ABSTRACT
BACKGROUND: Although the COVID-19 pandemic has accelerated the adoption of telemedicine and virtual consultations worldwide, complex factors that may affect the use of virtual clinics are still unclear. OBJECTIVE: This study aims to identify factors associated with the utilization of virtual clinics in the experience of virtual clinic service implementation in Taiwan. METHODS: We retrospectively analyzed a total of 187,742 outpatient visits (176,815, 94.2%, in-person visits and 10,927, 5.8%, virtual visits) completed at a large general hospital in Taipei City from May 19 to July 31, 2021, after rapid implementation of virtual outpatient clinic visits due to the COVID-19 pandemic. Data of patients' demographic characteristics, disease type, physicians' features, and specialties/departments were collected, and physicians' opinions regarding virtual clinics were surveyed and evaluated using a 5-point Likert scale. Multilevel analysis was conducted to determine the factors associated with the utilization of virtual clinics. RESULTS: Patient-/visit-, physician-, and department-level factors accounted for 67.5%, 11.1%, and 21.4% of the total variance in the utilization of virtual clinics, respectively. Female sex (odds ratio [OR] 1.27, 95% CI 1.22-1.33, P<.001); residing at a greater distance away from the hospital (OR 2.36, 95% CI 2.15-2.58 if distance>50 km, P<.001; OR 3.95, 95% CI 3.11-5.02 if extensive travel required, P<.001); reimbursement by the National Health Insurance (NHI; OR 7.29, 95% CI 5.71-9.30, P<.001); seeking care for a major chronic disease (OR 1.33, 95% CI 1.24-1.42, P<.001); the physician's positive attitude toward virtual clinics (OR 1.50, 95% CI 1.16-1.93, P=.002); and visits within certain departments, including the heart center, psychiatry, and internal medicine (OR 2.55, 95% CI 1.46-4.46, P=.004), were positively associated with the utilization of virtual clinics. The patient's age, the physician's age, and the physician's sex were not associated with the utilization of virtual clinics in our study. CONCLUSIONS: Our results show that in addition to previously demonstrated patient-level factors that may influence telemedicine use, including the patient's sex and distance from the hospital, factors at the visit level (insurance type, disease type), physician level (physician's attitude toward virtual clinics), and department level also contribute to the utilization of virtual clinics. Although there was a more than 300-fold increase in the number of virtual visits during the pandemic compared with the prepandemic period, the majority (176,815/187,742, 94.2%) of the outpatient visits were still in-person visits during the study period. Therefore, it is of great importance to understand the factors impacting the utilization of virtual clinics to accelerate the implementation of telemedicine. The findings of our study may help direct policymaking for expanding the use of virtual clinics, especially in countries struggling with the development and promotion of telemedicine virtual clinic services.
Subject(s)
COVID-19 , Pandemics , Telemedicine , Ambulatory Care Facilities , COVID-19/epidemiology , Female , Humans , Male , Multilevel Analysis , Outpatients , Retrospective Studies , Taiwan , Telemedicine/methods , Telemedicine/trendsABSTRACT
AIM AND OBJECTIVES: The purpose of this study was to explore the inter-relationships among resilience, nutrition, and leisure activity of older patients with cardiovascular disease and possible sarcopenia. Besides, the patterns of these three variables over a long-term follow-up was examine. MATERIAL AND METHODS: Quantitative longitudinal study design was used in this study. Sarcopenia is related to aging, lack of physical activity, and malnutrition. Complex inter-relationships exist in patients with regards to their resilience, nutritional status, leisure activities. A generalized estimating equation (GEE) was used for long-term follow-up observations, and data were collected form one month (T1), three months (T2) and six months (T3). A demographic questionnaire and the Chinese versions of the Resilience Scale (CRS), the Mini-Nutritional Assessment (MNA), and the Leisure Time Activities Scale (LTAS), were used to collect data. RESULTS: A total of 267 eligible participants were enrolled in this study, of whom 53% were men and 47% were women. The interactions among resilience, nutrition, and leisure activity were reported. Resilience was positively correlated with nutrition. Higher resilience was developed higher participation in leisure activities was found in older adults with possible sarcopenia. CONCLUSION: Resilience is a key factor for greater participation in leisure activities. Health professionals should develop feasible resilience interventions that would enhance patient's participation in leisure activities. Nutritional consulting and physical activity interventions should be combined in the case of older adults to prevent the occurrence of possible sarcopenia.
ABSTRACT
Digital contact tracing is being used by many countries to help contain COVID-19's spread in a post-lockdown world. Among the various available techniques, decentralized contact tracing that uses Bluetooth received signal strength indication (RSSI) to detect proximity is considered less of a privacy risk than approaches that rely on collecting absolute locations via GPS, cellular-tower history, or QR-code scanning. As of October 2020, there have been millions of downloads of such Bluetooth-based contract-tracing apps, as more and more countries officially adopt them. However, the effectiveness of these apps in the real world remains unclear due to a lack of empirical research that includes realistic crowd sizes and densities. This study aims to fill that gap, by empirically investigating the effectiveness of Bluetooth-based contact tracing in crowd environments with a total of 80 participants, emulating classrooms, moving lines, and other types of real-world gatherings. The results confirm that Bluetooth RSSI is unreliable for detecting proximity, and that this inaccuracy worsens in environments that are especially crowded. In other words, this technique may be least useful when it is most in need, and that it is fragile when confronted by low-cost jamming. Moreover, technical problems such as high energy consumption and phone overheating caused by the contact-tracing app were found to negatively influence users' willingness to adopt it. On the bright side, however, Bluetooth RSSI may still be useful for detecting coarse-grained contact events, for example, proximity of up to 20m lasting for an hour. Based on our findings, we recommend that existing contact-tracing apps can be re-purposed to focus on coarse-grained proximity detection, and that future ones calibrate distance estimates and adjust broadcast frequencies based on auxiliary information.