-
Telemedicine Journal and E-health : the... Dec 2023(Meta-Analysis)
Meta-Analysis Review
Topics: Humans; Arthritis, Rheumatoid; Telemedicine
PubMed: 37074335
DOI: 10.1089/tmj.2023.0074 -
American Journal of Physical Medicine &... Aug 2023Physical examinations are essential for in-person patient visits but remain difficult to replicate during virtual encounters. This work aims to identify gaps in the...
OBJECTIVES
Physical examinations are essential for in-person patient visits but remain difficult to replicate during virtual encounters. This work aims to identify gaps in the current state of telemedicine-based physical assessments by surveying physical medicine and rehabilitation physicians who perform physical examinations.
DESIGN
A survey of 29 Likert-scale questions and five open-ended questions was distributed to practicing physical medicine and rehabilitation physicians. The Likert-scale questions covered remote physical assessment, access, perception/engagement, implementation/effectiveness, and administrative concerns.
RESULTS
Fifty-three participants completed the survey. More than 80% of respondents suggested that while telemedicine was universally well accepted, they could not effectively perform telemedicine-based physical assessments, especially the musculoskeletal and neurological components. Remote assessment of upper and lower limb strength, reflexes, and sensation were examples of key unmet needs. Responses to open-ended questions suggested that telemedicine-based physical assessments can reduce the burden of travel and increase adherence to follow-up visits, but complex technology setup can pose difficulty for older patients and patients with cognitive deficits.
CONCLUSIONS
These findings suggest that current telemedicine technology is insufficient to meet physical medicine and rehabilitation physicians' telemedicine-based physical assessments needs. Despite high levels of provider and patient engagement with telemedicine, numerous deficits remain in performing musculoskeletal and neurological examinations. These results can inform future technology developments that address these identified telemedicine-based physical assessments gaps.
Topics: Humans; Needs Assessment; Telemedicine; Neurologic Examination; Surveys and Questionnaires; Physical and Rehabilitation Medicine
PubMed: 36927980
DOI: 10.1097/PHM.0000000000002175 -
Sexual and Reproductive Health Matters Dec 2023The non-governmental organisation Profamilia developed and implemented medical abortion through telemedicine in response to the Covid-19 pandemic. This service is now...
The non-governmental organisation Profamilia developed and implemented medical abortion through telemedicine in response to the Covid-19 pandemic. This service is now integrated as an alternative to in-person care and available to abortion-seekers across Colombia. Previous research has emphasised bottlenecks in abortion provision, but less is known about implementation processes and experiences. We assessed the feasibility and acceptability of telemedicine for medical abortion from the perspectives of key informants involved in the implementation in Colombia. We conducted 15 in-depth interviews with healthcare professionals, coordinators and support staff implementing telemedicine for medical abortion in the early phase of implementation, between March and October 2021. We analysed the data using the framework method and applied the normalisation process theory in our analysis and interpretation of findings. Our findings show that strong leadership, organisational efforts on pre-implementation training, monitoring and evaluation, and collaboration between diversely skilled and experienced providers are essential for successful implementation. Participants were generally positive towards the use of telemedicine for medical abortion; concerns related to effectiveness, safety and safeguarding existed mainly among providers with less clinical experience. We identified contextual barriers, such as social opposition, regulatory barriers, providers' unavailability, and poor phone and internet connections in rural areas, which impacted the feasibility of the intervention negatively. In conclusion, to ensure stakeholders' buy-in and for the service to reach all abortion seekers in need, future implementation endeavours must address concerns about safety and effectiveness, and tackle identified contexual barriers.In telemedicine for medical abortion, all or some components of abortion care, such as initial consultations, home delivery of abortion medication, and post-abortion follow up are provided with the use of telecommunications. Telemedicine for medical abortion has been shown to be a safe and effective form of service delivery.In this study, we interviewed 15 healthcare providers and staff involved in the implementation of a telemedicine service for medical abortion in Colombia to determine whether they deemed the service to be acceptable and feasible. We found that collaboration between providers of different backgrounds and levels of experience, appropriate training and strong leadership were key factors for successfully implementing the service. However, some healthcare providers, especially those with less clinical experience, were concerned that telemedicine for medical abortion may not be safe and may risk the health and well-being of abortion-seekers. Further, social opposition to abortion, unclear regulation and limited access to technology were identified as barriers that need to be addressed to ensure the service reaches all abortion-seekers in need.In conclusion, despite contextual barriers and some provider's concerns about medical safety, telemedicine for medical abortion was viewed as a positive and feasible form of service delivery in Colombia.
