 Israeli PTs completed an online survey that measured their overall occupational self-efficacy, their role stress induced by the provision of Tele-PT, their motivation to provide Tele-PT, and their demographic characteristics. Results: PTs' overall occupational self-efficacy was positively associated with PTs' motivation to provide Tele-PT (r= 0.328, p < .01) and fully mediated by role conflict (0.1757, 95% CI = [0.0231, 0.3797]) and by role ambiguity (0.1845, 95% CI = [0.0196, 0.4184]) (components of role stress) caused by the provision of Tele-PT. Conclusions: It is important to investigate the predictors and mediators of the motivation to provide Tele-PT because in the post-COVID-19 era health organizations are likely to adopt many tele-medicine services, and they need to find ways to mitigate perceived challenges.
Chapter
The telemedicine industry has evolved as an alternative method of patient contact in the presence of barriers to face-to-face contact such as the current COVID-19 pandemic or other geographic and temporal barriers that prevent patients from accessing healthcare. According to the World Health Organization (WHO), half of the world’s population cannot access basic health services. One of the promises of telemedicine is to reduce some of these barriers and improve access to healthcare and global health equity (Darkins and Cary, Telemedicine and telehealth: principles, policies, performance, and pitfalls, Springer, New York, 2000; Norris, Essentials of telemedicine and telecare, Wiley, London, 2002). Although telemedicine holds great promise, its implementation can be complicated by regulatory factors that can vary by country and region. Especially in developed nations, there may be complex laws and policies around aspects of telemedicine such as privacy and billing which can make its implementation difficult (Norris, Essentials of telemedicine and telecare, Wiley, London, 2002; Ackerman et al., Telemed J E Health 8(1):75, 2002).In this chapter, we provide an overview of purposes and mechanisms of telemedicine delivery, and the infrastructural and process requirements for a successful orthopedic telemedicine assessment. We discuss technical infrastructure required for a successful assessment including hardware, software, network, other tools, and physical space set-up. We then discuss the process involved in conducting smooth and effective encounter, both from the healthcare provider’s point of view as well as the patient’s point of view.KeywordsTelemedicine purposesInfrastructureProcess of telemedicine conductPatient checklist
Article
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Covid-19 is an infectious disease that will become a global pandemic in 2020. To reduce the transmission rate, WHO has issued various recommendations for the community, such as the use of masks, regular hand washing, coughing and sneezing etiquette, keeping a distance between people, avoiding crowded places, and others. The existence of public restrictions creates new problems for patients because of difficulties in seeking treatment. Telemedicine is a form of telehealth, which is a health service that is carried out remotely. This technology makes it easier for patients to interact with doctors without having to meet face to face. The purpose of this study was to determine the level of satisfaction of users of telemedicine services at RSIA Stella Maris Medan. The type of research used is non-experimental quantitative with a quantitative analytical study design. The population and samples used were 186 users of telemedicine services at RSIA Stella Maris. The results showed that users considered the features of the availability of options to be able to choose the treating doctor, the confidentiality of medical records, the stability of the internet network, the friendly and ready to help the attitude of the nurses, and the long waiting time for the drug delivery process as the most important features of each service dimension. To improve the quality of RSIA Stella Maris telemedicine services, many features are a priority to be improved, as well as features are maintained.
Article
Introduction: Due to COVID-19 the ability to see all patients face-to-face (FTF) was removed. Services implemented telehealth to cater for patients requiring musculoskeletal care. A service evaluation was undertaken to assess the effectiveness of a mixed telehealth/FTF approach and identify if stratifying patients could help tailor intervention. Methods: Retrospective analysis of data collected from patients who were assessed by Musculoskeletal Physiotherapists in one Scottish health board was undertaken. Patients were divided into low, medium and high risk sub-groups through the Keele STarT MSK tool. Outcome measures for pain and musculoskeletal health were taken at baseline/discharge along with satisfaction/preference. Descriptive and Inferential statistical analysis was conducted to establish whether changes in the outcome measures within and between risk sub-groups were statistically significant. Results: Pain level difference from baseline to discharge demonstrated clinically and statistically significant improvements across all risk groups (N = 89). Musculoskeletal health demonstrated clinically significant improvements across all risk groups and statistically significant improvements in the medium/high risk groups but not the low risk. Patients with knee osteoarthritis and low back pain in the medium risk group had fewest appointments while patients with chronic shoulder pain had the most. The majority of patients were satisfied with all mediums but preferred FTF or an option between telehealth/FTF in the future. Conclusion: Telehealth is a promising model of care when utilised in combination with FTF for patients with musculoskeletal conditions. Through stratification, identifying specific conditions and shared decision making it may be possible to treat certain patient groups via telehealth.
Article
Objective: The authors' objective was to compare the actual cost of a regional pediatric neurosurgery telemedicine clinic (PNTMC) with the estimated cost of a traditional physician-staffed outreach clinic. Methods: The authors' PNTMC was a partnership between the University of Florida College of Medicine-Jacksonville and Georgia Children's Medical Services to service the population of Georgia's Southeast Health District. Neurosurgeons based in Jacksonville conducted telemedicine visits with patients located at a remote site in Georgia with the assistance of nursing personnel from Children's Medical Services. The authors determined the actual annual per-patient costs at the Jacksonville and Georgia sites for fiscal years 2018 (FY18) and 2019 (FY19) and estimated the cost of providing traditional physician-staffed outreach clinics. Results: During FY18 and FY19, the neurosurgery team conducted an average of 24.5 telemedicine patient encounters per year at a cost of $369 per patient visit. The per-patient cost was 32.5% less than the estimated per-patient cost of $547 at a traditional outreach clinic. Conclusions: The authors provided neurosurgical telehealth visits to appropriate patients, with a substantial cost savings per patient visit compared with traditional physician-staffed outreach clinics.
