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Journal of Medical Internet Research Feb 2024Several systematic reviews (SRs) assessing the use of telemedicine for musculoskeletal conditions have been published in recent years. However, the landscape of evidence... (Review)
Review
BACKGROUND
Several systematic reviews (SRs) assessing the use of telemedicine for musculoskeletal conditions have been published in recent years. However, the landscape of evidence on multiple clinical outcomes remains unclear.
OBJECTIVE
We aimed to summarize the available evidence from SRs on telemedicine for musculoskeletal disorders.
METHODS
We conducted an umbrella review of SRs with and without meta-analysis by searching PubMed and EMBASE up to July 25, 2022, for SRs of randomized controlled trials assessing telemedicine. We collected any kind of patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs), and objective measures, including direct and indirect costs. We assessed the methodological quality with the AMSTAR 2 tool (A Measurement Tool to Assess systematic Reviews 2). Findings were reported qualitatively.
RESULTS
Overall, 35 SRs published between 2015 and 2022 were included. Most reviews (n=24, 69%) were rated as critically low quality by AMSTAR 2. The majority of reviews assessed "telerehabilitation" (n=29) in patients with osteoarthritis (n=13) using PROMs (n=142 outcomes mapped with n=60 meta-analyses). A substantive body of evidence from meta-analyses found telemedicine to be beneficial or equal in terms of PROMs compared to conventional care (n=57 meta-analyses). Meta-analyses showed no differences between groups in PREMs (n=4), while objectives measures (ie, "physical function") were mainly in favor of telemedicine or showed no difference (9/13). All SRs showed notably lower costs for telemedicine compared to in-person visits.
CONCLUSIONS
Telemedicine can provide more accessible health care with noninferior results for various clinical outcomes in comparison with conventional care. The assessment of telemedicine is largely represented by PROMs, with some gaps for PREMs, objective measures, and costs.
TRIAL REGISTRATION
PROSPERO CRD42022347366; https://osf.io/pxedm/.
Topics: Humans; Delivery of Health Care; Musculoskeletal Diseases; Osteoarthritis; Telemedicine; Telerehabilitation; Systematic Reviews as Topic; Meta-Analysis as Topic
PubMed: 38306156
DOI: 10.2196/50090 -
Worldviews on Evidence-based Nursing Jun 2024Telemedicine is an effective way to provide nursing home residents ease of access to consultations with healthcare professionals. It is safe, effective, and time- and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Telemedicine is an effective way to provide nursing home residents ease of access to consultations with healthcare professionals. It is safe, effective, and time- and cost-efficient, and can be used when there are movement restrictions, such as during the COVID-19 pandemic. This literature focuses only on healthcare professionals' experiences and perspectives on the use of telemedicine in long-term care facilities.
OBJECTIVES
This review concentrated on telemedicine programs that did not involve remote monitoring. It aimed to comprehensively appraise existing literature examining the facilitators and barriers in implementing telemedicine services in nursing homes.
METHODS
A systematic qualitative review was conducted with content analysis. Database searching was conducted in PubMed, Embase, Cochrane, Scopus, and CINAHL. Hand searching for gray literature and reference lists of included papers was also performed. Qualitative studies or mixed-method studies with a qualitative analysis addressing implementation of telemedicine in any long-term care facilities were included. The Critical Appraisal Skills Programme qualitative checklist was used to assess the quality of the included studies. The data were extracted and cross-checked between two reviewers. A third reviewer was consulted for any disagreements. Meta-aggregation was used to synthesize the results.
RESULTS
Eighty-one findings were extracted, which informed 16 categories and 13 synthesized findings. The synthesized findings were related to the innovation domain, infrastructure, work processes, individuals, and implementation processes.
LINKING EVIDENCE TO ACTION
This review highlighted factors that affect the successful implementation of a telemedicine service in nursing homes. These findings provide evidence to support the future utilization of this service in the nursing home setting. Further research should explore the best approach to address these barriers and facilitators.
Topics: Nursing Homes; Humans; Telemedicine; COVID-19; Qualitative Research; SARS-CoV-2; Pandemics
PubMed: 38340069
DOI: 10.1111/wvn.12711 -
Studies in Health Technology and... Oct 2023Mental health is one of the major global concerns in the field of healthcare. The emergence of digital solutions is proving to be a great aid for individuals suffering...
