Telemedicine and patients with heart failure: evidence and unresolved issues

ABSTRACT Heart failure is the leading cause of cardiac-related hospitalizations. Limited access to reevaluations and outpatient appointments restricts the application of modern therapies. Telemedicine has become an essential resource in the healthcare system because of its countless benefits, such as higher and more frequent appointments and faster titration of medications. This narrative review aimed to demonstrate the evidence and unresolved issues related to the use of telemedicine in patients with heart failure. No studies have examined heart failure prevention; however, several studies have addressed the prevention of decompensation with positive results. Telemedicine can be used to evaluate all patients with heart failure, and many telemedicine platforms are available. Several strategies, including both noninvasive (phone calls, weight measurement, and virtual visits) and invasive (implantable pulmonary artery catheters) strategies can be implemented. Given these benefits, telemedicine is highly desirable, particularly for vulnerable groups. Although some questions remain unanswered, the development of new technologies can complement remote visits and improve patient care.

Readiness and acceptance of Philippine General Hospital Medical Staff for Telemedicine as alternative method of patient consultation during the COVID-19 pandemic and post-enhanced community quarantine period

Introduction@#The coronavirus disease 2019 (COVID-19) pandemic prompted a shift from standard in-person consultation to non-patient contact methods such as telemedicine. To our knowledge, there was no published a priori evaluation of the telemedicine readiness and acceptance among the medical staff of the Philippine General Hospital (PGH) before implementing the institution’s telemedicine program. The lack of this vital pre-implementation step is understandable given the unprecedented crisis. However, if telemedicine programs will continue in the post-quarantine period, it is crucial to determine the facilitators and barriers to the use of telemedicine. @*Objective@#This study determined the level of readiness and acceptance for telemedicine as an alternative method for patient consultation during the COVID-19 pandemic and post-enhanced community quarantine period among PGH medical staff (consultants, residents, fellows). @*Methods@#The cross-sectional study was conducted from October 2020 to July 2021. Medical staff from the 16 clinical departments of the PGH were selected by systematic random sampling. Inclusion criteria included appointment as medical staff in PGH or University of the Philippines College of Medicine (UPCM), voluntary informed consent, internet access, and technical capacity to access e-mail and SurveyMonkey™. The online survey consisted of two questionnaires. It collected data on the demographic profile and outcomes of interest (e.g., telemedicine readiness and acceptance). Technological readiness was determined through the 16-item modified version of Technological Readiness Index (TRI) version 2.0, while telemedicine acceptance was determined through the modified version of the 19-item Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Descriptive and analytical statistics were performed at a 95% confidence interval. @*Results@#The study had an 87% response rate with 205 respondents, 62% of whom were physicians in training (resident physicians and fellows). The respondents had a median age of 33 years and were mostly males. Only 19% had telemedicine experience before the pandemic. The majority (51%) learned telemedicine on their own. The most common devices used for telemedicine were mobile or smartphones (53%) and laptops (38%). The primary source of internet for telemedicine was mobile broadband (e.g., cellular data) (40%). The majority practiced telemedicine at their home or residence (51%), followed closely by the hospital or clinic (47%). The mean score of the respondents on TRI was 3.56 (very good technological readiness), and 4.00 (very good telemedicine acceptance) on UTAUT (behavioral intention to use the system). Performance expectancy (p = 0.02), effort expectancy (p = 0.03), and self-efficacy (p = 0.02) were significantly directly related to telemedicine adoption, while anxiety (p = 0.03) was significantly inversely related. @*Conclusion@#The PGH medical staff were found to have very good telemedicine readiness and acceptance. This suggests a willingness to use telemedicine during the pandemic. Further studies on the organization and technical support system of the telemedicine program in the PGH are strongly recommended. The quality and efficiency of the program will strongly influence the continued use of telemedicine by the medical staff even after the pandemic.

