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Abstract

The current coronavirus (COVID-19) pandemic is again reminding us of the importance of using telehealth to deliver care, especially as means of reducing the risk of cross-contamination caused by close contact. For telehealth to be effective as part of an emergency response it first needs to become a routinely used part of our health system. Hence, it is time to step back and ask why telehealth is not mainstreamed. In this article, we highlight key requirements for this to occur. Strategies to ensure that telehealth is used regularly in acute, post-acute and emergency situations, alongside conventional service delivery methods, include flexible funding arrangements, training and accrediting our health workforce. Telehealth uptake also requires a significant change in management effort and the redesign of existing models of care. Implementing telehealth proactively rather than reactively is more likely to generate greater benefits in the long-term, and help with the everyday (and emergency) challenges in healthcare.

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... This adaptation was consistent with other subspecialty clinics across the country. 1,2 Since the inception of telehealth services in GeMS, our MH team has completed over 3300 virtual visits. While some MH services have returned to an in-person model, telehealth services have proven to be very popular with patients and clinicians, a trend that appears to be supported in emerging literature. ...
... While some MH services have returned to an in-person model, telehealth services have proven to be very popular with patients and clinicians, a trend that appears to be supported in emerging literature. [1][2][3] In fact, we anticipate that at least 50% of MH visits in our clinic will remain virtual postpandemic. In this article, we provide a narrative review of lessons learned when adapting our MH services to provide essential GAC to clients via telehealth, and how this process led to innovations in our clinical practice. ...
... travel, finances, etc.). 2 However, there is currently limited evidence regarding the outcomes of telehealth services for the TGD community. Furthermore, many clinicians have received little-to-no telehealth training. ...
Article
The COVID-19 pandemic has had significant effects on service delivery for transgender and gender diverse youth. Many in-person services were suspended in response to the need to follow quarantine and social-distancing guidelines, at both the state and national levels. In response, our pediatric gender clinic adopted a rapid implementation of telehealth services to provide access to gender affirming care. However, there exists little guidance on how to provide gender-affirming care via these platforms. In this article, we provide a narrative review of the development of a full-scale model for delivering telehealth services to transgender and gender diverse youth and their families during the COVID-19 pandemic. We also discuss the benefits and drawbacks of telehealth services for transgender and gender-diverse youth and focus on the continued need for advocacy around systemic barriers to care.
... Thus, caregivers are recommended to use ICT such as telemedicine and e-consultation. 3 In addition to that, with an increasing number of older people wanting to live in their own home for as long as possible, quality of life and patient empowerment are becoming more important. 4 Information and communication technology has the possibility to signal diseases at an early stage and can be used for medical rehabilitation at home. 2 It can enable individuals to monitor their vital signs with the use of activity trackers or other wearable sensors, for instance, fall detection systems, lifestyle monitoring, or GPS trackers. ...
... 11 However, the adoption rate of ICT applications is minimal among professionals such as nurses, and not adopting them appears to be quite common. 12 This seems to be one of the primary reasons why ICT implementation is generally failing 3 ; however, it is unclear what comprises the success and failure factors. Straub 13 refers to adoption as the decision an individual makes to either accept or reject an innovation and whether to integrate this innovation into their life. ...
... In early 2020, the first cases of COVID-19, the disease caused by a novel coronavirus (SARS-CoV-2), were diagnosed in the United States [1,2]. To reduce the spread of more robust telehealth services to meet the need of their patients [3][4][5][6]. In the context of a global pandemic, Andersen's Model of Healthcare Utilization (hereafter referred to as Andersen's Model) provides a useful framework for exploring factors that influence telehealth utilization during the COVID-19 pandemic, including factors that are unique to the pandemic itself [7,8]. ...
... H3: people with more preexisting conditions, more barriers to face-to-face healthcare, or worsening health during the pandemic will be more likely to use telehealth To improve telehealth utilization during the current public health crisis and prepare for future crises, it is important to understand the factors associated with an individual's decision to utilize telehealth services [6,[30][31][32]. Our study sought to identify factors associated with first time telehealth utilization in Arkansas during the COVID-19 pandemic. ...
Article
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Objective. To examine the factors associated with the first use of telehealth during the COVID-19 pandemic using Andersen’s Model of Healthcare Utilization. Andersen’s Model of Healthcare Utilization allowed the categorization of the independent variables into the following: (1) predisposing factors, including sociodemographic variables and health beliefs; (2) enabling factors, including socioeconomic status and access to care; and (3) need for care, including preexisting or newly diagnosed conditions and reasons to seek out care or to utilize a new mode of care. Methods. Potential respondents (n=4,077) were identified for recruitment from a volunteer registry in Arkansas. Recruitment emails provided a study description, the opportunity to verify meeting the study’s inclusion criteria and to consent for participation, and a link to follow to complete the survey online. The online survey responses were collected between July and August of 2020 (n=1,137). Results. Telehealth utilization included two categories: (1) utilizers reported the first use of telehealth services during the pandemic, and (2) nonutilizers reported they had never used telehealth. Lower odds of reporting telehealth utilization during the pandemic were associated with race (Black; OR=0.57, CI [0.33, 0.96]) and education (high School or less; OR=0.45, CI [0.25, 0.83]). Higher odds of reporting telehealth utilization included having more than one provider (OR=2.33, CI [1.30, 4.18]), more physical (OR=1.12, CI [1.00, 1.25]) and mental (OR 1.53, CI [1.24, 1.88]) health conditions, and changes in healthcare delivery during the pandemic (OR=3.49, CI [2.78, 4.38]). Conclusions. The results illustrate that disparities exist in Arkansans’ utilization of telehealth services during the pandemic. Future research should explore the disparities in telehealth utilization and how telehealth may be used to address disparities in care for Black Arkansans and those with low socioeconomic status.
... The recent Covid-19 pandemic has increased the demand and use of telehealth services rapidly (65)(66)(67). While the increased exposure to telehealth options might have positively influenced attitudes of practitioners an users (68,69), it also revealed that telehealth is still considered a more niche intervention option in many countries resulting in a lack of training of heath care professionals and reimbursement opportunities (70)(71)(72). ...
... In line with other (pre-)pandemic studies, our results show that telephone coaching can effectively promote mental health, not only as a necessity in a global health crisis but also in easing access for remotely living communities (73), lowering socio-economic costs (74,75) and offering alternatives for people with restricted (broadband) internet-access (75)(76)(77). Implementing a structure for telehealth in routine care can further strengthen and enable the health care system to spontaneously and flexibly react to future large scale health crisis (67,71,72). ...
Article
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Introduction Farmers have a high risk for depression (MDD). Preventive measures targeting this often remotely living population might reduce depression burden. The study aimed to evaluate the effectiveness of personalized telephone coaching in reducing depressive symptom severity and preventing MDD in farmers compared to enhanced treatment as usual (TAU + ). Methods In a two-armed, pragmatic randomized controlled trial ( N = 314) with post-treatment at 6 months, farming entrepreneurs, collaborating family members and pensioners with elevated depressive symptoms (PHQ-9 ≥ 5) were randomized to personalized telephone coaching or TAU + . The coaching was provided by psychologists and consists on average of 13 (±7) sessions a 48 min (±15) over 6 months. The primary outcome was depressive symptom severity (QIDS-SR16). Results Coaching participants showed a significantly greater reduction in depressive symptom severity compared to TAU + ( d = 0.39). Whereas reliable symptom deterioration was significantly lower in the intervention group compared to TAU + , no significant group differences were found for reliable improvement and in depression onset. Further significant effects in favor of the intervention group were found for stress ( d = 0.34), anxiety ( d = 0.30), somatic symptoms ( d = 0.39), burnout risk ( d = 0.24–0.40) and quality of life ( d = 0.28). Discussion Limiting, we did not apply an upper cutoff score for depressive symptom severity or controlled for previous MDD episodes, leaving open whether the coaching was recurrence/relapse prevention or early treatment. Nevertheless, personalized telephone coaching can effectively improve mental health in farmers. It could play an important role in intervening at an early stage of mental health problems and reducing disease burden related to MDD. Trial registration number and trial register German Clinical Trial Registration: DRKS00015655
... Bivariate analyses revealed older adults (55+) were more likely to be in the Social challenges and Social and Health challenges groups, and less likely to be in Social and Financial and Social, Health, Financial, and Daily living challenges groups. Conversely, there was a higher percentage of young adults (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) in the Social, Health, Financial, and Daily living challenges and a higher percent of middleaged adults (36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54) in the Social and Financial classes than expected. There were also significant differences in class by race/ethnicity (p = 0.005) and disability status (p = 0.001). ...
... Likewise, participants' lack of stable internet connection underscores some of the difficulty these rural-living adults had in accessing healthcare services. Indeed, COVID-19 has catalyzed a rapid massive shift to telemedicine to decrease person-to-person contact, and slow the spread of the virus [9,37]. However, reliance on virtual connections to support healthcare has raised concerns of further health disparities and inequity for rural populations without the necessary digital infrastructure. ...
Article
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Background Rural and remote communities faced unique access challenges to essential services such as healthcare and highspeed infrastructure pre-COVID, which have been amplified by the pandemic. This study examined patterns of COVID-related challenges and the use of technology among rural-living individuals during the first wave of the COVID-19 pandemic. Methods A sample of 279 rural residents completed an online survey about the impact of COVID-related challenges and the role of technology use. Latent class analysis was used to generate subgroups reflecting the patterns of COVID-related challenges. Differences in group membership were examined based on age, gender, education, race/ethnicity, and living situation. Finally, thematic analysis of open-ended qualitative responses was conducted to further contextualize the challenges experienced by rural-living residents. Results Four distinct COVID challenge impact subgroups were identified: 1) Social challenges (35%), 2) Social and Health challenges (31%), 3) Social and Financial challenges (14%), and 4) Social, Health, Financial, and Daily Living challenges (19%). Older adults were more likely to be in the Social challenges or Social and Health challenges groups as compared to young adults who were more likely to be in the Social, Health, Financial, and Daily Living challenges group. Additionally, although participants were using technology more frequently during the COVID-19 pandemic to address challenges, they were also reporting issues with quality and connectivity as a significant barrier. Conclusions These analyses found four different patterns of impact related to social, health, financial, and daily living challenges in the context of COVID. Social needs were evident across the four groups; however, we also found nearly 1 in 5 rural-living individuals were impacted by an array of challenges. Access to reliable internet and devices has the potential to support individuals to manage these challenges.
... 11 In light of this, and not least in the midst of a pandemic, VCs appear to offer a practical solution for going to the doctor as well as offering a potential opportunity for improvement in healthcare delivery, for instance, by facilitating access. 9,12,13 Correspondingly, in response to the outbreak of COVID-19, the facilitation of VCs through the already established My Doctor app was expeditiously implemented in Denmark, enabling citizens access to VCs with their general practitioner (GP) via their smartphone or tablet and therefore receive the necessary treatment and guidance from health professionals without fear of contracting the coronavirus. 14 Consequently, in the period from March to December 2020, when the majority of our data were recorded, 394,864 VCs were carried out in general practice. ...