INTRODUCTION
Mental health is one of the major global concerns in the field of healthcare. The emergence of digital solutions is proving to be a great aid for individuals suffering from mental health disorders. These solutions are particularly useful and effective when they are personalized. The objective of this paper is to understand the personalization factors and the methods that have been used to collect information to personalize the digital mental health solutions.
METHODS
This paper builds on a previous review that analyzed the personalization of digital solutions in mHealth, and expands on the extracted information for the specific case of mental health.
RESULTS
Ten mental health digital solutions have been analyzed. The paper focuses on targeted conditions, personalization factors and the methods used for collecting personalization factors.
DISCUSSION
The analyzed mental health digital solutions cover a wide range of health conditions. It is remarkable that most articles do not explicitly mention the factors used to personalize the solution. Among the solutions that mention them, there is a great diversity of factors utilized, such as age, gender, user preferences, and subjective behavior. The authors point out the methods for obtaining data to personalize the solutions, including in-app questionnaires, self-reports, and usage data of the solutions.
CONCLUSIONS
The analysis of current mental health digital solutions emphasizes the need to create guidelines for designing personalized digital solutions for mental health.
Topics: Humans; Mental Health; Mental Disorders; Telemedicine; Surveys and Questionnaires; Self Report
PubMed: 37869858
DOI: 10.3233/SHTI230797 -
Current Psychiatry Reports Sep 2023The purpose of this review is to summarize factors contributing to the current state of pediatric mental health access in ED settings and synthesize the existing... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to summarize factors contributing to the current state of pediatric mental health access in ED settings and synthesize the existing literature on the use of telepsychiatry to extend access to care, with particular focus on feasibility and sustainability.
RECENT FINDINGS
Children are presenting to emergency departments (EDs) with mental health concerns at an increasing rate, while ED capacity to treat psychiatric needs in children remains insufficient. This growing problem is compounded by decreased access to outpatient care and inpatient psychiatric beds, resulting in exorbitantly long waiting times, or "boarding," of children in crisis. Telepsychiatry has emerged as a strategy to decrease boarding of pediatric patients in ED settings by utilizing remote psychiatric professionals to provide consultation and assessment. Telepsychiatry in ED settings is an effective strategy to increase access to care and decrease length of stay for pediatric patients.
Topics: Humans; Child; Psychiatry; Telemedicine; Mental Disorders; Mental Health Services; Emergency Service, Hospital
PubMed: 37526863
DOI: 10.1007/s11920-023-01442-8 -
Orbit (Amsterdam, Netherlands) Aug 2023This study evaluates a web-based tool designed to augment telemedicine post-operative visits after periocular surgery.
PURPOSE
This study evaluates a web-based tool designed to augment telemedicine post-operative visits after periocular surgery.
METHODS
Adult, English-speaking patients undergoing periocular surgery with telemedicine follow-up were studied prospectively in this interventional case series. Participants submitted visual acuity measurements and photographs via a web-based tool prior to routine telemedicine post-operative visits. An after-visit survey assessed patient perceptions. Surgeons rated photographs and live video for quality and blurriness; external raters also evaluated photographs. Images were analyzed for facial centration, resolution, and algorithmically detected blur. Complications were recorded and graded for severity and relation to telemedicine.
RESULTS
Seventy-nine patients were recruited. Surgeons requested an in-person assessment for six patients (7.6%) due to inadequate evaluation by telemedicine. Surgeons rated patient-provided photographs to be of higher quality than live video at the time of the post-operative visit (p < 0.001). Image blur and resolution had moderate and weak correlation with photograph quality, respectively. A photograph blur detection algorithm demonstrated sensitivity of 85.5% and specificity of 75.1%. One patient experienced a wound dehiscence with a possible relationship to inadequate evaluation during telemedicine follow-up. Patients rated the telemedicine experience and their comfort with the structure of the visit highly.
CONCLUSIONS
Augmented telemedicine follow-up after oculofacial plastic surgery is associated with high patient satisfaction, rare conversion to clinic evaluation, and few related post-operative complications. Automated detection of image resolution and blur may play a role in screening photographs for subsequent iterations of the web-based tool.
