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The American Journal of Managed Care May 2024Challenges in implementing telemedicine disproportionately affect patients served in safety-net settings. Few studies have elucidated pragmatic, team-based strategies...
OBJECTIVES
Challenges in implementing telemedicine disproportionately affect patients served in safety-net settings. Few studies have elucidated pragmatic, team-based strategies for successful telemedicine implementation in primary care, especially with a safety-net population.
STUDY DESIGN
We conducted in-depth, semistructured qualitative interviews with primary care clinicians and staff in a large urban safety-net health care system on the facilitators, challenges, and impact of implementing team workflows for synchronous telemedicine video and audio-only visits.
METHODS
Interviews were analyzed using modified grounded theory with multistage coding. Common themes were identified and reviewed to describe within-group and between-group variations. We used the Practical, Robust Implementation Sustainability Model framework to organize the final themes with an implementation science lens.
RESULTS
Four themes emerged from 11 interviews: (1) having a dedicated individual preparing patients for video visits is a prerequisite for the successful introduction of video visits to patients with limited digital literacy; (2) health care maintenance during video and audio-only visits benefits from standardized workflows and communication; (3) the increased flexibility and accessibility of telemedicine visits were perceived benefits to patient care, despite barriers for subsets of patients; and (4) telemedicine visits generally have a positive impact on work experience for clinicians and staff due to increased efficiency, despite audio-only visits feeling less engaging.
CONCLUSIONS
Understanding how to strategically use team-based workflows to expand video visit access while ensuring care quality of all telemedicine visits will allow primary care practices to maximize telemedicine's benefits to patients in the safety-net setting.
Topics: Humans; Telemedicine; Primary Health Care; Workflow; Safety-net Providers; Patient Care Team; Qualitative Research; Female; Interviews as Topic; Male; Adult
PubMed: 38820184
DOI: 10.37765/ajmc.2024.89550 -
Family Practice Nov 2023There is a growing interest in the use of digital technologies to foster learning in the health professions, along with the drive to expand teleconsultations arising...
BACKGROUND
There is a growing interest in the use of digital technologies to foster learning in the health professions, along with the drive to expand teleconsultations arising from the COVID-19 pandemic. This study aims to explore whether telemedicine between levels of care can act as continuous medical education (CME) tool for general practitioners (GPs) and hospital consultants at the referral cardiology department.
METHODS
This qualitative study was embedded in an organizational case study of the introduction of a new service model in the Portuguese health system. Semi-structured interviews were audio-recorded and pseudonymized. The transcribed interviews were stored, coded, and content analysis was performed in MAXQDA.
RESULTS
A total of 11 physicians were interviewed. GPs and cardiologists recognized that telemedicine between levels of care could act as a CME tool. Although they departed with different expectations, telemedicine helped them collaborate as a multidisciplinary team, exchanging feedback about clinical decisions, and constructing knowledge collaboratively. Telemedicine also supplemented existing learning meetings. The consequences of technology adoption may be viewed as a result of the actors involved (including the technology itself), characteristics of the context (including the organization), and an interaction between such factors.
CONCLUSION
Teleconsultations can be a learning opportunity for the health professionals involved. Our findings suggest that, in the context of the Portuguese health system, telemedicine as a CME tool helped to build multidisciplinary teams which exchanged feedback and constructed shared knowledge to improve patients' outcomes. It also helped to identify practice-changing contents to be included in face-to-face educational meetings.
Topics: Humans; Education, Medical, Continuing; Pandemics; Telemedicine; Remote Consultation; Learning
PubMed: 37579324
DOI: 10.1093/fampra/cmad085 -
Studies in Health Technology and... Oct 2023The pilot project of pre-anesthetic evaluation through telemedicine at the Pedro Ernesto University Hospital (HUPE) of the State University of Rio de Janeiro (UERJ) is a...
The pilot project of pre-anesthetic evaluation through telemedicine at the Pedro Ernesto University Hospital (HUPE) of the State University of Rio de Janeiro (UERJ) is a commendable initiative that aims to address the challenges faced by patients in accessing preoperative care. The objective of this study was to reduce the waiting time between the surgical recommendation and its clinical clearance for the procedure. A service flow was established to enable patients to undergo a comprehensive evaluation, including examination and complementary tests, during a single visit with a general practitioner. Based on the type of surgery and the patient's comorbidities, the Teleconsultants Center assessed the case and provided the necessary guidance. A total of 20 patients were attended to in face-to-face sessions during morning shifts, with the participation of Internal Medicine and Anesthesiology. Subsequently, these patients' evaluations were scheduled for teleconsultation to assess their surgical risk. There has been a significant reduction in the time between the surgical recommendation and the clearance for the procedure with a notable improvement compared to the previous protocol. These initial outcomes demonstrate the project's potential to enhance the efficiency and effectiveness of the preoperative evaluation process through teleassistance.
Topics: Humans; Outpatients; Pilot Projects; Preoperative Care; Remote Consultation; Telemedicine
PubMed: 37869867
DOI: 10.3233/SHTI230806 -
The Senior Care Pharmacist Mar 2024
Topics: Telemedicine
PubMed: 38379134
DOI: 10.4140/TCP.n.2024.123 -
BMC Medical Informatics and Decision... Apr 2024The use of telemedicine technology has significantly increased in recent years, particularly during the Covid-19 pandemic. This study aimed to investigate the use of... (Review)
Review
BACKGROUND
The use of telemedicine technology has significantly increased in recent years, particularly during the Covid-19 pandemic. This study aimed to investigate the use of telemedicine technology for cancer patients during the Covid-19 pandemic.
