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Background: The literature supporting telehealth management is growing accelerated by the COVID-pandemic. We hypothesize that there are risks of adverse events associated with telehealth interventions. Methods: A review of PubMed (including MEDLINE), Embase, ISI (Web of Science), VHL/GHL, Scopus, Science Direct, and PsycINFO was conducted for all adverse events associated with telehealth from January 1, 1960 to March 1, 2021. This systematic review and meta-analyses were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Of 5,144 citations 78 published studies met criteria for quality evaluation and underwent full text ion including the qualitative synthesis. Of the 78 included studies 8 were included in the quantitative synthesis resulting in 2 meta-analyses. The results of the meta-analysis suggest that monitoring patients using telehealth techniques is associated with 40% lower mortality risks among patients suffering from heart failure, compared to those who received traditional care. The results of the random-effects meta-analysis showed the pooled relative risk of mortality to be 0.60, indicating that patients that underwent telemonitoring had a lower mortality risk compared with the patients that underwent usual care. Among patients with heart implants, patients who received telemonitoring had a 35% lower mortality risk compared to patients receiving traditional care. Conclusions: While RCTs of telehealth interventions demonstrate enhanced patient outcomes in a number of studies and pave the way to evidence-based practice, the heterogeneity of the research questions suggest an important need for more complementary studies with consistent outcome assessments.
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Objectives: The use of virtual care has accelerated since the emergence of COVID-19 pandemic. This study aims to analyze the differences in patient characteristics between new and existing type 2 diabetes mellitus (T2DM) patients that utilized virtual care. Method(s): Adult patients (age318 years) with T2DM who had a virtual care (phone or video) visit between April 1, 2020 and March 31, 2022 from the OptumLabs Data Warehouse were identified. The date of the first virtual visit was defined as the index date. Patients were required to be continuously insured at least 1 year prior to their index date (baseline) and at least 90 days of follow-up coverage. T2DM patients were categorized as newly diagnosed and as existing T2DM patients based on whether a diabetes diagnosis was observed in the baseline or not. Result(s): A total of 1,864,203 unique T2DM patients were eligible, with18.5% identified as newly diagnosed and 81.5% as existing T2DM patients. On average, newly diagnosed T2DM patients were younger than existing T2DM patients. Majority (54.5%) of newly diagnosed T2DM patients were commercially insured compared to only 38.6% existing T2DM patients. Among the existing T2DM patients, 61.2% were White, 17.9% Non-Hispanic Black, 12.7% Hispanic and 8.2% others. Of this population, 12.7 % had a household income >= $125,000, 13.3% had at least a Bachelor's degree, and 80.3% reside in a metropolitan area. For the newly diagnosed T2DM cohort, 59.7% were White, 15.3% Non-Hispanic Black, 13.4% Hispanic, and 11.6% others. More of the newly diagnosed T2DM cohort had higher household income, higher education, and resided in a metropolitan area compared to patients with existing T2DM. Conclusion(s): T2DM patients that used virtual care were heterogenous in terms of their baseline characteristics. This underscores the emerging trend that virtual care can potentially play a complementary role in managing patients with diabetes.Copyright © 2023
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INTRODUCTION: The emergence of COVID-19 and its ensuing restrictions on in-person healthcare has resulted in a sudden shift towards the utilization of telemedicine. The purpose of this study is to assess patient satisfaction and patient-reported outcome measures (PROMs) for individuals who underwent follow-up for shoulder surgery using telemedicine compared to those who received traditional in-person clinic follow-up. METHODS: Patients who underwent either rotator cuff repair or total shoulder arthroplasty during a designated pre-COVID-19 (traditional clinic follow-up) or peri-COVID-19 (telemedicine follow-up) span of time were identified. PROMs including the American Shoulder and Elbow Surgeons standardized assessment form, the three-level version of the EQ-5D form, the 12-Item Short Form survey, and a modified version of a published telemedicine survey were administered to participants six months post-operatively via phone call. RESULTS: Sixty patients agreed to participate. There was no significant difference between the pre-COVID-19 and peri-COVID-19 groups in patient satisfaction with their follow-up visit (p = 0.289), nor was there a significant difference in PROMs between the two groups. In total, 83.33% of the telemedicine group and 70.37% of the in-person clinic group preferred traditional in-person follow-up over telemedicine. DISCUSSION: In a cohort of patients who underwent telemedicine follow-up for shoulder surgery during the COVID-19 pandemic, there was no difference in patient satisfaction and PROMs compared to traditional in-person clinic follow-up. This study indicates that while the majority of participants preferred face-to-face visits, patients were relatively satisfied with their care and had similar functional outcome scores in both groups, despite the large disruption in healthcare logistics caused by COVID-19.