Topics: Adult; Humans; Surgery, Plastic; Follow-Up Studies; Telemedicine; Patient Satisfaction; Plastic Surgery Procedures; Postoperative Complications
PubMed: 35920583
DOI: 10.1080/01676830.2022.2104325 -
Orthopadie (Heidelberg, Germany) May 2024Digital transformation is shaping the future of orthopedics and trauma surgery. Telemedicine, digital health applications, electronic patient records and artificial... (Review)
Review
BACKGROUND
Digital transformation is shaping the future of orthopedics and trauma surgery. Telemedicine, digital health applications, electronic patient records and artificial intelligence play a central role in this. These technologies have the potential to improve medical care, enable individualized patient treatment plans and reduce the burden on the treatment process. However, there are currently challenges in the areas of infrastructure, regulation, reimbursement and data protection.
REALISING THE TRANSFORMATION
Effective transformation requires a deep understanding of both technology and clinical practice. Orthopedic and trauma surgeons need to take a leadership role by actively engaging with new technologies, designing new treatment processes and enhancing their medical skills with digital and AI competencies. The integration of digital skills into medical education and specialist training will be crucial for actively shaping the digital transformation and exploiting its full potential.
Topics: Humans; Telemedicine; Artificial Intelligence; Orthopedics; Electronic Health Records; Traumatology; Orthopedic Procedures; Wounds and Injuries; Acute Care Surgery
PubMed: 38538858
DOI: 10.1007/s00132-024-04496-5 -
BMC Psychiatry Nov 2023Perinatal depression affects an estimated 1 in 5 women in North America during the perinatal period, with annualized lifetime costs estimated at $20.6 billion CAD in...
Protocol for an economic evaluation of scalable strategies to improve mental health among perinatal women: non-specialist care delivered via telemedicine vs. specialist care delivered in-person.
BACKGROUND
Perinatal depression affects an estimated 1 in 5 women in North America during the perinatal period, with annualized lifetime costs estimated at $20.6 billion CAD in Canada and over $45.9 billion USD in the US. Access to psychological treatments remains limited for most perinatal women suffering from depression and anxiety. Some barriers to effective care can be addressed through task-sharing to non-specialist providers and through telemedicine platforms. The cost-effectiveness of these strategies compared to traditional specialist and in-person models remains unknown. This protocol describes an economic evaluation of non-specialist providers and telemedicine, in comparison to specialist providers and in-person sessions within the ongoing Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) trial.
METHODS
The economic evaluation will be undertaken alongside the SUMMIT trial. SUMMIT is a pragmatic, randomized, non-inferiority trial across five North American study sites (N = 1,226) of the comparable effectiveness of two types of providers (specialist vs. non-specialist) and delivery modes (telemedicine vs. in-person) of a behavioural activation treatment for perinatal depressive and anxiety symptoms. The primary economic evaluation will be a cost-utility analysis. The outcome will be the incremental cost-effectiveness ratio, which will be expressed as the additional cost required to achieve an additional quality-adjusted life-year, as assessed by the EuroQol 5-Dimension 5-Level instrument. A secondary cost-effectiveness analysis will use participants' depressive symptom scores. A micro-costing analysis will be conducted to estimate the resources/costs required to implement and sustain the interventions; healthcare resource utilization will be captured via self-report. Data will be pooled and analysed using uniform price and utility weights to determine cost-utility across all trial sites. Secondary country-specific cost-utility and cost-effectiveness analyses will also be completed. Sensitivity analyses will be conducted, and cost-effectiveness acceptability-curves will be generated, in all instances.
DISCUSSION
Results of this study are expected to inform key decisions related to dissemination and scale up of evidence-based psychological interventions in Canada, the US, and possibly worldwide. There is potential impact on real-world practice by informing decision makers of the long-term savings to the larger healthcare setting in services to support perinatal women with common mental health conditions.