Aplicação de healthbots em língua portuguesa: revisão narrativa / Application of healthbots in Portuguese: narrative review / Aplicación de healthbots en portugués: revisión narrativa

Objetivo: Esse estudo objetivou levantar e caracterizar as aplicações de healthbots em língua portuguesa, considerando seus papéis na transformação digital da jornada do paciente. Métodos: Revisão de literatura narrativa pela qual se investigou a acessibilidade e a objetividade das aplicações, tendo o paciente como usuário final. Os artigos foram analisados quanto ao uso de bots, tecnologias da informação e dispositivos utilizados, objetivo das aplicações, área médica de intervenção e disciplinaridade no desenvolvimento das soluções. Resultados: De treze artigos selecionados na busca contendo aplicações com automatização de tarefas, apenas cinco descreveram a utilização de bots. Conclusão: Os healthbots possuem potencial para promover o aprimoramento da jornada do paciente. Contudo, o desenvolvimento e o emprego de tais aplicações ainda não estão difundidos no Brasil.

Objective: This study aimed to raise and characterize the applications of healthbots in Portuguese, considering their roles in the digital transformation of the patient's journey. Methods: Review of narrative literature through which the accessibility and objectivity of the applications were investigated, with the patient as the end user. The articles were analyzed regarding the use of bots, information technologies and devices used, purpose of applications, medical area of intervention and disciplinary action in the development of solutions. Results: Of thirteen articles selected in the search containing applications with task automation, only five described the use of bots. Conclusion: Healthbots have the potential to improve the patient journey. However, the development and use of such applications are still not widespread in Brazil.

Objetivo: Este estudio tuvo como objetivo plantear y caracterizar las aplicaciones de los healthbots en portugués, considerando sus roles en la transformación digital del viaje del paciente. Métodos: Revisión de literatura narrativa mediante la cual se investigó la accesibilidad y objetividad de las aplicaciones, con el paciente como usuario final. Los artículos fueron analizados en cuanto al uso de bots, tecnologías y dispositivos de información utilizados, finalidad de las aplicaciones, área médica de intervención y acción disciplinaria en el desarrollo de soluciones. Resultados: De trece artículos seleccionados en la búsqueda que contienen aplicaciones con automatización de tareas, solo cinco describieron el uso de bots. Conclusión: los Healthbots tienen el potencial de mejorar el viaje del paciente. Sin embargo, el desarrollo y uso de tales aplicaciones aún no está muy extendido en Brasil.

Telemedicina: experiencia de monitoreo telefónico en Nutrición Enteral Domiciliaria en tiempos de Pandemia por COVID-19 / Telemedicine: phone monitoring experience upon Home Enteral Nutrition during COVID-19 Pandemic

Resumen Introducción: la aplicación de la telemedicina permite asegurar la atención sanitaria en el contexto de la pandemia por COVID-19. Objetivo: evaluar la telemedicina para el monitoreo de pacientes con nutrición enteral domiciliaria. Materiales y Método: estudio transversal, observacional y descriptivo, con muestreo no probabilístico intencional entre enero y junio de 2020. Se incluyeron pacientes con dificultad para acceder al cuidado domiciliario de profesionales en forma presencial. Todos los pacientes tenían seguro médico, sistema de emergencias a domicilio y un centro asistencial de referencia para derivación. Fueron excluidos pacientes que obligatoriamente necesitaban seguimiento presencial, imposibilidad de comunicación con familiar a cargo y negativa del paciente/familia a la modalidad remota. Variables: edad, sexo, diagnóstico médico, valoración global subjetiva (VGS) en las distintas comunicaciones con el paciente, adherencia a la indicación nutricional, satisfacción del paciente y complicaciones. Se realizó una encuesta telefónica de satisfacción. Las complicaciones se clasificaron en relacionadas y no relacionadas con el soporte nutricional enteral domiciliario (SNED). Resultados: se incluyeron 18 pacientes con diversos diagnósticos médicos. Se realizaron 80 comunicaciones con un total de 2370 días de seguimiento (131,7 ± 63,7 días/paciente), VGS inicial (n=18): 27,7% (n=5) estaba bien nutrido, 61,1% (n=11) en riesgo de desnutrición y 11,1% (n=2) presentaba desnutrición severa. En las 80 comunicaciones, el 97,5% (n=78) cumplió al 100% la prescripción nutricional y el 2,5% (n=2) la respetó en un 50%. Al finalizar el estudio, todos lograron cumplirla. Se observaron 15 eventos adversos: 13 relacionados con el SNED y 2 no relacionados. Dos pacientes fallecieron durante el seguimiento a causa de su patología de base. Satisfacción: el 72,2% (n=13) definió la atención general como muy buena, y el 27,7% (n=5) como excelente. En relación a la atención profesional se encontró que el 22,2% (n=4) la categorizó como excelente, 66,6% (n=12) muy buena y el 11,1% (n=2) buena. Conclusiones: la telemedicina es útil para monitorear el SNED permitiendo disminuir la inequidad geográfica y mejorar la accesibilidad a los cuidados de salud.