Topics: Pregnancy; Female; Humans; Colombia; Pandemics; COVID-19; Abortion, Induced; Telemedicine
PubMed: 37565788
DOI: 10.1080/26410397.2023.2236780 -
Telemedicine Journal and E-health : the... May 2024(Review)
Review
Topics: Telemedicine; Humans; India; Health Services Accessibility; Stakeholder Participation; Attitude of Health Personnel
PubMed: 38206654
DOI: 10.1089/tmj.2023.0297 -
Telemedicine Journal and E-health : the... Jun 2024
Topics: Humans; Telemedicine
PubMed: 38940636
DOI: 10.1089/tmj.2024.0295 -
Journal of Neurologic Physical Therapy... Oct 2023
Topics: Humans; Telemedicine
PubMed: 37725806
DOI: 10.1097/NPT.0000000000000457 -
BMC Health Services Research Nov 2023Given the rapid deployment of telemedicine at the onset of the COVID - 19 pandemic, updated assessment methods are needed to study and characterize telemedicine...
BACKGROUND
Given the rapid deployment of telemedicine at the onset of the COVID - 19 pandemic, updated assessment methods are needed to study and characterize telemedicine programs. We developed a novel semi - structured survey instrument to systematically describe the characteristics and implementation processes of telemedicine programs in primary care.
METHODS
In the context of a larger study aiming to describe telemedicine programs in primary care, a survey was developed in 3 iterative steps: 1) literature review to obtain a list of telemedicine features, facilitators, and barriers; 2) application of three evaluation frameworks; and 3) stakeholder engagement through a 2-stage feedback process. During survey refinement, items were tested against the evaluation frameworks while ensuring it could be completed within 20-25 min. Data reduction techniques were applied to explore opportunity for condensed variables/items.
RESULTS
Sixty initially identified telemedicine features were reduced to 32 items / questions after stakeholder feedback. Per the life cycle framework, respondents are asked to report a month in which their telemedicine program reached a steady state, i.e., "maturation". Subsequent questions on telemedicine features are then stratified by telemedicine services offered at the pandemic onset and the reported point of maturation. Several open - ended questions allow for additional telemedicine experiences to be captured. Data reduction techniques revealed no indication for data reduction.
CONCLUSION
This 32-item semi-structured survey standardizes the description of primary care telemedicine programs in terms of features as well as maturation process. This tool will facilitate evaluation of and comparisons between telemedicine programs across the United States, particularly those that were deployed at the pandemic onset.