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The outbreak of novel corona virus had led the entire world to make severe changes. A secured healthcare data transmission has been proposed through Telecare Medical Information System (TMIS) based on metaheuristic salp swarm. Patients need proper medical remote treatments in this Post-COVID-19 time from their quarantines. Secured transmission of medical data is a significant challenge of digitally overwhelmed environment. The objective is to impart the patients' data by encryption with confidentiality and integrity. Eavesdroppers can carry sniffing and spoofing in order to deluge the data. In this paper, a novel scheme on metaheuristic salp swarm based intelligence has been sculptured to encrypt electrocardiograms (ECG) for data privacy. Metaheuristic approach has been blended in cryptographic engineering to address the TMIS security issues. Session key has been derived from the weight vector of the fittest salp from the salp population. The exploration and exploitation control the movements of the salps. The proposed technique baffles the eavesdroppers by the key strength and other robustness factors. The results, thus obtained, were compared with some existing classical techniques with benchmark results. The proposed MSE and RMSE were 28,967.85, and 81.17 respectively. The time needed to decode 128 bits proposed session key was 8.66 × 1052 years. The proposed cryptographic time was 8.8 s.
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Background: Patient education programs are an integral component of care, which helps promote patient engagement and improved clinical outcomes. The role and durability of virtual learning programs for patients (pts) with atrial fibrillation (AF) requires further study. Objective(s): To assess the utilization, acceptance, durability, and benefits of virtual learning for pts with atrial fibrillation as well as the impact on virtual care models. Method(s): A comprehensive 3-hour virtual symposium on AF via an online video platform was offered to pts and family in 2021 and 2022. The program was sponsored by an academic teaching hospital free to pts and promoted through social media. Participants could watch live and the recorded presentation was also made available for future viewing. A follow up survey was sent to attendees that included questions on demographic information and opinions regarding virtual education and care. Comparisons were made between the 2022 and 2021 programs. Result(s): A total of 465 participants registered for the 2022 program (48% increase from 2021) and 146 participants logged on (31% of registrants - down from 34% in 2021). A follow-up survey was sent to all registrants with 55 respondents, (89% watched the program live). Most respondents were >65 years old (58%);female (76%), Caucasian (89%), completed graduate school (40%) and lived 50+ miles away (36%). Four patients were from outside the US. Minority populations were under-represented relative to the local population demographics (black 0%, Hispanic 1.8%). The total cost of the program was $20/pt. The majority of respondents (58% - an increase of 22% from 2021) indicated they preferred a virtual program and if they had a choice, 61% preferred virtual (11% increase);and 53% indicated that program participation increased the likelihood of them performing a remote/virtual clinic visit with their provider. COVID was no longer an influence for most (57.4%). Presentations were made publicly available after the October 2022 program and have been viewed 247 times. Conclusion(s): Virtual education for pts with AF can be successfully offered, with a high enrollment rate at a fraction of the cost of an in-person program. Attendees generally prefer virtual over in person and can increase participation worldwide. This program influences future acceptance of virtual care as well as potential models of virtual care delivery. Greater efforts need to be made, however, to include under-represented populations. [Formula presented]Copyright © 2023
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Introduction: Dietary therapy for eosinophilic esophagitis (EoE) is an effective first-line treatment aimed at identifying triggers by systematically removing then reintroducing food groups. Success on diet therapy can be augmented by working with a dietitian, but this is not a universal clinical resource. Virtual or telehealth approaches to nutrition care may offer opportunities to implement diet therapy for EoE. We conducted a retrospective study at a tertiary center with six GI dietitians to compare real-world standard in-person versus virtual EoE nutrition practices in terms of access, follow-up< and disease control. Method(s): We identified adults with EoE referred to GI nutrition through query of the electronic medical record by ICD-10 diagnoses and confirmed by chart review. As all nutrition visits prior to the COVID pandemic were performed in-person, standard care was defined as care established in January-December 2019 and virtual care in January-December 2021. Associations were analyzed using Chi-squared and Student's t test (Table). Result(s): A total of 204 patients were included;99 referred for standard in-person and 105 virtual nutrition care. The cohorts did not differ significantly by gender, age at the time of referral, race, and distance lived to our center. Of these, 55.6% (55) standard and 48.6% (51) virtual visits were completed with a dietitian (p=0.341) and 4-food elimination diet was the most commonly planned diet. The majority initiated the diet (80.0% standard, 78.4% virtual, p=0.842) and among them, half successfully