Article
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Objective To analyse how the patient's use of handheld technology in video consultations with their general practitioner affects communication and the possibilities for the delivery of quality healthcare. Focusing on the visually communicated aspects of the video consultation, we present three episodes from our recordings of eight video consultations between Danish general practitioners and patients. Methods Using a multimodal social semiotic framework to conduct a micro-level analysis, we present episodes from our data in which the hardware's affordance of mobility gave rise to salient events in the interactions of patients who used handheld devices to carry out their video consultations. Results Patients’ use of technology plays a significant role in the interactions between general practitioner and patient and is thus an important factor to consider in how practice is shaped when using handheld video consultation technology. Conclusions Our findings demonstrate that the mobility of handheld devices (smartphone, tablet) can be used to augment sensing and embodiment and enhance the delivery of healthcare in video consultations. However, mobility may also disrupt the interaction. As a result, possibilities for the delivery of quality healthcare lie quite literally in the patients’ hands.
... Telehealth supported patients and caregivers during the pandemic, ensuring the continuity of providing qualified healthcare to patients with a need, especially elderly patients with mobility issues and chronic diseases. Patients in rural areas do not need to cancel their appointment due to lack of transportation or traveling costs [1]. Since COVID-19 forced many industries to work remotely including healthcare organizations, the use of telehealth has dramatically increased. ...
Article
Telehealth is an advanced technology using digital information and telecommunication facilities that provide access to health services from a distance. It slows the transmission factor of COVID-19, especially for elderly patients and patients with chronic diseases during the pandemic. Therefore, understanding patient perspectives on telehealth services and the factors impacting their option of telehealth service will shed light on the measures that healthcare providers can take to improve the quality of telehealth services. This study aimed to evaluate perceptions of telehealth services among different patient groups and explore various aspects of telehealth utilization in the United States during the COVID-19 pandemic. An online survey distributed via social media platforms was used to collect research data. In addition to the descriptive statistics, both correlation and regression analyses were conducted to test research hypotheses. The empirical results highlighted that the factors such as accessibility to telehealth services and the type of specialty clinics that the patients required play important roles in the effectiveness of telehealth services they received. However, the results found that patients' waiting time to receive telehealth services and their annual income did not significantly influence their desire to select receiving healthcare services via telehealth. The limitations of the study and future research directions are discussed.
... Rehabilitation and other services delivering occupational therapy had to quickly change the way occupational therapy services has been delivered so far. Telehealth has been a known possible medium in providing service, but it hasn't been implemented as much in a period before the worldwide COVID-19 pandemic [4,5]. ...
Article
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Introduction: COVID-19 circumstances and related restrictions affected health care service delivery. Health care service delivery, including occupational therapy, transitioned from usual face-to-face therapy to telehealth. Purpose of the systematic review was to examine the experiences using telehealth in occupational therapy. Methods: PubMed, Science Direct, CINAHL, Cochrane, OT seeker, Web of Science, and the Sage journal databases was searched. The PRISMA protocol was followed and applied to the review. Articles not including occupational therapy, letters to editor and editorials were excluded from the review. Evidence levels for the articles were determined based on the ranking system by OCEBM Levels. Results: Articles describing the use of telehealth in occupational therapy services were included. Eleven studies rated levels V, IV, and II reached the review criteria and five themes were identified. The emerged themes were: (a) development of new skills, (b) therapist attitudes toward telehealth, (c) user satisfaction with telehealth services, (d) need for interprofessional collaboration, (e) positive and negative factors in service delivery. Conclusions: There is limited evidence on occupational therapists' perceptions in using telehealth during the COVID-19 pandemic. Not only occupational therapists but also other health professionals should be more encouraged and supported by teams, management, and policies to be part of telehealth services in times of pandemics. Innovative strategies should be developed in occupational therapy to provide continuous service delivery aimed in maintaining occupational therapy goal, engagement, and participation for occupational therapy users. Providing telehealth services, not just in occupational therapy, should be administered and supported through legislation. Keywords: Telehealth; Telemedicine; Occupational therapy; Covid 19
... However, telemedicine could be the only way to help treat military and civilian patients with routine and emergent conditions. 1 Telemedicine has indeed the potential to deliver health services in a various range of clinical settings especially when face-to-face healthcare becomes unavailable, as demonstrated during the COVID-19 pandemic. 2 There is no legal recognition of telemedicine as a (direct) fundamental right, although healthcare has been considered a human right since 1946. 3 Pursuant the article 7 (K) of the Statute of the International Criminal Court, a crime against humanity is 'Other inhumane acts (…) intentionally causing great suffering, or serious injury to body or mental or physical health'. ...
... This may be done through research and deployment of artificial intelligence to proactively identify posts on social media from people who are in crisis and likely to commit suicide. Such vulnerable persons may be reached through different types of virtual psychotherapeutic mechanisms, including video-conferencing, the conduct of cognitive-behavioral and mindfulnessbased smartphone therapies, and chess-edutainment [49,50]. Most African nations, especially Nigeria, Ghana, South Africa, and Kenya, already have a telecommunications density exceeding 100%, which serves as a veritable tool for the implementation of mobile psycho-therapeutic care and services. ...
Chapter
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Since the upsurge of Coronavirus in 2019, the WHO and the US CDC have been detecting and characterizing new variants and providing updates to healthcare workers, the public, and global partners on its spread and effects on patients with noncommunicable diseases and co-morbid ailments. Epidemiology and virologic evidence suggest that COVID-19 and its subsequent deadly variants have been associated with mental and neurological manifestations, including delirium or encepha-lopathy, agitation, acute cerebrovascular disease, meningoencephalitis, impaired sense of smell or taste, anxiety, depression, and sleep problems. While data on these complications may be available in the global north and south, there is a paucity of literature in most African States. Recent developments in COVID-19-related theories and concepts include ethical principles for clinical, counseling, psycho-therapeutic, and rehabilitation options for special and vulnerable populations, such as pediatric patients, pregnant women, mothers, older people, PLWDs, and other marginalized groups. However, there is no known coordinated and multidisciplinary continuum of clinical, counseling, and psychotherapy COVID-19 care pathways for symptomatic and asymptomatic patients and their families in the African States. Hence, the need for this scoping analysis of existing literature on the psycho-social and health implications of COVID-19 Comorbidity-Related Complications for vulnerable persons in developing societies.
... Furthermore, one study demonstrated that patient satisfaction scores were higher for patients who had a video visit versus an in-person visit and who received care during the COVID-19 pandemic versus before the COVID-19 pandemic [9]. In practice, physicians can use telehealth, and video visits specifically, to remotely monitor and manage patients' acute and chronic medical needs and triage patients who may potentially need more intensive treatment [10]. Given such benefits, researchers and practitioners continue to promote the ongoing use of video visits as a remote care option [11]. ...
Article
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Background During the COVID-19 pandemic, stay-at-home orders as well as shortages of personal protective equipment forced primary care physicians (PCPs) to transition rapidly from in-person visits to telehealth. While telehealth expanded extensively in a short period of time, research about the consequences of the shift to remote care is lacking. The objective of this qualitative study was to examine how telehealth benefited PCPs and their patients during the COVID-19 pandemic. Methods From July to August 2020, semi-structured interviews were conducted with 20 PCPs associated with a single academic medical center to examine their perspectives about delivering care remotely during the COVID-19 pandemic. All interviews were recorded, transcribed verbatim, coded, and analyzed using deductive thematic analysis. Results PCPs identified several benefits of remote care delivery for both physicians and patients. They indicated that (1) patients were reassured that they could receive safe and timely care, (2) remote visits were convenient for patients, (3) patients were comfortable receiving care at home, and (4) video visits enhanced patient- and family-centered care during the COVID-19 pandemic. Participants also noted that (1) telehealth accommodated working from home, (2) physicians were equitably reimbursed for telehealth visits, and that (3) telehealth promoted physician work-life balance. Conclusions Our data provides preliminary evidence that PCPs and their patients had positive experiences with remote care during the early months of the COVID-19 pandemic. Physicians identified opportunities by which telehealth could enhance the delivery of patient-centered care by allowing them to see patients’ home environments and to engage family members and caregivers during telehealth visits. More research is needed to understand how to sustain these benefits beyond the global COVID-19 pandemic and ensure patients’ needs are met.
... The reliance on telehealth to deliver outpatient appointments at the beginning of the coronavirus disease 2019 (COVID-19) pandemic demonstrates that these models of care have reached a maturity and capacity to serve more patients than they ever had before. 1,2 The subsequent plateau and retreat from the peak levels of activity ( Fig. 1), despite broad support by health consumers, [3][4][5][6] indicate that telehealth has not become a genuine alternative to in-person appointments for many public hospital departments across Queensland, Australia. ...
Article
Objective: This study investigated hospital-based specialist services that provide both traditional hospital outpatient appointments (in-person) or through a live videoconferencing session (telehealth) to referred patients. Referral letters submitted to these clinics were assessed against an inclusion criterion and grouped according to which of delivery method the patient received for their appointment (in-person or telehealth). These groups were then compared for differences to see what factors, if any, influence the likelihood of a patient being offered a telehealth appointment. Methods: An extract of all referral letters meeting inclusion criteria between July 01, 2019 and June 30, 2020 were collected (n = 441). Letters were grouped according to delivery modality (in-person or telehealth) and differences between the groups, including variables such as patient demographics, clinical condition, and urgency and the reviewing clinician were assessed for associations. Results: This study observed that where the referring clinician suggested a telehealth appointment for their patient, this was more likely to be offered (38.25%) compared with referrals that did not (7.36%) (x 2 1 = 28.33, p = 0.1857, odds ratio = 2.77). Patients were more likely to be offered a telehealth appointment the further they lived from the treating facility (T = -4.51 on 106.59 df, p = 1.622 e-05). Variation in the selection of delivery modality among reviewing clinicians was also observed (x 2 1 = 42.334, p < 1.42e-08). Discussion: Existing research indicates there is a strong link between the perceptions clinicians as individuals have of telehealth and a willingness to offer this modality to patients. Despite this, specific information about a patient contained within a referral letter may influence the delivery modality that the patient will be offered for their initial appointment. It is important that this information is more routinely included in letters sent by referring clinicians to hospital-based specialist services. It is equally important that when included, this information is identified and actioned by reviewing clinicians in a consistent way. Doing so will benefit patients by increasing the likelihood that they will receive specialist outpatient care in a manner that suits them best.
... WHO declared the COVID-19 outbreak as a pandemic on March 11, 2020, and it has appeared as a threat to the entire world irrespective of the economy [1,2]. The sudden appearance of this pandemic in the low economies created a huge panic because these nations are not at all prepared to deal with such a huge number of very infectious COVID-19 positive patients within a short time with their existing healthcare facilities. ...
Article
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Background A developing country like Bangladesh suffers very much from the sudden appearance of the COVID-19 pandemic due to the shortage of medical facilities for testing and follow-up treatment. The Portable Health Clinic (PHC) system has developed the COVID-19 module with a triage system for the detection of COVID-19 suspects and the follow-up of the home quarantined COVID-19 patients to reduce the workload of the limited medical facilities. Methods The PHC COVID-19 system maintains a questionnaire-based triage function using the experience of the Japanese practice of diseases management for early detection of suspected COVID-19 patients who may need a confirmation test. Then only the highly suspected patients go for testing preventing the unnecessary crowd from the confirmation PCR test centers and hospitals. Like the basic PHC system, it also has the features for patients’ treatment and follow-up for the home quarantined COVID-19 positive and suspect patients using a telemedicine system. This COVID-19 system service box contains 4 self-checking medical sensors, namely, (1) thermometer, (2) pulse oximeter, (3) blood pressure machine, and (4) glucometer for patient's health monitoring including a tablet PC installed with COVID-19 system application for communication between patient and doctor for tele-consultancy. Results This study conducted a COVID-19 triage among 300 villagers and identified 220 green, 45 light-yellow, 2 yellow, 30 orange, and 3 red patients. Besides the 3 red patients, the call center doctors also referred another 13 patients out of the 30 orange patients to health facilities for PCR tests as suspect COVID-19 positive, and to go under their follow-up. Out of these (3 + 13 =) 16 patients, only 4 went for PCR test and 3 of them had been tested positive. The remaining orange, yellow and light-yellow patients were advised home quarantine under the follow-up of the PHC health workers and got cured in 1-2 weeks. Conclusions This system can contribute to the community healthcare system by ensuring quality service to the suspected and 80% or more tested COVID-19 positive patients who are usually in the moderate or mild state and do not need to be hospitalized. The PHC COVID-19 system provides services maintaining social distance for preventing infection and ensuring clinical safety for both the patients and the health workers.