Abstract Introduction. telemedicine guarantees health care in the context of the COVID-19 pandemic. Objective: to evaluate telemedicine for monitoring patients with home enteral nutrition. Materials and methods: an observational, descriptive and cross-sectional study, with intentional non-probability sampling, was conducted between January and June, 2020. The patients included were the ones with difficulty to have access to home care by professionals face-to-face. All the patients had health insurance, a home emergency service and a referral center. Patients who necessarily needed face-to-face follow-up, impossibility of communication with a family member in charge, and refusal of the patient / family to the remote modality were excluded. Variables: age, gender, diagnosis, subjective global assessment (SGA) in the different communications with the patient, adherence to nutritional indication, patient satisfaction and complications. A telephone satisfaction survey was conducted. Complications were classified as related and unrelated to home enteral nutritional support (SNED). Results: 18 patients with various medical diagnoses were included. 80 communications were made with a total of 2370 days of follow-up (131.7 ± 63.7 days / patient). SGA (n = 80): 33.75% (n = 27) were well nourished, 58.75% (n = 47) at risk of malnutrition, and 7.5% (n = 6) had severe malnutrition. 97.5% (n = 78) complied 100% with the nutritional prescription and 2.5% (n = 2) respected it by 50%. At the end of the study, all were able to fulfil it. 15 adverse events were observed: 8 related to SNED and 7 unrelated. Two patients died during follow-up due to their underlying pathology. Satisfaction: 72.22% (n = 13) defined general care as very good, and 27.78% (n = 5) as excellent. In relation to professional care, it was found that 22.22% (n = 4) categorized it as excellent, 66.67% (n = 12) very good and 11.11% (n = 2) good. Conclusion: Telemedicine is useful to monitor the SNED, allowing to reduce geographic inequity and improve accessibility to health care.

Telecuidado para idosos com alzheimer e seus cuidadores: revisão sistemática / Telecuidado a los ancianos con alzheimer y sus cuidadores: revisión sistemática / Telecare to elderly people with alzheimer and their caregivers: systematic review

RESUMO Analisar a literatura sobre o uso do telecuidado como Intervenção de Enfermagem na assistência ao idoso com Alzheimer e seus cuidadores. Trata-se de revisão sistemática da literatura nas bases LILACS, PubMed, CINAHL e Elsevier, baseada na proposta PRISMA. Os critérios de inclusão foram: artigos que abordassem diretamente ações de telecuidado por enfermeiros; estudos de coorte e ensaios clínicos randomizados com sigilo de alocação; artigos indexados; publicados nos idiomas português, inglês e espanhol; recorte temporal de 2007 a 2017. Foram encontrados dois artigos sobre telecuidado como Intervenção de Enfermagem no suporte e apoio aos cuidadores familiares de idosos com demência. O uso do acompanhamento por telefone foi realizado associado a outra tecnologia assistida. O acompanhamento por telefone foi associado ao uso de câmeras, e os próprios cuidadores realizavam as filmagens da rotina; ainda foram realizadas teleconferências em chamadas de vídeo entre cuidadores e profissionais. O telecuidado pode ser considerado uma prática avançada da enfermeira e alternativa acessível na assistência aos idosos com Alzheimer e seus cuidadores.

RESUMEN Analizar la literatura sobre el uso del telecuidado como intervención de enfermería en el cuidado al anciano con Alzheimer y sus cuidadores e identificar en la literatura las principales tecnologías asistidas y los instrumentos de evaluación en el cuidado al anciano con Alzheimer y sus cuidadores. Se trata de una revisión sistemática de la literatura en las bases Lilacs, PubMed, Cinahl y Elsevier, basado en la propuesta PRISMA. Los criterios de inclusión fueron: artículos que tratasen directamente de acciones de telecuidado por enfermeros; estudios de cohorte y ensayos clínicos randomizados con sigilo de asignación; artículos indexados; publicados en los idiomas portugués, inglés y español; recorte temporal de 2007 a 2017. Fueron encontrados dos artículos sobre el uso del telecuidado como intervención de enfermería en la atención y el apoyo a los cuidadores familiares de ancianos con demencia. El uso del acompañamiento por teléfono fue realizado junto a otra tecnología asistida. En un estudio el acompañamiento por teléfono fue asociado al uso de cámaras, donde los propios cuidadores realizaban las filmaciones de la rutina de cuidados, y en el otro estudio fueron realizadas teleconferencias en video llamadas entre cuidadores y profesionales. Se concluye que el telecuidado puede ser considerado una práctica avanzada de la enfermera y una alternativa accesible en el cuidado a los ancianos con Alzheimer y sus cuidadores.