attained histologic remission with the elimination phase (63.6% standard, 47.5% virtual, p=0.324). Ultimate treatments plans included remaining on dietary therapy (25.5% standard, 23.5% virtual, p=0.728), no treatment or lost to follow-up (34.6% standard, 25.5% virtual), and medication (25.5% standard, 41.2% virtual). Conclusion(s): There is a growing demand for nutrition care in EoE and in our tertiary practice, we found no differences in the success and response rate on elimination diet or follow-up between patients receiving standard or virtual nutrition care. Virtual approaches to implementing EoE dietary therapy may serve to complement in-person care and offer opportunities for those lacking local dietitian access. However, up to one-third of patients are lost to follow-up or remain untreated, also highlighting a need to identify, understand, and overcome barriers to treatment uptake and disease control .
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Background: The COVID-19 pandemic has altered how we deliver care to people with cystic fibrosis (CF) across the spectrum of disease severity. Because of lockdowns and avoiding exposure to COVID-19 by limiting inperson clinic visits, clinical care has pivoted from standard practices to virtual care in combination with in-person traditional visits. This approach has allowed patients to be monitored and treated in a timely manner. Such virtual visits have the advantage of reducing the time commitment for clinic visits because the patient does not have to travel to and from the hospital, but virtual care lacks the ability to conduct a physical examination and to obtain objective and standardized testing of key measurements known to be associated with health outcomes in CF. The objective of this study was to evaluate the attitude of patients to virtual delivery of care and their comfort level with such care. Method(s): This is a prospective, cross-sectional survey of adults with CF who are followed at St. Michael's Adult CF Center in Toronto, Canada. An online survey was created using SurveyMonkey to assess attitudes toward and satisfaction with virtual care. The survey was emailed to participants and included the Canadian CF Registry ID;a reminder email sent a week later. Baseline demographic and clinical data were obtained from the Canadian CF Registry and presented as median (range) or proportions as appropriate. Questions using a 3-point Likert scale will be categorized into agree, neutral, and disagree. Result(s): A total of 210 participants (53.0% female) completed the survey (median age 37.8, range 19.2-78.9). Median age of diagnosis was 2.2, 95.7% were Caucasian, 76.0% had completed post-secondary education, 63.0% were employed and 11.0% were students, 75% were pancreatic insufficient, 39.0% had CF-related diabetes, and 12.4% were post lung-transplant. Median percentage predicted forced expiratory volume in 1 second was 65.8% (range 17.9-126.9%), and median body mass index was 23.6 kg/m2 (range 15.5-45.7 kg/m2). Eighty-one percent of respondents had had a virtual visit before completing the survey. Sixty percent of respondents felt that in-person visits were the preferred way of completing a medical assessment, and 27.0% preferred virtual visits. Seventy-three percent felt it was important for the virtual visit to occur at the booked time, 59.0% had concerns that their lung function was not assessed during virtual visits, 46.0% felt they were losing the benefits of allied health team assessments with virtual visits, and 40.0% worried that their health would decline if primarily seen virtually. Just over half of respondents wanted to continue with virtual visits in some capacity after the pandemic. The optimal proportion of in-person visits was felt to be 50.0%. More than 85% of respondents were comfortable with technology (phone or computer) and had reliable access to the Internet to conduct virtual visits. Seventy percent of people would like to have access to a home spirometer, but cost was a barrier. Conclusion(s): From the patient's perspective, in-person visits were still the preferred way to complete a medical assessment, which seemed to be driven by concerns over lack of methods for assessment, particularly lung function, and access to the multidisciplinary team. Home spirometers, if freely available, might increase comfort with virtual appointments.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved
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The aim of this research is to describe the use of telemedicine applied to patients characterised by a particular state of illness, which often drives them toward a frail and chronic status, in a systematic manner. This work employed the Tranfield approach to carry out a systematic literature review (SLR), in order to provide an efficient and high-quality method for identifying and evaluating extensive studies. The methodology was pursued step by step, analysing keywords, topics, journal quality to arrive at a set of relevant open access papers that was analysed in detail. The same papers were compared to each other and then, they were categorised according to significant metrics, also evaluating technologies and methods employed. Through our systematic review we found that most of the patients involved in telemedicine programs agreed with this service model and the clinical results appeared encouraging. Findings suggested that telemedicine services were appreciated by patients, they increased the access to care and could be a better way to face emergencies and pandemics, lowering overall costs and promoting social inclusion.Copyright © 2022 Inderscience Enterprises Ltd.