Article
Background context: Musculoskeletal (MSK) pain presents a global challenge. Individual and group pain management programmes (PMPs) are recommended approaches for patients with chronic MSK disorders. With advances in remote healthcare capability, telehealth, and the recent COVID‐19 pandemic, the importance of telehealth PMPs has become even more evident. Nevertheless, it is not known how patients perceive PMPs for their MSK complaint when delivered via telehealth. Objective: To synthesise the evidence of patients' experiences of group and individual telehealth PMPs for chronic MSK pain. Design: A scoping review informed by the PRISMA extension for scoping reviews. Data sources: Based on a planned search strategy, modified following initial searches, an electronic search was conducted of key databases: Cochrane Library, Medline, CINAHL, EMBASE, AMED, SportDiscus and APA PsychInfo from 2010 until 11 May 2021. Study selection: Any qualitative or mixed methods study reporting patient experiences of telehealth PMPs for patients with MSK disorders. Data extraction and data synthesis: Data were extracted and synthesised using thematic analysis. Results: From 446 identified studies, 10 were included. Just two studies investigated group telehealth PMPs for patients with MSK disorders, with eight delivered individually. Four main themes emerged: (1) Usability of the technology, (2) Tailored care, (3) Therapeutic alliance and (4) Managing behaviour. The findings highlight patient acceptability of telehealth to support self‐management for chronic MSK disorders, with appropriate clinical and technical support. Group telehealth has the potential to empower patients with peer support. Remote delivery of PMPs also impacts on how patients and providers interact, communicate and develop a therapeutic relationship. Conclusions and implications: Barriers and enablers to engagement in telehealth PMPs for patients with chronic MSK disorders have been identified. Peer support and group cohesiveness can be achieved remotely to enhance the patient experience. There is a critical need for further research in this area.
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Tunisia experienced huge changes in demographic, social, economic and political fields over the last six decades since independence. Until now, it is still a country of huge contrasts. Important progress on political transition led to an open democratic system of governance, whereas, economic field has not known the same fate [1]. Tunisian population accounts 11,839,475 people on August 30, 2020, according to the last update of the United Nations data, which corresponds to 0.15% of the worldwide population. Median population’s age is about 32.8 years. Population distribution by age was detailed in Figure 1 and showed a stationary type pyramid with declining birth rate and relatively low death rate. According to last previsions, Tunisia’s population will continue to grow until 2058 reaching a plateau of 13.96 million people [2]. Life expectancy is continuously increasing since 1955 in both sex (Figure 2). Population density in Tunisia is about 76 per Km2, with a total land area of 155,360 Km2. Almost 70.1% of Tunisians live in urban areas distributed in many sizable cities (Figure 3) [2, 3]. The largest one corresponds to the capital of Tunisia, Tunis in the North east, including a population of about one million. Sfax, located in the South East, is the next largest and populated city following the capital with a population of 330,000. Other cities are distributed in different areas of the Tunisian territory with populations over 100,000 including mainly Sousse in the Center East, Kairouan in the Center, Gabes in the South East, Bizerte in the extreme North, Aryanah in the North East and Gafsa in the South West [4, 5]. Thus, it’s obvious that major cities are scattered randomly on the Tunisian territory with unequal access to healthcare. Although better sanitary conditions, these urban areas could not totally ensure support to the healthcare needs of the neighboring regions whether urban or rural.
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The rapid spread of Coronavirus disease (COVID-19) has led to global pandemic affecting mental and physical well-being of people around the world. Given the highly contagious nature of COVID-19, public authorities in order to restrict the escalation of the virus ordered social lockdown and asked people to self-quarantine at homes if they develop any symptoms. As a result, these new social regulations have changed how individuals live and carry out everyday tasks in the general society. Reduced physical activity during lockdown has enhanced vulnerability to develop infections and non-communicable diseases. While on the other side, due to absence of routine medical surveillance, the condition of people with existing chronic conditions has deteriorated. Re-allocation of health care resources to treat COVID-19 patients put forward unprecedented challenge for the healthcare system in terms of providing medical support to non-infected out-patients. Extended social lockdowns are also causing adverse repercussions for physiotherapy and rehabilitation out-patient services. COVID-19 restrictions have hampered the in-person interaction of therapists and patients for in-person consultations and therapy sessions. Thus, leading to overall delay in the management and recovery of patients, especially those who are at a critical stage of treatment. During these unprecedented times of COVID19 pandemic, provision of telehealth appeared to be the guiding light to tackle these evolving challenges of public health. Focusing on the out-patients who need close supervision for therapies and counselling, in this piece, “I” am arguing that methods of telemedicine and tele-rehabilitation should be actively adopted in the healthcare services to bridge the gap caused due to COVID-19.
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