Topics: Humans; United States; COVID-19; Telemedicine; Surveys and Questionnaires; Pandemics; Primary Health Care
PubMed: 37978511
DOI: 10.1186/s12913-023-10130-5 -
Seminars in Arthritis and Rheumatism Dec 2023In this article, we review published literature on "telerheumatology", a term describing the use of telemedicine in rheumatology. This field has received considerable... (Review)
Review
In this article, we review published literature on "telerheumatology", a term describing the use of telemedicine in rheumatology. This field has received considerable recent attention through the development of efficient digital technologies, resulting in a good level of satisfaction among patients and health care professionals. In 2020, the social distancing constraints during the COVID-19 pandemic accelerated more widespread adoption worldwide. Telerheumatology is particularly suited for patients with rheumatoid arthritis who have achieved a sustained therapeutic target of remission or low disease activity. To facilitate remote consultations and meet expectations of rheumatologists and patients, international and national guidelines have recently been proposed and existing tools, such as Patient-Reported Outcomes questionnaires, have had to be digitally adapted. In addition, telerheumatology toolkits are proposed by the Arab League of Associations for Rheumatology (ArLAR), the Association of American Medical College (AAMC), and the American College of Rheumatology (ACR) for all learners, from medical students to practicing clinicians, encouraging the acquisition of telehealth skills and facilitating their integration into their routine clinical practice. The main benefits reported for this mode of health care are greater access to specialty care, flexibility, reduced rates of missed appointments, as well as improved patient engagement and autonomy. Limitations include the absence of physical examination. However, to implement telerheumatology effectively and widely in daily clinical practice, some barriers still need to be addressed. These include training of health care professionals, technological restrictions and reimbursement mechanisms. Despite the advantages of telerheumatology, it is not intended to replace face-to-face visits, but rather as a way to enhance access to care, service delivery and health care support for patients.
Topics: Humans; Remote Consultation; Rheumatology; Pandemics; Telemedicine; Delivery of Health Care
PubMed: 37813005
DOI: 10.1016/j.semarthrit.2023.152271 -
BMJ (Clinical Research Ed.) Sep 2023
Topics: Humans; Telemedicine
PubMed: 37730379
DOI: 10.1136/bmj.p2138 -
Journal of Medical Internet Research Jul 2023Side effects of breast cancer treatment may persist long into survivorship, reducing quality of life (QOL) in patients with breast cancer and survivors. There is growing... (Review)
Review
BACKGROUND
Side effects of breast cancer treatment may persist long into survivorship, reducing quality of life (QOL) in patients with breast cancer and survivors. There is growing evidence for the use of digital health technologies, such as mobile apps, to support self-management, decrease symptom burden, and improve QOL in patients with cancer. However, an updated overview of the effects of mobile apps on QOL and well-being in patients with breast cancer and survivors is needed.
OBJECTIVE
The aim of this review was to provide an overview of breast cancer-specific, mobile app-driven lifestyle or behavioral interventions in patient care through to survivorship and their impact on QOL and mental well-being.
METHODS
A systematic search of PubMed, Scopus, and Web of Science was conducted to identify relevant studies. The inclusion criteria were limited to original studies involving a trial of a mobile app-driven lifestyle or behavioral intervention for patients with breast cancer or survivors and using QOL or well-being measures. The results of the studies that met the inclusion criterion were then synthesized in text and table format. The quality of the evidence was assessed with the Cochrane risk-of-bias tool.
RESULTS
A total of 17 studies with the number of participants ranging from 23 to 356 met the inclusion criterion. Of the 17 reviewed studies, 7 (41%) delivered an app-only intervention, and 10 (59%) combined an app with additional supporting materials, such as SMS text messaging, telecoaching, wearables, or printed materials. Among the 17 reviewed studies, 6 (35%) focused on aiding patients with breast cancer during the active treatment phase (excluding ongoing hormone therapy), whereas the remaining 11 (65%) focused on survivorship. The majority of the studies (14/17, 82%) observed some positive effects on QOL or well-being measures.
CONCLUSIONS
The results of the review indicate that mobile apps are a promising avenue for improving QOL and well-being in breast cancer care. Positive effects were observed in patients undergoing active treatment in all reviewed studies, but effects were less clear after chemotherapy and in long-term survivors. Although lifestyle and behavioral digital interventions are still being developed, and further research should still be pursued, the available data suggest that current mobile health apps aid patients with breast cancer and survivors.
Topics: Humans; Female; Breast Neoplasms; Mobile Applications; Quality of Life; Survivors; Text Messaging; Telemedicine
PubMed: 37494111
DOI: 10.2196/42852