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Purpose of Study The COVID-19 pandemic required rapid, global healthcare shifts to prioritize urgent or pandemic-related care and minimize transmission. Little is known about impacts on pediatric orthopedic surgeons during this time. We aimed to investigate COVID-19 related changes in practice, training, and research among pediatric orthopedic surgeons globally. Methods Used An online, cross-sectional survey was administered to orthopedic surgeons with interest in pediatrics in April 2020. The survey captured demographics and selfreported experiences during the pandemic. Surgeons were recruited through web media and email lists of orthopaedic societies over 2 months. Descriptive statistics were used to analyze results. Summary of Results We received 460 responses from 45 countries. 358 (78.5%) respondents reported lockdown measures in their region at time of survey. Most (n=337, 94.4%) reported pausing all elective procedures. Surgeons reported reduction in average number of surgeries per week, from 6.89 (SD=4.61) pre-pandemic to 1.25 (SD=2.26) at time of survey (mean difference= 5.64;95% CI=5.19, 6.10). Average number of elective outpatient appointments per week decreased from 67.89 (SD=45.78) pre-pandemic to 11.79 (SD=15.83) at time of survey (mean difference=56.10, 95% CI: 5.61, 60.58). 177 (39.4%) surgeons reported using virtual modes of outpatient appointments for the first time. Of 290 surgeons with trainees, 223 (84.5%) reported systems to continue training. Of 192 surgeons with research, 149 (82.8%) reported continuing research activities during pandemic. Most reported cessation (n=75, 64.1%) or reduction (n=40, 34.1%) in patient recruitment at time of survey. Conclusions We found significant impacts on pediatric orthopaedic practice with uptake of technology to provide care continuity. Understanding global impacts can inform sustainable practices to provide continuity in future disruptions. We will pursue follow-up surveys to assess longitudinal impacts on surgeons. Epidemiological studies are needed to assess impacts of delayed and virtual care on patient outcomes.
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Purpose of Study In response to the coronavirus pandemic, the Central Montana Medical Center (CMMC) in Lewistown, Montana bolstered its telemedicine program while restricting in-person visits. Patients inexperienced with technology- -especially the elderly-forwent care. The purpose of this study was to determine how telemedicine access can be improved for residents of Lewistown senior living communities (SLCs), defined as independent, assisted living and nursing home facilities for older adults. Methods Used CMMC administration cite patient inexperience with technology and clinician buy-in as the largest barriers to telemedicine utilization (personal communication, July 28, 2020). To elucidate, Lewistown SLC administrators were surveyed. The vast majority did not assist residents with telemedicine visits, but almost all expressed interest in offering it if training were provided. CMMC clinicians were also surveyed. Most had no telemedicine training and few felt comfortable using it. Therefore, SLC staff and clinician training were identified as avenues to improve telemedicine delivery. Two studies were evaluated to ascertain the benefit of such interventions. Summary of Results The first study found access to telemedicine and telemedicine-trained staff reduced emergency department (ED) use among SLC residents by 18% annually. Residents without access to such services experienced a 1% growth in ED visits (Shah et al., 2015). The second study assessed variability in medical care between virtual visit companies. Significant variations were observed across all measures, underscoring the necessity of provider telemedicine training (Schoenfeld et al., 2017). Both studies and SLC/clinician survey results were presented to CMMC administration. Conclusions Training SLC staff to assist residents with telemedicine visits may increase telemedicine usage and healthcare access. Similarly, training CMMC clinicians on virtual physical exams and history collection may improve their confidence in telemedicine technology and quality of virtual care. The survey results and literature suggest both interventions would have a significant impact on telemedicine delivery in Lewistown. Future steps include determining level of training for SLC staff and exploring telemedicine training programs for providers.