... The use of telemedicine in the COVID-19 pandemic is aiding in improving the epidemiological control, and therefore management, of clinical cases [8,9]. It is a method of protecting both infected and non-infected individuals as well as physicians [10,11]. ...
Article
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During the recent COVID-19 pandemic, healthcare providers have been encouraged to increase their use of telemedicine and to adopt telemedicine platforms for the majority of their clients who have chronic illnesses. Due to the outbreak itself, almost all countries worldwide were placed under emergency lockdowns. In this paper, we reviewed the literature regarding the use of telemedicine during the COVID-19 pandemic. Consequentially, we identified the adoption of telemedicine in various countries worldwide and evaluated their future steps in order to increase the adoption of e-health technologies. As a result of COVID-19, the e-health agenda, especially telemedicine, has been accelerated in several countries. COVID-19 is affecting individuals’ daily lives and has created major difficulties in the management of healthcare facilities for both infected and non-infected patients. A large portion of the rapid increase in the use of telemedicine can be attributed to evidence from previous pandemics as well as progress made by the field in response to COVID-19, especially in industrialized countries. A lack of effective treatment, large numbers of unvaccinated individuals, as well as social distancing and lockdown measures suggest telemedicine is the safest and most appropriate way of working with patients and doctors. In spite of this willingness, a large number of barriers need to be overcome in order for the telemedicine system to function properly and effectively throughout countries. In order for telemedicine to be sustainable and beneficial beyond the pandemic, several technical, educational, infrastructure, legal, and economic issues must be addressed and solved.
... Another study conducted by our team based on the same sample population indicated that the prevalence of behavioral intention to visit hospitals for scheduled medical consultations was 62.3% during the COVID-19 pandemic, and fear of HAI was a negatively-associated factor (39). To minimize the concern of HAI, remote medical consultations (e.g., hotline consultation) that can manage diseases and assess the necessity of facility-based services have been suggested during the COVID-19 pandemic (40,41). Future studies are warranted to investigate and compare levels of care-seeking behaviors for different types of medical consultations during the COVID-19 pandemic and understand the associated factors. ...
Article
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Background The study investigated the level of behavioral intention to consult doctors for flu symptoms (BICDFS) during the Coronavirus Disease 2019 (COVID-19) pandemic and examined its associations with illness representations of COVID-19 and fear of COVID-19 during clinic visits in a general Chinese adult population. Methods A random telephone survey was conducted among 300 residents in Hong Kong, China in April 2020 when the second wave of COVID-19 was just ended in the region. The participants were asked about their intention to consult doctors if they had mild or severe flu symptoms in the next week (from 1 = definitely no to 5 = definitely yes ). Illness representations of COVID-19 were measured by the Chinese version of the Brief Illness Perception Questionnaire (BIPQ). The fear of COVID-19 during clinic visits were assessed by two single items. Linear regression adjusted for background variables and hierarchical strategies were employed. Results Of the participants, 52.3 and 92.0% showed an intention to consult doctors for mild and severe flu symptoms, respectively. Adjusted for background factors, COVID-19-related cognitive representations (consequences: standardized b = 0.15, p = 0.010; understanding: standardized b = 0.21, p = 0.001) and emotional representations (concern: standardized b = 0.17, p = 0.001; negative emotions: standardized b = 0.19, p = 0.001) were positively associated with BICDFS. In the hierarchical model, independent significant factors of BICDFS included understanding ( standardized b = 0.16, p = 0.013) and negative emotions ( standardized b = 0.17, p = 0.008). The fear-related variables showed non-significant associations with the BICDFS. Conclusions Promotion of care-seeking behaviors for flu symptoms during the COVID-19 pandemic should consider improving people's understanding of COVID-19 and providing advice on related coping strategies for emotional responses to COVID-19.
... Many electrophysiology consultations may be completed without a physical visit of patients to hospital, by reviewing their reports and monitoring data which can minimize disease spread. 7,8 In telecardiology, further information is virtually exchanged between patients and cardiologist via various Internet platforms like video calling, WhatsApp, FaceTime, Skype, and Google Duo. 9 Aim of this study was to evaluate feasibility, safety, and impact of teleconsultations among patients with various implantable electronic devices [pacemakers, implantable cardioverter defibrillator (ICD), cardiac resynchronization therapy-defibrillator (CRT-D)]. ...
Article
Full-text available
Background: During ongoing coronavirus disease 2019 (COVID-19) pandemic, social isolation and lockdown measures were implemented to prevent spread of virus which created enormous challenges to patient healthcare. In order to overcome these challenges, teleconsultation (telecardiology) was initiated. Objective of this study was to assess outcome of telecardiology using audio/visual/audio-visual consultation among patients with implantable cardiac devices. Methods: Telecardiology was performed (either physician-initiated or patient-initiated) among 1200 patients over a five-month period (July 13 to December 13, 2020) to review health status of patients to decide further course of treatment and to access their satisfaction level with telecardiology. Results: Teleconsultation was cardiologist- and patient-initiated in 1042 (86.8%) and 158 (13.2%) cases, respectively. 1117 (93.2%) patients were stable, while scheduled admission, urgent hospitalization, and death were noted in 20 (1.8%), 45 (3.9%), and 18 (1.5%) patients, respectively. Next visit was rescheduled in 986 (82.2%), while 127 (10.6%) were called earlier because of battery depletion. Majority (n = 1077, 89.8%) were satisfied. Conclusion: Telecardiolgy is an effective option during COVID-19 to minimize interpersonal contact, spread of disease, psychological stress, and burden on already stretched healthcare.
... It is essential to have a work plan for follow-up the patient, including the responsibility and confidentiality in sharing personal health information using technology. Therefore, telehealth requires careful planning and implementation to reap the benefits [5][6][7][8]. ...
Article
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Telehealth is the delivery of health-related services and information using electronic information and communication technologies. Telehealth enables the health service providers to connect with a remote patient to provide care, advice, reminders, education, intervention, monitoring and facilitates remote admissions. Due to COVID-19 related travel restrictions, disruptions in access to healthcare were observed in Sri Lanka. Therefore, a telehealth solution to connect patients where specialist medical doctors were inaccessible or unavailable, was planned and implemented in the North Central province of Sri Lanka in 2020. The objective of this case study is to describe the experience during the planning and implementation of the telehealth intervention. Issues faced during planning and implementation were securing adequate funds, limited knowledge of information technology among the health staff, the reluctance of patients to explain and show the signs through video consultation, and difficulties faced during the allocation of responsibility at each step of the telehealth services and provision of network facilities to peripheral hospitals. These issues were Original Research Article Kumarasinghe et al.; AJARR, 16(8): 1-8, 2022; Article no.AJARR.88192 2 overcome by creating awareness among the key stakeholders on telehealth and its advantages, addressing concerns of the patients and conducting awareness campaigns on telehealth, streamlining the maintenance of equipment and most importantly, addressing concerns of the administrators, including health officials, and obtaining their consensus for the implementation of telehealth services. If these key issues can be forecasted and addressed timely, telehealth services could be successfully implemented in a resource-limited country like Sri Lanka.
... In the past, disasters, epidemics, and pandemics have often led to advances in innovative techniques, such as telemedicine [3,4]. The coronavirus disease 2019 (COVID- 19) pandemic has accelerated the process of implementing this technical innovation internationally, as well as in Germany, as the use of telemedicine procedures became necessary in many places owing to the existing contact restrictions [5][6][7][8][9][10][11]. ...
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Background In the wake of the coronavirus disease 2019 (COVID-19) pandemic, administrative barriers to the use of telemedicine have been reduced in Germany. The study focused on the analysis of use and assessment of telemedicine by physicians working in the outpatient sector, considering the perspective of different disciplines during the COVID-19 pandemic in Germany. Methods The anonymous cross-sectional online survey within the study COVID-GAMS was conducted from 16 November 2020 to 1 January 2021. General practitioners; cardiologists; gastroenterologists; paediatricians; gynaecologists; ear, nose, and throat (ENT) specialists were randomly selected and invited to participate in the survey. At the same time, open recruitment to the online survey was conducted via the professional societies. Descriptive and regression analyses were performed based on the data of 1521 outpatient responding physicians. Results The use of telephone and video consultation increased during the pandemic. Regarding the frequency of use, physicians already using telephone/video consultations in March/April 2020 report an increase in such services. General medicine was associated with an increased use of telephone and video consultations than cardiology, gynaecology or ENT, and in the case of telephone consultations also compared to paediatrics. General practitioners assessed the subjective usefulness higher than gynaecology and ENT. And the self-reported proportion of patients receiving telemedical care was higher correlated with general medicine than all other disciplines. The location of the practice (rural vs. urban), type of practice (individual vs. group) and gender (male vs. female) were also shown to be significant influencing factors on the variables mentioned above. Barriers reported by physicians not using telemedicine were the lack of equivalence to face-to-face contact and perceived low demand from patients. Conclusion The COVID-19 pandemic has led to a significant increase in the use of telemedicine, to varying degrees in the different specialities. Individual and structural factors lead to a reduced use of telemedicine and there are physician’s and patient’s barriers that have prevented telephone and video consultations from gaining acceptance by physicians. All these factors must be addressed if telemedicine procedures are to be implemented widely.
... During the COVID-19 pandemic, a number or telehealth or remote visit solutions have been trialled worldwide, as they offered a safe way to deliver healthcare services in an optimal manner whilst minimising face-to-face exposure [3]. In UK several digital solutions for video consultations or for symptoms checking were rapidly inserted into practice, especially in non-acute care (e.g., "AccuRx" 3 or "Attend Anywhere" 4 ). ...
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Telehealth has long been highlighted as a way to solve issues of efficiency and effectiveness in healthcare and to improve patients' care and has become fundamental to address patients' needs during the COVID-19 pandemic; however previous studies have shown mixed results in the user acceptance of such technologies. Whilst many previous studies have focussed on clinical application of telehealth, we focus on the adoption of telehealth for virtual assessments visits aimed to evaluate the suitability of a property where a patient is discharged, and eventual adaptations needed. We present a study of stakeholders' attitudes towards such virtual assessment visits. The study has been carried out with healthcare professionals and patients and allowed us to identify user attitudes, barriers and facilitators for the success of virtual assessment visits from the point of view of healthcare professionals and patients. Finally, we discuss implications for designers of telehealth services and guidelines that can be derived from our study.