ABSTRACT This research aims to analyze the literature on the use of telecare as a nursing intervention in the care of the elderly with Alzheimer's and their caregivers and also to identify in the literature the main assisted technologies and the instruments of evaluation in the care of the elderly people with Alzheimer's and their caregivers. It is a systematic review of the literature on the bases Lilacs, PubMed, Cinahl and Elsevier, based on the PRISMA proposal. The inclusion criteria were: articles that directly addressed actions of telecare by nurses; cohort studies and randomized controlled trials with allocation confidentiality; indexed articles; published in Portuguese, English and Spanish; temporal cut from 2007 to 2017. Two articles on the use of telecare as the nursing intervention in the support to family caregivers of elderly people with dementia were found. The use of telephone monitoring was performed with other assisted technology. In one study, telephone follow-up was associated with the use of cameras, where the caregivers filmed the care routine, and in the other study teleconferences were performed on video calls between caregivers and professionals. It can be concluded that telecare can be considered an advanced practice of the nurse and an accessible alternative in the care of elderly people with Alzheimer's and their caregivers.

Identidad de lugar en usuarios de teleasistencia: un análisis conversacional / Telecare user's place identity: A conversation analysis

Este artículo presenta un análisis discursivo de la identidad de lugar en usuarios de teleasistencia domiciliaria. Dicho análisis es parte de los resultados de dos proyectos de investigación interesados por el cuidado de las personas mayores y dependientes en España. Los datos analizados se extraen de un conjunto de diez grupos de discusión llevados a cabo en Cataluña durante 2009 (n=62). A partir del rastreo del uso que los participantes hacen de una frase hecha ("no hay lugar como el hogar"), se propone un examen secuencial y detallado de los datos inspirado en el análisis conversacional y la psicología discursiva. Este examen resalta el carácter co-producido de la identidad de lugar y llama la atención sobre diferentes herramientas discursivas que los participantes emplean para enfrentar las amenazas que la conversación le plantea a dicha identidad. El resultado es la descripción del contexto en el que se produce una identidad de hogar que da sentido a la preferencia que los participantes muestran por envejecer en casa. Dicha identidad de hogar se presenta como un recurso de orden explicativo y retórico.

This article presents a discourse analysis of place-identity in home telecare users. This analysis is part of the results of two research projects concerned with the care of old and dependent people in Spain. The data analyzed come from a set of ten focus groups conducted in Catalonia in 2009 (n=62). Drawing from tracking the participants' use of a fixed phrase ("there is no place like home"), a sequential and detailed examination of the data inspired by conversation analysis and discursive psychology is proposed. This examination highlights the co-produced nature of place-identity and draws attention to different discursive tools which the participants use to deal with threats that conversation supposes to that identity. The result is the description of the context in which a home-identity that gives meaning to the participants' preference for aging at home is produced. This home-identity is presented as an explanatory and rhetoric resource.

Utility of telemedicine for children in India.

Objective. To show utility of telemedicine for children in Indian subcontinent. Methods. Retrospective analysis of data on 306 consecutive patients (age range 0–15 yr) managed between yr 2005-2008 in telemedicine centre of a tertiary care hospital in North India. The patient consultations were conducted using two customized soft wares – Televital and Sanjeevani. Data was extracted on a predesigned Performa. Results. The data included clinical details, investigations and radiological images. Ten percent of children were critically ill and could not have been in a position to be transported safely. Twelve percent of the consultations resulted in videoconferencing. There was a paucity of feedback back and follow up of these consultations. Conclusion. It is possible to provide e-health care through telemedicine to children in Indian rural and semi-urban setting. The e-health can be extended to critically ill children including newborns on a restricted basis.