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Background: Since 2015, the Cystic Fibrosis Foundation (CFF) has collected and reported experience-of-care (XoC) data. Data collection was discontinued with the onset of the COVID-19 pandemic in 2020. In 2021, CFF convened a steering committee of a person with cystic fibrosis (CF), caregivers, and clinicians to develop a XoC survey to help understand and improve the XoC at CFF accredited programs. Method(s): Using prior CFF patient and family XoC surveys (2015-2020 pediatric and adult versions) [1,2] and a telehealth survey created in 2020 [3], draft pediatric and adult versions of the survey were developed. The steering committee and CFF leaders conducted three rounds of reviewand revision. After the surveys were professionally translated into Spanish, and the CFF Spanish Speakers Committee reviewed them, the surveys were programmed into Qualtrics for data collection. The data collection process was piloted with selected programs before a national launch. Result(s): Pediatric and adult surveys were developed in English and Spanish. The surveys cover in-person and telehealth (phone/video) visits and visits that are a mix of in-person and telehealth. The topics include interactions with care team members, relationship-centered care, care planning, shared decision-making, overall quality of care, race and ethnicity, gender identity, infection, prevention and control, quality of the virtual connection, and experience with remote monitoring. People with CF (PwCF) and their families are invited to complete a survey once every 6 months by text or email. PwCF and family contact data (email and mobile phone number) are stored in CFF's CFSmartReports Patient and Family Tool. After a clinic visit, contact data are electronically transferred to the Qualtrics platform to trigger a survey invitation. Responses are anonymous and reported back to programs via an electronic dashboard in near-real time. The data collection process was tested with three pediatric and three adult care programs for 3 weeks before the national launch on October 25, 2021. More than 2,000 PwCF and their families have completed a survey. Conclusion(s): The new XoC surveys offer PwCF and their families an opportunity to share feedback about their in-person and virtual care experiences. Efforts are underway to create a national report for dissemination and to engage programs with the data reported in their dashboards to celebrate what PwCF and their families appreciate about their care and to work together with them to improve gaps.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved
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With the COVID-19 pandemic there was a swift and necessary adoption of telehealth for medical care, including medical nutrition therapy services. While the pandemic control measures have entered a new phase in Australia, the federal government has pledged to continue some Medical Nutrition Therapy (MNT) services as virtual consultations. It is important to ensure that service is equitable for all in the community and that the digital divide does not prevent access for disadvantaged groups. Older patients may be particularly at risk, and it is important to assess their ability to understand and accept virtual care. The aim of this scoping review was to identify available tools for assessing digital literacy in middle-aged and older adults and to determine their feasibility for patient use and their applicability to MNT services. The review followed the Joanna Briggs Institute guide for scoping reviews.(1) Five medical databases, reference lists of the identified studies and publications from main authors were searched to source peer-reviewed articles published in English from 2014 to February 2021. Studies for inclusion were those that used or tested a digital literacy tool in participants aged 45 years and above. Quantitative study designs conducted in clinical, community or population settings were considered Studies not meeting these criteria were deemed ineligible. The results were synthesised in tabular form and with a narrative review The generalisability of the included studies was assessed, and the applicability of the identified tools were evaluated using a four point-scale informed by the National Health Medical Research Council guide for developers of guidelines. Searches yielded 866 articles of which 30 studies (31 reports) inclusive of 11,620 participants, were used in the final analysis. Seven tools for assessment of digital literacy were identified, and the electronic health Literacy Scale (eHEALS) and modifications of this tool were most frequently used. Other tools included the Computer Proficiency Questionnaire and variations for mobile and wireless networks. Most studies found low digital health literacy among older adults. The eHEALS was found to be the most applicable for practitioners to use for assessing suitability of virtual care for their patients. This tool is inclusive of eight questions self-administered using a Likert scale (5-point) and covering the domains of traditional literacy, health and scientific literacy, information literacy as well as media and computer literacy. The findings highlight the importance of locating an appropriate digital literacy tool for older adults to better inform telehealth-delivered MNT practice. Future studies should explore effective interventions and educational programs for disadvantaged and under-served populations to help connect them with healthcare services online.