... 10 Our study shows that UCAREs are very much on board with this strategy: The rate of face-to-face consultations decreased by 62%, from 90% of consultations to less than half, whereas the rate of remote consultations, mainly done by phone calls and WhatsApp, increased by more than 600%, from one in 10 consultations to more than two thirds. Remote consultations have been shown to be a useful tool during the COVID-19 pandemic, 20,21 but the long-term consequences of remote care for patients with CU in terms of costs, benefits, impact on physician/patient relation, data protection and confidentiality, comfort, risk of malpractice, and effectiveness of disease management remain to be characterized. 22,23 CURICT, a recent UCARE study of the use of Internet and communication technologies (ICTs) by patients with urticaria, found that almost all CU patients have access to ICTs and that most patients use ICTs regularly to obtain CU-related information. ...
... A key factor in slowing the transmission of an infectious pathogen is "social distancing" to decrease personto-person contact. Telemedicine can perform remote triaging of care, assist in diagnosis via video consultations and testing, provide care for those who are infected, disseminate public advice and education, and serve as a tool to coordinate and deliver routine medical care [12]. The implementation of telemedicine during the ongoing COVID 19 pandemic was not only restricted to first-world economies in North America and Europe but lowerresource countries such as Africa, Latin America, the Middle East, and Asia [9,13]. ...
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The COVID-19 pandemic has been an unprecedented health crisis for the general population as well as for patients with chronic illnesses such as those requiring maintenance dialysis. Patients suffering from chronic kidney disease requiring dialysis are considered a high-risk population. Multiple reports have highlighted an increased need for intensive care and higher death rates among this group of patients. Most maintenance dialysis patients are in-centre haemodialysis patients who receive treatment in shared facilities (community dialysis centres). The inability to maintain social distancing in these facilities has led to case clustering among patients and staff. This poses a substantial risk to the patients, their household members, and the wider community. To mitigate the risks of COVID-19 transmission, telemedicine was rapidly adopted in the past year by nephrologists and other allied-health staff to provide care via remote consultations and reviews. Telemedicine poses unique challenges even in an era where so much is performed online with a high degree of success and satisfaction. In applying distant clinical care for maintenance haemodialysis patients via telemedicine, there is a need to ensure adequate protection for the health and safety of patients as well as understand the ethical and legal implications of telemedicine. We discussed, in this article, these three core aspects of patient safety and quality, ethics and legal implications in telemedicine, and how each of these is crucial to the safe and effective delivery of care in general as well as unique aspects of this in Singapore.
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Background: The coronavirus pandemic of 2019 (COVID-19) forced worldwide recognition and implementation of telehealth as a means of providing continuity of care by varied health care institutions. Diabetes is a global health threat with rates that continue to accelerate, thereby causing an increased need for clinicians to provide diabetes care and education to keep up with demand. Utilizing technology to provide education via phone/smartphone, video/audio, web, text message, mobile apps, or a combination of these methods can help improve patient access and clinical outcomes, cut costs, and close gaps in care. Methods: While numerous publications have summarized the various tools and technologies available for capturing remote clinical data and their relevance to diabetes care and self-management, this review focuses on self-educational telehealth tools available for diabetes self-management, their advantages and disadvantages, and factors that need to be considered prior to implementation. Recent relevant studies indexed by PubMed were included. Results: The widespread use and popularity of phones/smartphones, tablets, computers, and the Internet by patients of all age groups, cultures, socioeconomic and geographic areas allow for increased outreach, flexibility, and engagement with diabetes education, either in combination or as an adjunct to traditional in-person visits. Demonstrated benefits of using health technologies for diabetes self-management education include improved lifestyle habits, reduced hemoglobin A1C levels, decreased health care costs, and better medication adherence. Potential drawbacks include lack of regulation, need for staff training on methodologies used, the requirement for patients to be tech savvy, privacy concerns, lag time with technology updates/glitches, and the need for more long-term research data on efficacy. Conclusions: Telehealth technologies for diabetes self-education improve overall clinical outcomes and have come a long way. With increasing numbers of patients with diabetes, it is expected that more optimal and user-friendly methodologies will be developed to fully engage and help patients communicate with their physicians.
Article
Introduction: Telehealth is an applicable, acceptable, cost-effective, easily accessible, and speedy method for pregnant women. This study aimed to examine the impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancies. Methods: Studies were selected from PubMed, Science Direct, Web of Science, EBSCO, Scopus, and Clinical Key databases according to the inclusion and exclusion criteria from January to February 2021. Cochrane risk-of-bias tools were used in the quality assessment of the studies. Results: Four observational and eight randomized controlled studies were included in this meta-analysis (telehealth: 135,875, control: 94,275). It was seen that the number of ultrasound (p < 0.01) and face-to-face visits (p < 0.01), fasting insulin (p < 0.01), hemoglobin A1C before delivery (p < 0.01), and emergency cesarean section rates (p = 0.05) were lower in the telehealth group. In the telehealth group, the women's use of antenatal corticosteroids (p = 0.03) and hypoglycemic medication at delivery (p = 0.03), the total of nursing interventions (p < 0.01), compliance with actual blood glucose measurements (p < 0.01), induction intervention at delivery (p = 0.003), and maternal mortality (p < 0.001) rates were higher. Two groups were similar in terms of the use of medical therapy, total gestational weight gain, health problems related to pregnancy, mode and complications of delivery, maternal intensive care unit admission, fetal-neonatal growth and development, neonatal health problems and mortality, follow-up, and care costs. Discussion: Telehealth and routine care yielded similar maternal/neonatal health and cost outcomes. It can be said that telehealth is a safe technique to work with in the management of high-risk pregnancies.
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Pandemics are well-known as epidemics that spread globally and cause many illnesses and mortality. Because of globalization, the accelerated occurrence and circulation of new microbes, the infection has emerged and the incidence and movement of new microbes have sped up. Using technological devices to minimize the visit durations, specifying days for handling chronic diseases, subsidy for the staff are the alternatives that can help prevent healthcare systems from collapsing during pandemics. The study aims to define the efficient usage of optimization tools during pandemics to prevent healthcare systems from collapsing. In this study, a new integrated framework with fuzzy information is developed, which attempts to prioritize these alternatives for policymakers. First, rating data are assigned respective fuzzy values using the standard singleton grades. Later, criteria weights are determined by extending Cronbach´s measure to fuzzy context. The measure not only understands data consistency comprehensively, but also takes into consideration the attitudinal characteristics of experts. By this approach, a rational weight vector is obtained for decision-making. Further, an improved Weighted Aggregated Sum Product Assessment (WASPAS) algorithm is put forward for ranking alternatives, which is flexibly considering criteria along with personalized ordering and holistic ordering alternatives. The usefulness of the developed framework is tested with the help of a real case study. Rank values of alternatives when unbiased weights are used is given by 0.741, 0.582, 0.640 with ordering as R 1 R 3 R 2. The sensitivity/comparative analysis reveals the impact of the proposed model as useful in selecting the best alternative for the healthcare systems during pandemics.
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Heart failure is associated with high rates of hospitalization, which are more prevalent in frail patients, impacting the quality of life and clinical outcomes. Telemedicine is considered cost-effective for improving patient self-management and hospitalization. However, socioeconomic deprivation and frailty could hinder access to virtual care. We investigated if frailty and socioeconomic factors were associated with telemedicine access among heart failure patients. For this cross-sectional analysis of Continuum study, 35 patients were allocated to the “able to use” group (had a smart device and were able to use it) or the “not able to use” group. Socioeconomic deprivation was determined according to the deprivation index. Frailty was assessed using the Fried criteria. The mean age was 69.9 ± 9 years, 74% were in New York Heart Association class II. A total of 14 patients (39%) were physically frail. Patients considered not able to use the app were more socioeconomically deprived ( p = 0.011) and frail ( p = 0.036). There was no correlation between frailty score and socioeconomic deprivation ( r = 0.15, p = 0.411). Telemedicine use seems to be independently associated with frailty and socioeconomic deprivation in heart failure patients. More efforts should be made to foster the inclusion of vulnerable patients and improve global telemedicine access.
Article
The COVID-19 pandemic resulted in rapid telemedicine implementation. This study aimed to identify mean differences in telehealth maternity care provided by perceived patient acceptability and clinician satisfaction, and to determine the association between acceptability, satisfaction, and perceived anticipation of long-term telehealth utilization in family medicine maternity care. Data from the 2020 Council of Academic Family Medicine Educational Research Alliance general membership survey of family medicine educators and practicing clinicians were analyzed. Respondents who reported providing maternity care in the 12 months preceding the survey were included (N = 290). Descriptive statistics were calculated. ANOVA was used to determine the mean difference in percent maternity care provided by reported clinician satisfaction and perceived patient acceptability. Logistic regression models were fit to determine associations between perceived telehealth satisfaction and acceptability with long-term use. The sample was 67 percent female, 85 percent white, mean age of 45 years (SE = .63). 51 percent reported total prenatal visits decreased since pandemic onset. Greater agreement with perceived patient telehealth acceptability (OR = 3.73 , 95 percent CI 1.09, 12.71) and clinician telehealth satisfaction (OR = 3.72 , 95 percent CI 1.40, 9.86) was significantly associated with anticipated long-term usage. Perceived patient telehealth acceptance and clinician satisfaction were significantly higher among clinicians providing more telehealth and positively associated with anticipated long-term use.
Article
Objective: In response to the COVID-19 pandemic, use of telehealth to deliver care was recommended across the Australian health system. This study aims to explore the barriers and enablers to delivery of psycho-oncology services via telehealth and attitudes to use of telehealth in psycho-oncology. Methods: Twenty-one psycho-oncology clinicians participated in semi-structured telephone interviews. Transcribed interviews were thematically analysed using the framework method. Results: Three key themes were identified which described the overall experience of delivering psycho-oncology services via telehealth: (1) Context Matters- for whom is telehealth effective, when is it less effective; (2) Therapy content and telehealth implementation ; (3) Recommendations for Sustainability. Conclusions: These insights into the barriers and enablers to delivering psycho-oncology services via telehealth inform future research and clinical practice. While there is support for the continued use of telehealth in psycho-oncology, there are significant improvements needed to ensure effective implementation and continued benefit. This article is protected by copyright. All rights reserved.