Topics: Humans; Female; Mental Health; Cost-Benefit Analysis; Anxiety; Depressive Disorder; Telemedicine
PubMed: 37940930
DOI: 10.1186/s12888-023-05318-2 -
The British Journal of Oral &... Feb 2024In the backdrop of telemedicine's rise, this review explores its integration into oral and maxillofacial surgery (OMFS), especially given the healthcare access... (Review)
Review
In the backdrop of telemedicine's rise, this review explores its integration into oral and maxillofacial surgery (OMFS), especially given the healthcare access challenges faced by nearly 20% of the rural population in the United States of America. The study underscores the potential of telemedicine to address disparities in access to OMFS care, particularly in rural areas, by improving patient care, reducing travel needs, and fostering collaborative diagnosis and treatment. The findings advocate for broader adoption of telemedicine in OMFS, contingent upon supportive policy and infrastructure changes.
Topics: Humans; Telemedicine; Head; Rural Population
PubMed: 38160080
DOI: 10.1016/j.bjoms.2023.11.003 -
Journal of the American Board of Family... 2024This issue highlights changes in medical care delivery since the start of the COVID-19 pandemic and features research to advance the delivery of primary care. Several...
This issue highlights changes in medical care delivery since the start of the COVID-19 pandemic and features research to advance the delivery of primary care. Several articles report on the effectiveness of telehealth, including its use for hospital follow-up, medication abortion, management of diabetes, and as a potential tool for reducing health disparities. Other articles detail innovations in clinical practice, from the use of artificial intelligence and machine learning to a validated simple risk score that can support outpatient triage decisions for patients with COVID-19. Notably one article reports the impact of a voluntary program using scribes in a large health system on physician documentation behaviors and performance. One article addresses the wage gap between early-career female and male family physicians. Several articles report on inappropriate testing for common health problems; are you following recommendations for ordering Pulmonary Function Tests, mt-sDNA for colon cancer screening, and HIV testing?
Topics: Humans; Artificial Intelligence; Family Practice; COVID-19; Telemedicine; Big Data; SARS-CoV-2; Quality Improvement; Primary Health Care; Pandemics
PubMed: 38740469
DOI: 10.3122/jabfm.2024.240050R0 -
Psychiatric Services (Washington, D.C.) Jul 2024The authors sought to examine trends in stimulant initiation and follow-up care for attention-deficit hyperactivity disorder (ADHD) via telemedicine.
OBJECTIVE
The authors sought to examine trends in stimulant initiation and follow-up care for attention-deficit hyperactivity disorder (ADHD) via telemedicine.
METHODS
This retrospective longitudinal study used national, deidentified commercial health insurance outpatient claims among children (ages 2-17 years; N=535,629) and adults (ages 18-64 years; N=2,116,160) from January 2019 through April 2022. Regression analyses were used to examine risk for stimulant initiation, whether initiation occurred via telemedicine or in-person care, and receipt of a follow-up visit.
RESULTS
The mean monthly adjusted number of stimulant initiations per 100,000 enrollees was similar for children before and during the COVID-19 pandemic (prepandemic, 57 initiations; during pandemic, 56 initiations) but increased for adults (prepandemic, 27 initiations; during pandemic, 33 initiations). Initiations via telemedicine peaked at 53%-57% in April 2020 and dropped to about 14% among children and 28% among adults in April 2022. Telemedicine initiations were significantly more common among psychiatrists than among other prescribers (OR=3.70, 95% CI=3.38-4.06 [children]; OR=3.02, 95% CI=2.87-3.17 [adults]) and less common for rural residents (OR=0.57, 95% CI=0.40-0.82 [children]; OR=0.75, 95% CI=0.61-0.92 [adults]). Follow-up care was significantly more common among individuals whose care was initiated via telemedicine than among those receiving in-person care (OR=1.09, 95% CI=1.00-1.19 [children]; OR=1.61, 95% CI=1.53-1.69 [adults]).
CONCLUSIONS
Many stimulant treatments were initiated via telemedicine. Proposed rules to prohibit controlled substance prescribing without an in-person evaluation would require significant changes in current practice, potentially limiting access to stimulant medications for ADHD.
Topics: Humans; Telemedicine; Adolescent; Child; Adult; Central Nervous System Stimulants; Attention Deficit Disorder with Hyperactivity; Retrospective Studies; Male; Female; Middle Aged; Child, Preschool; Young Adult; Longitudinal Studies; COVID-19; United States
PubMed: 38239181
DOI: 10.1176/appi.ps.20230421