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Background/Purpose: RBST patients have limited supportive care resources and feel secluded as few healthcare providers have expertise in these diseases. The NCI-CONNECT specialized clinic for adults with RBSTs created a multidisciplinary approach with a genetic counselor, knowledgeable healthcare team, and group sessions with a health and wellness counselor (CARES). The CARES sessions created an educational and supportive space for patients to share their unique experiences. We report the adaptation of the CARES group that evolved from in-person to virtual during COVID. Method(s): Patients with RBSTs and their families attended weekly (1 h) groups at their clinic appointments. The CARES group leaders (A.A, S.S) led wellness/coping presentations (15-20 min) and a guided discussion on the topic. In 2021, the COVID pandemic shifted the group to monthly virtual meetings, and educational content was shared via a closed-Facebook group and NCI-CONNECT website. Six groups included presenters within Neuro-Oncology, shortened prerecorded presentations (10 min) allowing for more engagement opportunities, and a coping activity concluded the meeting. Emailed survey feedback was requested (5 out of 13 completed). Result(s): On average, six patients attended each group. Topics included mindfulness, distress, relational challenges, body image, and an educational series on symptom management. All presentations can be found on the NCI-CONNECT website. Patients reported enjoyment in the ability to connect with others, with 80% preferring monthly virtual meetings. Open-ended comments noted that hearing other patients' stories created connections patients expressed they needed. Conclusions and Implications: The virtual CARES group created an accessible space for RBST patients to build relationships and gain support to manage the uncertainties of coping with a rare disease during a time of physical isolation. Patient responses capture the need to continue the group further. Future work will focus on expanding the group based on patient needs and building metrics to understand the overall group benefits in a virtual world.
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In this technique, it has been proposed to agree the session keys that have been generated through dual artificial neural networks based on the Telecare Health COVID-19 domain. Electronic health enables secure and protected communication between the patients and physicians, especially during this COVID-19 pandemic. Telecare was the main component which served the remote and non-invasive patients in the crisis period of COVID-19. Neural cryptographic engineering support in terms of data security and privacy is the main theme for Tree Parity Machine (TPM) synchronization in this paper. The session key has been generated on different key lengths and key validation done on the proposed set of robust session keys. A neural TPM network receives a vector designed through same random seed and producing a single output bit. Duo neural TPM networks' intermediate keys would be partially shared between the patient and doctor for the purpose neural synchronization. Higher magnitude of co-existence has been observed at the duo neural networks at the Telecare Health Systems in COVID-19. This proposed technique has been highly protective against several data attacks in the public networks. Partial transmission of the session key disables the intruders to guess the exact pattern, and highly randomized through different tests. The average p-values of different session key lengths of 40 bits, 60 bits, 160 bits, and 256 bits were observed to be 221.9, 259.3, 242, and 262.8 (taken under multiplicative of 1000) respectively.
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Introduction: Telemedicine is a follow-up system that can improve the quality of management and cost-effectiveness of rapidly increasing diabetes patients. Methods: Two hundred adult patients with diabetes were enrolled in this prospective, randomized study. Consecutive patients were divided equally into two groups. Both groups received routine care visits quarterly. TeleDiab group also sent self-monitoring of blood glucose data and received short message service over the transmission system for 12 months. After the study was completed, all patients continued their routine care visits, and their data were evaluated for another 12 months. Six years after the initial study, patients were contacted by phone during the Covid-19 lockdown, and their status was assessed. Results: At the end of the study, glycemic control, kidney function, and lipid parameters of the TeleDiab group were statistically significantly better than the Usual Care group. There was no significant change in the weights of the patients. It was observed that this state of wellbeing continued both at the end of the second year and during the Covid-19 lockdown. Individuals with type 2 diabetes were found to benefit more from telemedicine. Discussion: It has been beneficial to guide patients with applications such as TeleDiab in diseases such as diabetes that require lifelong follow-up. On the other hand, the importance of telemedicine programs in the management of chronic diseases in the current pandemic conditions has come to the fore even more. Telemedicine is an effective motivational tool to ensure optimal control not only of glycemic but also of kidney and lipid parameters.