Article
Background: Long before the outbreak of COVID-19, chatbots had been playing an increasingly crucial role and gaining growing popularity in healthcare. In the current omicron waves of this pandemic when the most resilient healthcare systems at the time are increasingly being overburdened, these conversational agents (CA) are being resorted to as preferred alternatives for healthcare information. For many people, especially the adolescent and middle-aged, mobile phones are the most favored source of information. As a result of this, it is more important than ever to investigate the user experience of and satisfaction with chatbots on mobile phones. Objective: The objective of this study was twofold: (i) Informed by Deneche & Warren's evaluation framework, Zhu, Janssen, Wang & Liu's measures of variables, and the Theory of Consumption Values, we designed a new assessment model for evaluating the user experience of and satisfaction with chatbots on mobile phones; and (ii) we aimed to validate the newly-developed model and use it to gain an understanding of the user experience of and satisfaction with the popular healthcare chatbots that are available for use by young people aged between 17 and 35 in southeast China in self-diagnosis and acquiring information about COVID-19 and virus variants that are currently spreading. Methods: First, in order to assess user experience and satisfaction, we identified the assessment model based on relevant literature and the Theory of Consumption Values. Second, the chatbots were pre-screened and selected for investigation. Subsequently, 413 informants were recruited from Nantong University, China. This was followed by a questionnaire survey soliciting the participants' experience of and satisfaction with the selected healthcare chatbots via an Internet questionnaire survey platform (https://www.wjx.cn/). Finally, quantitative and qualitative analyses were made to find the informants' perception. Results: The data collected were highly reliable (cronbach α=0.986) and valid (communalities=0.632~0.823, KMO=0.980, percentage of cumulative variance (rotated)=75.257%, P<.001). The findings of this study suggest a considerable positive impact of the functional, epistemic, emotional, social, and conditional values on the participants' overall user experience and satisfaction and a positive correlation between these values and user experience and satisfaction (Pearson Correlation P<.001). The functional values (mean=1.762) and epistemic values (mean=1.834) of the selected chatbots were relatively more important contributors to the students' positive experience and overall satisfaction than the emotional values (mean=1.993), the conditional values (mean=1.995), and the social values (mean=1.998). All the participants (n=413, 100%) basically had a positive experience and were thus basically satisfied with the selected healthcare chatbots. The five grade categories of participants showed different degrees of user experience and satisfaction: seniors (mean=1.853) were the most receptive to healthcare chatbots for COVID-19 self-diagnoses and information, and second-year graduate candidates (mean=2.069) were the least receptive; freshmen (mean=1.883) and juniors (mean=1.925) felt slightly more positive than sophomores (mean=1.989) and first-year graduate candidates (mean=1.992) when engaged in conversations with the chatbots. Besides, female informants (mean=1.931) showed a relatively more receptive attitude towards the selected chatbots than male respondents (mean=1.999). Conclusions: This study investigates the use of healthcare chatbots among young people (aged 17-35) in China, focusing on their user experience and satisfaction examined through an assessment framework. The findings show that the five domains in the new assessment model all have a positive impact on the participants' user experience and satisfaction. In this paper, we examined the usability of healthcare chatbots as well as actual chatbots used for other purposes, enriching the literature on the subject. This study also provides practical implication for designers and developers as well as for governments of all countries, especially in the critical period of the omicron waves of COVID-19 and other future public health crises. Clinicaltrial:
Article
BACKGROUND: Tele-physiotherapy continues to rise, noticeably in Saudi Arabia which established a tele-physiotherapy initiative in 2018. However, data about the population’s understanding of tele-physiotherapy are scarce. OBJECTIVE: To explore Saudi population’s perception of tele-physiotherapy, and the correlation between quality of life and tele-physiotherapy preferences. METHODS: A cross-sectional online survey conducted on Riyadh residents, using a self-administered tele-physiotherapy survey and the SF-12 quality of life (QoL) index (Arabic version). RESULTS: Of 1011 participants, 85.3% were female, 50.8% were aged 26 to 50 years, almost 75% had university-level education, and 34.2% were employed. Only 19% had heard about tele-physiotherapy, with 43.7% of them citing social media as a source. Only 2.5% had tried tele-physiotherapy. Almost half reported uncertainty about most of the tele-physiotherapy questions, and over half recognised limitations e.g., anxiety about incorrectly performing the exercises (79.7%), therapist communication (51.7%), technical problems (70.7%), and privacy violations (66.3%). However, 58.7% said they would try tele-physiotherapy. There was no significant correlation between SF-12 QoL scores and participants’ tele-physiotherapy knowledge. CONCLUSIONS: There was a significant lack of knowledge among our cohort of patients about tele-physiotherapy. Even though, the willingness to try tele-physiotherapy was generally positive. More strategies need to be implemented to educate the Saudi individuals about tele-physiotherapy.
Article
Introduction The use of video consulting (VC) in Wales UK has expanded rapidly. Previous VC evidence has been the subject of small-scale projects and evaluations. Technology Enabled Care Cymru is an all-Wales digital service and rolls out digital interventions and evaluates on large scales, thus capturing representative data sets across Wales, and therefore a wide range of National Health Service (NHS) specialties. Objective To extract and analyse narrative feedback from patients and clinicians using the NHS Wales VC Service for 6 months (September 2020 to March 2021). Design A coding reliability approach of a cross-sectional study was conducted. Setting From all health boards across Wales. Participants NHS patients and clinicians across primary, secondary and community care settings in Wales. Results Data were captured on benefits, challenges and sustainability of VC. A coding reliability analysis was used with six domain summaries materialising to include: ‘The Ease of VC’; ‘The Personal Touches’; ‘The Benefits of VC’; ‘The Challenges of VC’; ‘Technical Quality’; and ‘Recommendations & Future Use’. An additional 17 subdomains are included. Direct quotations from patients and clinicians are provided for context. Conclusions A total of 22 978 participants were included. These data help demonstrate that NHS remote service delivery, via the method of VC, can be highly satisfactory, well accepted and clinically suitable yielding many benefits. Despite this, the data are not without its challenges surrounding engagement and suitability for VC. The NHS Wales VC Service rolled out and evaluated at scale and demonstrates that VC has potential for long-term sustainability. For the future, use a ‘blended approach’ for NHS appointments that are clinically judged and centred on patient choice.
Article
Most countries did not have a consolidated digital health structure before the pandemic. Both social distancing and mental health problems resulting from the situation justify the urgency of discussions on web-mediated interventions. The objective of this work is to present the panorama of technological mediation in mental health services and their specificities in the context of the pandemic. This paper is grounded on a critical look at the migration from face-to-face care to the Internet environment, highlighting: the international experiences using digital technologies in the pandemic context; the challenges in online consultations, emphasizing the importance of the ethical, technical/technological, and clinical domains, which are recurring issues in the international literature; the challenges and perspectives in the use of technologies. It is essential to develop strategies aligned with government incentives, aiming at the quality of the offered services and the guarantee of an adequate hybrid qualification.
Article
Background During the COVID-19 pandemic, the focus of many health care systems shifted in order to prioritize and allocate resources toward treating those affected by COVID-19. What this has meant for other patient populations remains unclear. We aimed to determine if there have been changes to acute care access for patients with inflammatory bowel disease (IBD) during the COVID-19 pandemic. Methods A retrospective cohort study was performed in IBD patients seen during (March 1, 2020 to August 31, 2020) and before (March 1, 2019 to August 31, 2019) the COVID-19 pandemic. IBD-related emergency room (ER) access, hospitalization, inpatient care and follow-up and post-discharge ER access were assessed. Results A total of 1229 participants were included. A higher proportion of patients accessed ER during the pandemic (44.6% versus 37.2%, P = 0.0097). A higher proportion of hospitalizations resulted from IBD-related ER visits during the pandemic period (41.6% versus 32.4%, OR = 1.48, 95% CI = 1.14 to 1.94, P = 0.0047), though length of stay was shorter (7.13 ± 8.95 days versus 10.11 ± 17.19 days, P = 0.015) and use of rescue infliximab was less. No change was seen in inpatient surgical intervention. Despite similar proportions of follow-up appointments post-hospital discharge (pre-pandemic, 77.9% versus pandemic, 78.3%), more ER visits occurred in the first 30 days following hospitalization for patients in the pandemic cohort (24.4% versus 11.1%, P = 0.0015). Conclusion These data highlight the need for ER services and hospitalization amongst IBD patients during the COVID-19 pandemic. This suggests that a return to pre-pandemic IBD care infrastructure is needed to mitigate the need for acute care access.
Article
In recent years, and especially due to COVID-19, a large number of telehealth interventions have been implemented. The large amount of information requires a differential analysis with an emphasis on rurality and the practice of parents/caregivers in the care and attention of children. The objectives of this study were to synthesize the available evidence on telehealth interventions aimed at parents and caregivers of children living in rural settings, and to identify relevant methodological aspects that are considered in such interventions. A systematic review was conducted in the Medline (Ovid), Embase, Scopus, APA-PSYCNET, Web of Science and LILACS databases. Studies published between 2000 and 2020 were considered. A narrative synthesis of the main results of the studies was performed, including basic characteristics, details of the interventions, and the main outcome measures. The quality of the studies included was assessed using the Joanna Briggs Institute Critical Appraisal tools. A total of 596 potential studies were identified, of which only nine were included. Quality assessment was consistent in all nine studies. Parents and caregivers of children with speech and language impairment, motor impairment or problems in performing activities of daily living, with behavior problems, and with autism spectrum disorder were the main populations groups benefiting from the interventions. Telehealth interventions were implemented by means of online sessions, pre-recorded sessions and self-learning modules, among others. Results, although variable, evidence positive outcomes regarding the development of multiple skills in children, their parents and family members, as well as the opportunity to provide timely access to health services. Finally, Telehealth is increasingly becoming a useful tool to provide counsel and knowledge to parents and caregivers living in rural areas that will enable them to properly manage health problems.
Article
Purpose: To examine Canadian physiotherapists’ experiences in adapting their delivery of patient care during the COVID-19 pandemic. We examine the level of strain on the profession and barriers and enablers to virtual care and provide strategies to support future virtual care implementation. Methods: From May–October 2020, a series of eight cross-sectional survey cycles were distributed every 2–4 weeks through branches and divisions of the Canadian Physiotherapy Association, social media, and personal networks. Descriptive statistics summarized the main findings. Open ended questions were first analyzed inductively using thematic analysis, then deductively mapped to the Capability-Opportunity-Motivation Behavioural (COM-B) Model. Results: Between 1,820 (cycle 1) and 334 (cycle 7) physiotherapists responded. Median strain level was 5/5 (cycle 1) and dropped to median 3/5 (cycles 5-8). In cycle 1, 55% of physiotherapists had ceased in-person care, while 41% were providing modified in-person care. Of these physiotherapists, 79% were offering virtual care. As modified in-person care increased, virtual care continued as a substantial aspect of practice. Physiotherapists identified barriers (e.g., lack of hands-on care) and enabling factors (e.g., greater accessibility to patients) for virtual care. In-depth examination of the barriers and enablers through the COM-B lens identified potential interventions to support future virtual care implementation, including education and training resources for physiotherapists and communication and advocacy to patients and the public on the value of virtual care. Conclusions: Canadian physiotherapists exhibited high adaptability in response to COVID-19 through the rapid and widespread use of virtual care. By creating an in-depth understanding of the barriers and enablers to virtual care, along with potential interventions, this work will facilitate future opportunities to support and enhance physiotherapists’ delivery of virtual care.
Article
Background: There is growing global evidence on the adoption and effectiveness of eHealth (including mobile health and telehealth) by First Nation peoples including Aboriginal and Torres Strait Islander people. Although there are frameworks to guide eHealth development, implementation, and evaluation, it is unknown whether they adequately encapsulate the health, cultural, and community-related priorities of Aboriginal and Torres Strait Islander people. Objective: The aim of this research program is to prepare a best practice framework that will guide the co-design, implementation, and evaluation of culturally safe eHealth interventions within existing models of health care for Aboriginal and Torres Strait Islander people. The framework will be a synthesis of evidence that represents best practices in eHealth, as determined by Aboriginal and Torres Strait Islander people. Methods: Research activities to develop the best practice framework will occur in stepped but overlapping qualitative research phases with governance from an existing multiagency research collaboration (the Collaboration). The research protocol has been informed by key research frameworks such as the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) and Developers of Health Research Reporting Guidelines. The seven phases of research will include the following: systematic literature review, scoping review, theme development, theme consultation, Delphi processes for expert reviews, and dissemination. Results: Members of the Collaboration conceived this research program in August 2020, and a draft was produced in June 2021 with subsequent funding obtained in July 2021. The Collaboration approved the protocol in December 2021. Results for several research phases of the best practice framework development are expected by January 2023, commencing with the systematic literature review and the scoping review. Conclusions: The research program outlined in this protocol is a timely response to the growing number of eHealth interventions with Aboriginal and Torres Strait Islander people. A best practice framework is needed to guide the rigorous development and evaluation of eHealth innovations to promote genuine co-design and ensure cultural safety and clinical effectiveness for Aboriginal and Torres Strait Islander people. International registered report identifier (irrid): DERR1-10.2196/34904.
Article
Parsonage–Turner Syndrome or neuralgic amyotrophy is a peripheral neuropathy typically characterized by an abrupt onset of pain, followed by progressive neurological deficits (e.g. weakness, atrophy, occasionally sensory abnormalities) that involve the upper limb, mainly the shoulder, encompassing an extensive spectrum of clinical manifestations, somehow difficult to recognize. This case report describes the proper management of a 35-year-old, bank employee and sports amateur who reported subtle and progressive upper limb disorder with previous history of neck pain. SARS-CoV-2 pandemic era made patient's access to the healthcare system more complicated. Nevertheless, proper management of knowledge, relevant aspects of telerehabilitation-based consultation for musculoskeletal pain, advanced skills, tools and technologies led the physiotherapist to suspect an atypical presentation of Parsonage–Turner Syndrome. Further, neurologist consultation and electromyography suggested signs of denervation in the serratus anterior and supraspinatus muscle. Therefore, an appropriate physiotherapist's screening for referral is conducted to correct diagnosis and thorough treatment.
Article
Introduction Remote assessment creates opportunities for monitoring child development at home. Determining the possible barriers to and facilitators of the quality of telemonitoring motor skills allows for safe and effective practices. We aimed to: (1) determine the quality, barriers and facilitators of Alberta Infant Motor Scale (AIMS) home videos made by mothers; (2) verify interrater reliability; (3) determine the association between contextual factors and the quality of assessments. Methods Thirty infants at biological risk aged between three and ten months, of both sexes, and their mothers were included. Assessments were based on asynchronous home videos, where motor skills were evaluated by mothers at home according to AIMS guidelines. The following were analyzed: video quality; stimulus quality; camera position; and physical environment. The video characteristics were analyzed descriptively. The intraclass correlation coefficient was used to calculate interrater reliability and the regression model to determine the influence of contextual factors on the outcome variables. Significance was set at 5%. Results Remote assessment of AIMS exhibited high image and stimulus quality, and a suitable physical environment. Interrater reliability was high for all domains: prone ( r = 0.976); supine ( r = 0.965); sitting ( r = 0.987); standing ( r = 0.945) and total score ( r = 0.980). The contextual factors had no relation with assessment quality. Discussion Assessments conducted remotely by the mothers showed high video quality and interrater reliability, and represent a promising assessment tool for telemedicine in at-risk infants in the first year of life.
Article
Introduction Coronavirus disease 2019 accelerated the use of virtual visits within health care. We examined the utility of telemedicine for conducting visits in a tertiary head and neck practice. Methods A retrospective study was conducted on patients presenting via video to a tertiary-level head and neck clinic between January 2020 and December 2020. Patient demographics were collected in addition to visit indication, diagnostic imaging/tests at the time of visit, and post-visit plan. Visits were deemed successful if evaluation by video was sufficient in determining a clinical plan and did not require deferment of recommendations for subsequent in-person consult visits and/or work-up (labs, imaging). Logistic regression was performed to identify variables that served as significant predictors of successful video visits. Results A total of 124 video visits were reviewed. Video visits were successful for the initial evaluation 88.7% of the time ( n = 110). Computerized tomographic scans were the most available diagnostic test, available for 54% of patients ( n = 67), followed by biopsy report 30.6% ( n = 38). Visit indication had a statistically significant effect on whether a treatment plan could be made ( p = 0.024). For new patients with parotid masses ( n = 42), definitive treatment plans could be made 97.6% of the time ( n = 41). Patients presenting with an indication of thyroid mass (odds ratio: 0.19 (confidence interval: 0.00072–0.50), p = 0.018) and other neck mass (odds ratio: 0.035 (confidence interval: 0.0014, 0.90), p = 0.043) were at significantly lesser odds than parotid patients to have a successful video visit. Discussion In this study, virtual visits were successful for a high percentage of head and neck visits, particularly among patients seeking evaluation for parotid-related concerns.
Article
Introduction: Adoption of telemedicine by healthcare facilities has dramatically increased since the start of coronavirus pandemic; yet, major differences exist in universal acceptance of telemedicine across different population groups. The goal of this study was to examine population-based factors associated with current and/or future use of telemedicine in Alabama. Methods: A cross-sectional survey was administered to 532 participants online or by phone, in four urban and eight rural counties in Alabama. Data were collected on: demographics, health insurance coverage, medical history, access to technology, and its use in accessing healthcare services. Generalized logit regression models were used to estimate the odds of choosing "virtual visit" and "phone communication" compared to "in-person visit" for the preferred choice of visit with the healthcare provider; as well as odds for willingness to participate in "virtual visit" in the future. Results: Our study sample had a mean age of 43 (±15) years, 72.9% women, 45.9% Black or African American; 59.4% population living in an urban county. The odds of "phone communication" were higher compared to the odds of "in-person visit", with a unit increase in age (odds ratio: 1.02, 95% confidence interval: 1.00-1.03), after adjusting for other covariates. Among participants with past experience of virtual communications, the odds for choosing "virtual visit" were significantly higher compared to choice of in-person visit (odds ratio for virtual visit: 3.23, 95% confidence interval: 2.01-5.18), adjusted for other covariates. Further, people with college or more education were 71% less likely to choose "No" compared to those with high school or lower general education development education for future virtual visit [odds ratio for college or more: 0.29, 95% confodence interval: 0.10-0.87). Likewise, participants residing in rural counties were 57% less likely to choose "No" compared to urban counties for future virtual visit (odds ratio for rural participants: 0.43, 95% confidence interval:0.19-0.97). Discussion: Our study found notable differences in age, education, and rurality for use and/or preference for telemedicine. Medical institutions and healthcare providers will need to account for these differences to ensure that the implementation of telemedicine does not exacerbate existing health disparities.
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The COVID-19 pandemic has highlighted limitations in access to healthcare. During the current public health emergency (PHE), Medicare, private insurers and state licensing boards have made policy changes liberalizing reimbursement for telehealth. Historically, Medicare and large private insurers (in the US) have presumed information technology (IT) fluency by patient populations. However, data demonstrate that there are numerous populations who demonstrate very limited utilization of IT for accessing healthcare, including older adults. These data demonstrate the importance of assessing IT utilization to make healthcare accessible to individual patients, and to better understand patterns of IT utilization among groups with historically low IT utilization. Under pressure from medical and consumer groups, Medicare and private insurers allowed reimbursement for telephone-only virtual visits during the PHE, but indicate that termination of the PHE will be coupled with termination of more liberal telehealth policies. In addition, Medicare and private insurers continue to seek loopholes allowing exclusion of various types of telehealth, which will make telehealth (and healthcare) inaccessible to the most vulnerable populations, including older adults. Recommendations are made for assessment of IT utilization as part of routine patient intake assessment, in order to make healthcare accessible, improve communication between patients and healthcare providers, and to improve treatment outcomes. Recommendations are also made for permanent telehealth policy changes that will make healthcare more accessible to at-risk populations.
Article
Purpose This study examined how allied health professionals (e.g., speech-language pathology, physical therapy, and occupational therapy), who provide services to low socioeconomic–status (SES) families through a Texas-based pediatric home health agency, responded to a shift from in-person to telehealth service delivery during the COVID-19 pandemic. Method A 28-item survey was sent out to the 308 clinical staff members at the Texas-based pediatric agency. One hundred thirty-eight respondents completed the survey in its entirety with a response rate of 44.8%. Results Across the allied health professions, most therapists identified themselves as “somewhat prepared,” whereas few respondents identified themselves as “very prepared” or “not at all prepared” to transition to telehealth service delivery. Regardless of perceived differences in service delivery models and challenges faced during the rapid transition to telehealth, therapists largely rated client progress as similar between in-person and telehealth sessions despite reporting level of client engagement, response to cues, and ability to engage in hands-on activities as better in-person than in telehealth sessions. Comparisons among allied health professions and considerations related to the specific population served are discussed. Conclusions Survey results from the allied health professionals at Care Options for Kids and the clinical population of low-SES, early intervention clients were consistent with findings from similar surveys conducted in which the clinical populations were not defined (client age, diagnosis, etc.), suggesting that during the pandemic, allied health professionals face similar challenges as they adopt a telehealth service delivery model. Additional training and access to resources may address some of these challenges. As the pandemic persists, results from this survey may be used to inform therapy companies in their decision-making processes related to the implementation of telehealth.
Chapter
The rise of dementia among the old population across the world will rapidly make financial suffering on healthcare industries, yet convenient acknowledgment of early notice for dementia and appropriate reactions to the event of dementia can upgrade clinical treatment. Usage of medical service data and health behavior are generally more available than clinical information, and a pre-screening apparatus with effectively open information could be a decent answer for dementia-related issues. In this chapter, we applied different deep neural networks (DNN) algorithms including Convolutional Neural Networks (CNN), Residual Neural Networks (RNN), Inception V3, and Dense Neural Networks (Densenet) were applied to the classification of MRI brain images. We considered brain images of 1098 subjects data collected from OASIS-3 imaging datasets whose age range was between 42 and 95. The system has been run with and without fine-tuning of features. The comparison of different models was performed and it is found that CNN and Dense net was outperformed other models and provided comprehensive performance outcomes with an accuracy of 95.7%, and 95.5%, respectively. This method can help both patients and doctors on early pre-screening of possible dementia.