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Advances in technology have resulted in increasing adoption of virtual dermatology services across the National Health Service. This has accelerated dramatically during the COVID-19 pandemic. Providing remote consultation alternatives empowers many patients to manage their health away from traditional in-person services. However, there is concern that universal implementation of such services may potentially widen healthcare inequalities for some patient groups. Reliably identifying at-risk groups is challenging. Co-design of health services has been proposed as a method to ensure equality and appropriateness of provision for all patients accessing a service by including them in the design process. In this study we profile the digital health literacy of patients with chronic skin conditions with the aim of using this information to redesign virtual services to support their long-term skin health. The Multidimensional Readiness and Enablement Index for Health Technology (READHY), comprising the eHealth Literacy Questionnaire (eHLQ), Health Literacy Questionnaire (HLQ) and Health Education Impact Questionnaire (heiQ), was used to assess patient skills, confidence and experience in using technology to manage their health. Consecutive patients under long-term follow-up in two specialist clinics supporting chronic skin conditions (organ transplant surveillance and biologics monitoring) completed questionnaires either in person or over the telephone. Between July and November 2021, 99 of 128 (77.3%) of patients invited to participate took part. Overall, these patients showed high levels of self-management skills, determination not to let health problems control their life and good support from family and healthcare professionals. In the domains related to digital skills, the responses were diverse. A cluster analysis identified multiple groups of patients with varying combinations of higher or lower level of digital health literacy, social and healthcare support, as well as capabilities in handling health condition and emotional responses. These preliminary data have provided important information for optimizing a co-design process aimed at tailoring services to support patients with chronic skin diseases. In particular, it has identified patient groups with distinct differences in terms of digital health literacy. Recognition of these groups and their differing profiles in terms of barriers to accessing virtual healthcare will be a key consideration in ensuring equitable representation in the service co-design process. It provides opportunities to target support to those patients with lower digital health literacy skills so that they may benefit from virtual services or adaptation of these services to address their specific needs. Alternatively, it allows recognition of patient groups who have higher digital health literacy and may safely benefit from alternative approaches to service provision such as patient-initiated follow-up.
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Background: With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. Research question: We explored GPs' perspectives on digital remote care's main benefits and challenges. Method(s): GPs across 20 countries completed an online questionnaire between June and September 2020. GPs' perceptions of main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. Result(s): In our survey 1605 respondents participated. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and the accompanying legal frameworks. Main challenges included patient's preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital remote care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues and regulatory weaknesses. Conclusion(s): At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how. Lessons learned during the emergency phase can inform the stable adoption of virtual care solutions and co-design processes and platforms that are technologically robust, secure, and supported by a long-term strategic plan.
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Determining the perception and sentiment of public's opinion of telemedicine and telecare has benefits to healthcare organizations, physicians and patients. Determining a relationship between opinion and demographic elements will aid in developing ways to close the gap between perception and readiness to implement healthcare technology for patients. The concept of telemedicine becomes more critical due to the onset of pandemics such as COVID-19. In addition, with telemedicine being a viable option to reduce cost and inconvenience for the patient, while delivering care that is effective and efficient, having patient buy in will be a key element. This study aims to identify the perception about telemedicine and telecare based on the posts by Twitter users eighteen months before and after COVID-19 pandemic. We leveraged VADER sentiment analysis model to identify the sentiment of the public using the tweets they posted. Out of approximately 1,073,817 tweets included, 491,695 unique tweets from 10,495 unique users met the inclusion criteria Among all countries, United States dominated the tweet volume. Among all the states in US, it is interesting to note that district of Columbia dominated the tweet volume. Among tweets from top five English speaking countries, interestingly after March 2020, the average sentiment of all countries seems to converge to the same value. Results indicate that before COVID-19 outbreak, people had neutral perception or sentiment towards telemedicine, while after the onset of increased cases and high alert situations, people tend to support Telemedicine and the overall perception started to grow towards the positive side. © 2022 IEEE.