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While there has been a staggering decline in global child mortality, sub-Saharan Africa (SSA) has consistently contributed the largest share. The 2020 global estimates on child mortality indicate SSA contributing 42%, 53% and 61% of neonatal, under-five, and 5-9 deaths, respectively. Moreover, the 1990-2020 child mortality data indicate an upward trend in SSA’s contribution in all age groups. The persistent high child mortality within the region could be attributed, amongst others, to inequities in health services’ access within countries. Additionally, there have been limited interventions that target children aged 5 years and beyond due to the limited research and data systems. As the focus of this paper-based thesis, Uganda as the study area shows the same issues within the SSA context. Therefore, it presents a novel opportunity to understand child health and mortality mechanisms among children aged 0-9 years. Guided by the concepts of interdependence, social interactions and health service delivery systems’ drawn from social and health systems and life-course perspectives, the thesis’ specific objectives are to: 1) determine the under-10 mortality age-specific estimates; 2) assess the epidemiological shift in the under-10 mortality risk factors and causes of death; 3) assess the role of Low Birth Weight (LBW) in mediating the new-born mortality risk factors and the role of institutional delivery in new-born mortality; 4) identify key community and household predictors of suspected pneumonia and diarrhoea, and 5) examine how multiple factors concurrently affect access to appropriate health care services. Using a decade (2005-2015) of event history data collected by Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) in Eastern Uganda in Chapter 31, I found that the under-10 and 5-9 years of age mortality probabilities were 99 per 1000 live births and 11 per 1000 children aged 5-9 years, respectively. The new-born mortality and perinatal mortality were estimated at 22 and 31 per 1000 live births, respectively, with death within the first day of life (0-1 day) contributing the largest share (62%). I found that the magnitude of the association of the risk factors with under-10 mortality varied by age, with a stronger association observed among infants. The order of the top causes of mortality altered with age, with gastrointestinal infections and injuries emerging among 5-9 years old, but malaria and malnutrition remaining among the leading four mortality causes. Using Iganga-Mayuge HDSS data in Chapter 42, I found that institutional delivery had an insignificant inverse effect on new-born mortality. The LBW mediated multiple factors, including adolescence age, rural residence, multiple births and unmarried marital status. The novel machine learning technique applied on 2006-2016 Uganda DHS data in Chapter 53 helps us identify rural-urban differentials in the deterministic pattern of a child’s diarrhoea and acute respiratory infection (ARI). The study findings confirm the notion that ARI and diarrhoea risk factors overlap. These factors relate to the household’s structure and composition, which is characterised by poor hygiene and sanitation and poor household environments that make children more suspectable of developing these diseases; maternal socio-economic factors such as education, occupation, and fertility (birth order); individual risk factors such as child age, birth weight and nutritional status; and protective interventions (immunisation). Furthermore, the qualitative data analysis collected in Chapter 64 revealed how multiple factors concurrently affect access to obstetric and child health care services. Chapter 6 findings were used to develop a multisectoral and multidimensional implementation framework for obstetric and child health care services in resource-poor settings. Overall, the application of life course and systemic approach in the analysis and interpretation of the results provides an insight into the need for holistic interventions (social, structural, and health systems) throughout the stages of child development. Each paper brings new insights into the mechanisms and determinants of under-10 mortality in resource-poor settings. Together, the papers help us build a stronger life-course and health systems framework for child health and survival, contributing to the recent call for redesigning child health programs.
Article
The COVID-19 pandemic caused disruptions in behavioral health services (BHS), essential for people experiencing homelessness (PEH). BHS changes created barriers to care and opportunities for innovative strategies for reaching PEH. The authors conducted 50 qualitative interviews with behavioral health providers in the USA during August-October 2020 to explore their observations of BHS changes for PEH. Interviews were transcribed and entered into MAXQDA for analysis and to identify salient themes. The largest impact from COVID-19 was the closure or limited hours for BHS and homeless shelters due to mandated "stay-at-home" orders or staff working remotely leading to a disconnection in services and housing linkages. Most providers initiated telehealth services for clients, yielding positive outcomes. Implications for BHS are the need for long-term strategies, such as advances in communication technology to support BHS and homeless services and to ensure the needs of underserved populations are met during public health emergencies.
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Chronic spinal pain conditions can often be successfully managed by a non-surgical, multidisciplinary approach, however many individuals are unable to access such specialised services within their local community. A possible solution may be the delivery of care via telerehabilitation. This study aimed to evaluate clinicians’ perspectives on providing clinical care via telerehabilitation during the early implementation of a novel spinal telerehabilitation service. Eight clinicians’ were recruited, completing surveys at four separate time points. Confidence in providing treatment via telerehabilitation significantly improved with time (?2(3)=16.22, p=0.001). Clinicians became significantly more accepting of telerehabilitation being a time- (?2(3)=11.237, p=0.011), and cost-effective (?2(3)=9.466, p=0.024) platform in which they could deliver care. Overall satisfaction was high, with technology becoming easier to use (p=0.026) and ability to establish rapport significantly improved with experience (p=0.043). Understanding clinicians’ perspectives throughout the early implementation phase of a new telerehabilitation service is a critical component in determining long-term sustainability.
Book
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This book is the culmination of a four year effort in a NATO Science for Peace and Security (SPS) Programme including Romania, Finland, Moldova, the Ukraine and the United States. Through 15 chapters, the book presents telemedicine applications in disaster.
Article
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Introduction: Telemedicine is an application of information and communication technology in the healthcare environment. This study aimed to compare knowledge and perceptions of telemedicine technology among different groups of clinicians. Methods: This survey study was conducted in 2013. The potential participants included 532 clinicians who worked in two hospitals and three clinics in a northern province of Iran. Data were collected using a five-point Likert-scale questionnaire. The content validity of the questionnaire was checked, and the reliability was calculated using Cronbach's alpha coefficient (α = 0.73). Results: The results showed that most of the clinicians (96.1 percent) had little knowledge about telemedicine. They perceived the advantages of telemedicine at a moderate level and its disadvantages at a low level. The knowledge of dentists about this technology was less than that of other groups, and as a result they were less positive about the advantages of telemedicine compared to nurses, general physicians, and specialists. Conclusion: The limited knowledge of clinicians about telemedicine seems to have influenced their perceptions of the technology. Therefore, providing healthcare professionals with more information about new technologies in healthcare, such as telemedicine, can help to gain a more realistic picture of their perceptions.
Article
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Introduction: Despite a growing literature base, substantial investment, and policy changes within governments, the integration of telehealth into routine clinical care has been limited. The availability of appropriate systematic education and training for practitioners has been highlighted as necessary for strong adoption. However, the availability and nature of telehealth-related education and training for practitioners is not understood. By reviewing the literature, we aimed to describe the delivery of education and training in telehealth, with particular focus on content, modes of delivery, types of institutions, and target clinician groups. Methods: We performed searches using PubMed, Scopus, Embase, Web of Science, PsycINFO, the Cochrane Library, and ERIC. We included studies that were focused on the delivery of telehealth-related academic or vocational education and training. We extracted information pertaining to country, programs and their participants, and tabulated the results. Results: Altogether 388 articles were identified, of which nine studies were selected for final review. Programs from five countries were represented and articles were spread across telemedicine and clinically oriented journals. Education and training in telehealth has been provided as both university level and vocational courses using conventional classroom based delivery methods and e-learning. Reported curriculum items included terminology, clinical applications, the evidence-base, and technological aspects. Conclusions: Published evidence in peer-reviewed literature on telehealth education and training is limited. According to this review, a number of topics relating to telehealth have been covered by existing education programs both within tertiary and professional development levels.
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To conduct a review of reviews on the impacts and costs of telemedicine services. A review of systematic reviews of telemedicine interventions was conducted. Interventions included all e-health interventions, information and communication technologies for communication in health care, Internet based interventions for diagnosis and treatments, and social care if important part of health care and in collaboration with health care for patients with chronic conditions were considered relevant. Each potentially relevant systematic review was assessed in full text by one member of an external expert team, using a revised check list from EPOC (Cochrane Effective Practice and Organisation of Care Group) to assess quality. Qualitative analysis of the included reviews was informed by principles of realist review. In total 1593 titles/abstracts were identified. Following quality assessment, the review included 80 heterogeneous systematic reviews. Twenty-one reviews concluded that telemedicine is effective, 18 found that evidence is promising but incomplete and others that evidence is limited and inconsistent. Emerging themes are the particularly problematic nature of economic analyses of telemedicine, the benefits of telemedicine for patients, and telemedicine as complex and ongoing collaborative achievements in unpredictable processes. The emergence of new topic areas in this dynamic field is notable and reviewers are starting to explore new questions beyond those of clinical and cost-effectiveness. Reviewers point to a continuing need for larger studies of telemedicine as controlled interventions, and more focus on patients' perspectives, economic analyses and on telemedicine innovations as complex processes and ongoing collaborative achievements. Formative assessments are emerging as an area of interest.
Article
Introduction The aim of this study was to explore how telehealth facilitates or impedes the provision of culturally appropriate healthcare to Indigenous Australians from the perspective of staff at an Aboriginal Community Controlled Health Service (ACCHS). Methods An exploratory qualitative study was performed. Semi-structured interviews were conducted with nine ACCHS staff. Interview transcripts were analysed using thematic analysis. Results One central theme and three sub-themes were identified. The central theme of Care provided in a supportive environment describes how telehealth enabled specialist consultations to be conducted in the safe environment of an ACCHS instead of a mainstream health service. The first sub-theme described how telehealth improved affordability and convenience and brought a reduction in the stress of healthcare. The second sub-theme explained the importance of the presence of an Indigenous health worker to facilitate culturally appropriate healthcare. The third sub-theme described how telehealth supported a holistic view of health. Discussion Our findings show culturally appropriate healthcare may be enhanced by the use of telehealth because it allows care to be provided in the supportive environment of an ACCHS. It allows the community member to have the advocacy and assistance of an Indigenous health worker and reduces the burden of travel and dislocation from community and family.
Article
Information and communications technology has become central to the way in which health services are provided. Technology-enabled services in healthcare are often described as eHealth, or more recently, digital health. Practitioners may require new knowledge, skills and competencies to make best use of eHealth, and while universities may be a logical place to provide such education and training, a study in 2012 found that the workforce was not being adequately educated to achieve competence to work with eHealth. We revisited eHealth education and training in Australian universities with a focus on medical schools; we aimed to explore the progress of eHealth in the Australian medical curriculum. We conducted a national interview study and interpretative phenomenological analysis with participants from all 19 medical schools in Australia; two themes emerged: (i) consensus on the importance of eHealth to current and future clinical practice; (ii) there are other priorities, and no strong drivers for change. Systemic problems inhibit the inclusion of eHealth in medical education: the curriculum is described as ‘crowded’ and with competing demands, and because accrediting bodies do not expect eHealth competence in medical graduates, there is no external pressure for its inclusion. Unless and until accrediting bodies recognise and expect competence in eHealth, it is unlikely that it will enter the curriculum; consequently the future workforce will remain unprepared.
Article
Background: Disasters, whether natural or manmade, are unpredictable. While there may be some forewarning as in natural disasters like a hurricane, response is often suboptimal. There is a need for an integrated and structured action for all three well defined phases of disaster management (pre-, during, and postdisaster) that must be addressed to ameliorate the impact on life and the necessary steps for recovery. Over the past several decades, telemedicine has been integrated in some form of disaster response. This adoption and integration has been shown to be effective. Since 2013, North Atlantic Treaty Organization (NATO), under the auspices of the Science for Peace and Security Programme, has worked on developing a Multinational Telemedicine System (MnTS) for disaster response. Methods: A group of subject matter experts from Europe and the United States developed the MnTS by establishing the network and a concept of operations, to be used in disaster management between countries. Results: An integrated system, including personnel, hardware, communication protocols, portable power generation, medical kits, and Web-based tools, was developed and successfully tested in the Euro-Atlantic Disaster Response Coordination Centre's Exercises Ukraine 2015. The field exercise tested and validated the MnTS and identified areas of improvement. The system and its evaluation provide additional information for establishing deployment capabilities. Conclusions: A MnTS approach to telemedicine in disaster response and management is possible and should be further advanced.
Article
Introduction: With the escalating costs of health care, issues with recruitment and retention of health practitioners in rural areas, and poor economies of scale, the question of delivering people to services or services to people is a dilemma for health authorities around the world. People living in rural areas have poorer health outcomes compared to their urban counterparts, and the problem of how to provide health care and deliver services in rural locations is an ongoing challenge. Telehealth services can efficiently and effectively improve access to healthcare for people living in rural and remote areas of Australia. However, telehealth services are not mainstream or routinely available in many rural and remote locations. The barriers to integration of telehealth into mainstream practice have been well described, but not the factors that may influence the success and sustainability of a service. Our aim was to collate, review and synthesise the available literature regarding telehealth services in rural and remote locations of Australia, and to identify the factors associated with their sustained success. Methods: A systematic literature review of peer-reviewed and grey literature was undertaken. Electronic databases were searched for potentially relevant articles. Reference lists of retrieved articles and the grey literature were also searched. Searches identified 970 potentially eligible articles published between 1988 and 2015. Studies and manuscripts of any type were included if they described telehealth services (store-and-forward or real-time videoconferencing) to provide clinical service or education and training related to health care in rural or remote locations of Australia. Data were extracted according to pre-defined criteria and checked for completeness and accuracy by a second reviewer. Any disagreements were resolved with discussion with a third researcher. All articles were appraised for quality and levels of evidence. Data were collated and grouped into categories including clinical speciality, disciplines involved, geographical location and the role of the service. Data relating to the success or sustainability of services were grouped thematically. Results: Inclusion criteria were met by 116 articles that described 72 discrete telehealth services. Telehealth services in rural and remote Australia are described and we have identified six key factors associated with the success and sustainability of services: vision, ownership, adaptability, economics, efficiency and equipment. Conclusions: Telehealth has the potential to address many of the key challenges to providing health in Australia, with its substantial land area and widely dispersed population. This review collates information regarding the telehealth services in Australia and describes models of care and characteristics of successful and sustainable services. We identified a wide variety of telehealth services being provided in rural and remote areas of Australia. There is great potential to increase this number by scaling up and replicating successful services. This review provides information for policy makers, governments and public and private health services that wish to integrate telehealth into routine practice and for telehealth providers to enhance the sustainability of their service.
Article
Healthcare systems require a paradigm shift in the way healthcare services are delivered to counteract demographic changes in patient populations, expanding technological developments and the increasing complexity of healthcare. Participatory design (PD) is a methodology that promotes the participation of users in the design process of potential telehealth applications. A PD project can be divided into four phases including: the identification and analysis of participant needs; the generation of ideas and development of prototypes; testing and further development of prototypes; and evaluation. PD is an iterative process where each phase is planned by reflecting on the results from the previous phase with respect to the participants' contribution. Key activities of a PD project include: fieldwork; literature reviewing; and development and testing. All activities must be applied with a participatory mindset that will ensure genuine participation throughout the project. Challenges associated with the use of PD include: the time required to properly engage with participants; language and culture barriers amongst participants; the selection of participants to ensure good representation of the user group; and empowerment. PD is an important process, which is complemented by other evaluation strategies that assess organisational requirements, clinical safety, and clinical and cost effectiveness. PD is a methodology which encourages genuine involvement, where participants have an opportunity to identify practical problems and to design and test technology. The process engages participants in storytelling, future planning and design. PD is a multifaceted assessment tool that helps explore more accurately clinical requirements and patient perspectives in telehealth.
Article
As more and more technologies are infused into service delivery, service providers must continuously renegotiate the ways in which they understand service delivery across increasingly high-tech, low-touch modalities. This exploratory qualitative study examines what health care service providers experience when offering separated services in the empirical context of telehealth. In-depth phenomenographic interviews sourced across multiple hospital and health care sites revealed that service providers experience (1) depersonalization, (2) clinical voyeurism, (3) intangibility negotiation, and (4) a need to manage change around identities and roles. These emergent understandings highlight the individual and qualitatively distinct differences in the ways in which service providers experience service separation in telehealth. Our findings address current service science priorities to leverage technology for service delivery as a way to advance separated service design. Further they provide an understanding-based approach toward building new theories from the service provider’s perspective on separation in technology-infused services. Our findings suggest strategies and tactics service providers use to overcome the potential challenges arising from not being physically colocated with their customers during service separation.
Article
We undertook a scoping review of the published literature to identify and summarise key findings on the telehealth interventions that influence waiting times or waiting lists for specialist outpatient services. Searches were conducted to identify relevant articles. Articles were included if the telehealth intervention restructured or made the referral process more efficient. We excluded studies that simply increased capacity. Two categories of interventions were identified – electronic consultations and image-based triage. Electronic consultations are asynchronous, text-based provider-to-provider consultations. Electronic consultations have been reported to obviate the need for face-to-face appointments between the patient and the specialist in between 34–92% of cases. However, it is often reported that electronic consultations are appropriate in less than 10% of referrals for outpatient care. Image-based triage has been used successfully to reduce unnecessary or inappropriate referrals and was used most often in dermatology, ophthalmology and otolaryngology (ENT). Reported reduction rates for face-to-face appointments by specialty were: dermatology 38–88%, ophthalmology 16–48% and ENT 89%. Image–based triage can be twice as effective as non-image based triage in reducing unnecessary appointments. Telehealth interventions can effectively be used to reduce waiting lists and improve the coordination of specialist services, and should be considered in conjunction with clinical requirements.
Article
With the digital revolution, telehealth is evolving from clinics to the home. In this review, the authors summarize current trends, barriers and limitations, and the potential for telehealth to improve health care delivery.
Article
Introduction: Telemedicine is a disruptive innovation within health care settings as consultations take place via audio-visual technology rather than traditional face-to-face. Specialist perceptions and experiences of providing audio-visual consultations in emergency situations, however, are not well understood. The aim of this exploratory study was to describe the experience of medical specialists providing acute stroke decision-making support via telemedicine. Methods: Data from the Victorian Stroke Telemedicine (VST) programme were used. The experiences of specialists providing an acute clinical telemedicine service to rural emergency departments were explored, drawing on disruptive innovation theory. Document analysis of programme consultation records, meeting minutes and in-depth individual interviews with three neurologists were analysed using triangulation. Results: Since February 2014, 269 stroke telemedicine consultations with 12 neurologists have occurred. Retention on the roster has varied between 1 and >4 years. Overall, neurologists reported benefits of participation, as they were addressing health equity gaps for rural patients. Negative effects were the unpredictability of consultations impacting on their personal life, the mixed level of experience of colleagues initiating the consult and not knowing patient outcomes since follow-up communication was not routine. Conclusions: Insights into workforce experience and satisfaction were identified to inform strategies to support specialists to adapt to the disruptive innovation of telemedicine.
Article
Objective The aim of this study is to identify the extent to which the Medicare item numbers and incentives, introduced in July 2011, have been effective in stimulating telehealth activity in Australia. Methods A retrospective descriptive study utilising data on the uptake of telehealth item numbers and associated in-person services, from July 2011 to April 2014, were obtained from Medicare Australia. The main outcome measures were number of telehealth services over time, plus uptake proportionate to in-person services, by jurisdiction, by speciality, and by patient gender. Results Specialist consultations delivered by video communication and rebated by Medicare rose to 6000 per month, which is 0.24% of the total number of specialist consultations. The highest proportional uptake was in geriatrics and psychiatry. In 52% per cent of video consultations the patient was supported by an on-site healthcare provider, most commonly a general practitioner. There were substantial jurisdictional differences. A significantly lower percentage of female patients were rebated for item 99, which is primarily used by surgeons. Conclusions Medicare rebates and incentives, which are generous by world standards, have resulted in specialist video consultations being provided to underserved areas, although gaps still remain that need new models of care to be developed. What is known about the topic? Video consultations have been rebated by Medicare since July 2011 as a means of increasing access to specialist care in rural areas, aged care facilities and Aboriginal health services. What does this paper add? The uptake of this telehealth initiative has grown over time, but still remains low. For half the video consultations the patient was supported by an on-site healthcare provider, most commonly a general practitioner. Geriatrics and psychiatry are the specialties with the highest proportional uptake. What are the implications for practitioners? New models of care with a greater focus on consultation-liaison with primary care providers need to be developed to realise the potential of this initiative and to fill continuing gaps in services.
Article
Telehealth, the delivery of health care services at a distance using information and communications technology, has been slow to be adopted and difficult to sustain. Researchers developing theories concerning the introduction of complex change into health care usually take a multifactorial approach; we intentionally sought a single point of intervention that would have maximum impact on implementation. We conducted a qualitative interview study of 36 Australian telehealth services, sampled for maximum variation, and used grounded theory methods to develop a model from which we chose the most important factor affecting the success of telehealth. We propose that clinician acceptance explains much of the variation in the uptake, expansion, and sustainability of Australian telehealth services, and that clinician acceptance could, in most circumstances, overcome low demand, technology problems, workforce pressure, and lack of resourcing. We conclude that our model offers practical advice to those seeking to implement change with limited resources.
Article
Currently telehealth is being offered as an innovative solution to austerity, staffing issues and problems accessing care in Canada’s rural communities. Despite the current enthusiasm for telehealth in provincial and federal policy documents, many of these promises have not been realized. The Labrador region is a large and sparsely populated area that was vested with a federal “Smart Community” project to increase the region’s technological capacity, making it one of the most connected locales in the country. While telehealth was a key component of the SmartLabrador plan, there has been limited uptake of newly available technologies for the purposes of mediating distance in health care. My work critically examines the factors surrounding this lack of uptake, and takes the work of Harold Innis as a starting point when analyzing the breakdown of time and space in Labrador. Focused around qualitative field research conducted in Labrador in 2003, I explore spatialization, structuration and work practice as they relate to telehealth use and non-use in the region. I review federal and provincial telehealth policy to provide a macro context for the study, which I then link to meso and micro levels of analysis in organization structures and situated work practice. I examine telehealth in the user context from the health care provider perspective. This reveals several constraints that have limited the usage of new technologies for health communication in Labrador. The user context must be considered in the design of telehealth programs and policy if the desired outcomes for telehealth are to be realized. The barriers to telehealth use are not simply technical, but relate to issues of privacy, culture and trust. I discuss these and other barriers with a focus on the needs of the Labrador community.
Article
China started to pay more attention to the construction of a regional and national health information network after the outbreak of the severe acute respiratory syndrome (SARS) epidemic in 2003. The construction of a public health system is considered the most important part of national medical reform, with information and computer technology serving as the key to deploying regional collaborative medical service, also known as e-health. In this paper, we analyze the difficulties in carrying out e-health projects in China, a discussion of ongoing projects, and a case presentation representing current progress.
Article
Telemedicine can help improve access to health care for people in rural and remote communities, but its uptake has been slow and fragmented. A telepaediatric service in Queensland, initiated in 2000, has made use of mobile "robot" videoconferencing systems. It has been cost-effective and well accepted by patients and clinicians. Telegeriatric services were instigated in Queensland in 2005, principally using videoconferencing. Telegeriatrics has been ideal for frail older patients in remote areas. For telemedicine to become a mainstream service, its focus must move beyond simply the provision of equipment and network connectivity. Telemedicine must be funded adequately if it is to be successful.
Article
There are myriad telehealth applications for natural or anthropogenic disaster response. Telehealth technologies and methods have been demonstrated in a variety of real and simulated disasters. Telehealth is a force multiplier, providing medical and public health expertise at a distance, minimizing the logistic and safety issues associated with on-site care provision. Telehealth provides a virtual surge capacity, enabling physicians and other health professionals from around the world to assist overwhelmed local health and medical personnel with the increased demand for services postdisaster. There are several categories of telehealth applications in disaster response, including ambulatory/primary care, specialty consultation, remote monitoring, and triage, medical logistics, and transportation coordination. External expertise would be connected via existing telehealth networks in the disaster area or specially deployed telehealth systems in shelters or on-scene. This paper addresses the role of telehealth in disaster response and recommends a roadmap for its widespread use in preparing for and responding to natural and anthropogenic disasters.
Coronavirus (COVID-19): What is social distancing?
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