METHODS
This was a scoping review conducted in 2023. Various databases including PubMed, Web of Science, Scopus, Cochrane Library, Ovid, IEEE Xplore, ProQuest, Embase, and Google Scholar search engine were searched. All quantitative, qualitative, and mixed-method studies published in English between 2020 and 2022 were included. Finally, the needed data were extracted, and the results were synthesized and reported narratively.
RESULTS
A total of 29 articles were included in this review. The results showed that teleconsultation, televisit, and telerehabilitation were common telemedicine services, and video conferencing and telephone were common technologies used in these studies. In most cases, patients and healthcare providers preferred these services compared to the face-to-face consultations due to their convenience and advantages. Furthermore, the findings revealed that in terms of clinical outcomes, telemedicine could effectively reduce anxiety, pain, sleep disorders, and hospital admission rates.
CONCLUSION
The findings provided valuable insights into the various telemedicine technologies, services, users' perspectives, and clinical outcomes in cancer patients during the Covid-19 pandemic. Overall, the positive outcomes and users' satisfaction showed that the use of telemedicine technology can be expanded, particularly in cancer care. Future research needs to investigate both clinical and non-clinical effectiveness of using various telemedicine services and technologies for improving cancer care delivery, which can help to develop more successful strategies for implementing this technology.
Topics: Humans; COVID-19; Pandemics; Telemedicine; Remote Consultation; Anxiety Disorders; Neoplasms
PubMed: 38641567
DOI: 10.1186/s12911-024-02507-1 -
Revista Latino-americana de Enfermagem 2023to evaluate the evidence about telehealth strategies in caring for people with chronic kidney disease. (Review)
Review
OBJECTIVE
to evaluate the evidence about telehealth strategies in caring for people with chronic kidney disease.
METHOD
integrative literature review. The search for primary studies was carried out in six databases: PubMed/MEDLINE, Web of Science, EMBASE, CINAHL, LILACS, and Scopus. The sample consisted of 48 articles published between 2000 and 2021. The telehealth strategy was applied by a multidisciplinary team of doctors, nurses, pharmacists, nutritionis, and social workers. The type of study, country, strategy applied, setting, population, and professional were extracted from the articles. The studies were selected by reading the title and abstract (phase 1) and then reading them in full (phase 2), categorizing them by telehealth strategy. The results were summarized descriptively and the studies were classified according to their level of evidence.
RESULTS
the home was the most representative in dialysis and conservative treatment. Six categories of telehealth strategies were identified: remote monitoring devices, teleconsultation, digital platforms, apps, multimodality strategies, and telephone contact.
CONCLUSION
using these strategies for the care of people with chronic kidney disease presents different forms and implementations, being feasible for the renal population at any stage of the disease and applicable by different health professionals with an emphasis on the home environment. The evidence shows that telehealth favors lower cost, accessibility to remote locations, and better monitoring of dialysis with positive resul in symptom control, risk reduction, and patient training.
BACKGROUND
Telehealth in chronic kidney disease care is feasible and promising. (2) Telehealth is feasible for people at all stages of CKD. (3) Health promotion and monitoring were the most applied by telehealth. (4) Remote care can reduce costs, emergencies, and contac with the clinic. (5) Nurses mainly used telephone contact and teleconferencing.
Topics: Humans; Telemedicine; Remote Consultation; Renal Insufficiency, Chronic; Renal Dialysis; Ambulatory Care Facilities
PubMed: 38055586
DOI: 10.1590/1518-8345.6824.4049 -
Journal of Clinical Nursing Sep 2023To evaluate the effectiveness of eHealth interventions to reduce stress and promote mental health in healthcare professionals, and to compare the efficacy of different... (Review)
Review
AIMS
To evaluate the effectiveness of eHealth interventions to reduce stress and promote mental health in healthcare professionals, and to compare the efficacy of different types of programs (guided vs. self-guided; 'third-wave' psychotherapies vs. other types).
BACKGROUND
Healthcare workers present high levels of stress, which constitutes a risk factor for developing mental health problems such as depression and anxiety. eHealth interventions have been designed to reduce these professional's stress considering that the characteristics of this delivery method make it a cost-effective and very appealing alternative because of its fast and easy access.
DESIGN
A systematic review of quantitative studies.
METHODS
A comprehensive database search for quantitative studies was conducted in PubMed, EMBASE and Cochrane (until 1 April 2022). The systematic review was conducted in accordance with the PRISMA and SWiM reporting guidelines. The quality of the studies was assessed using the National Heart, Lung and Blood Institute tools.
RESULTS
The abstracts of 6349 articles were assessed and 60 underwent in-depth review, with 27 fulfilling the inclusion criteria. The interventions were classified according to their format (self-guided vs. guided) and contents ('third-wave' psychotherapies vs. others). Twenty-two interventions emerged, 13 of which produced significant posttreatment reductions in stress levels of health professionals (9 self-guided, 8 'third wave' psychotherapies). Significant effects in improving depressive symptomatology, anxiety, burnout, resilience and mindfulness, amongst others, were also found.
CONCLUSION
The evidence gathered in this review highlights the heterogeneity of the eHealth interventions that have been studied; self-guided and 'third-wave' psychotherapy programs are the most common, often with promising results, although the methodological shortcomings of most studies hinder the extraction of sound conclusions.
PROTOCOL REGISTRATION
PROSPERO CRD42022310199. No Patient or Public Contribution.
Topics: Humans; Health Personnel; Mental Health; Telemedicine; Health Promotion; Mindfulness
PubMed: 36703266
DOI: 10.1111/jocn.16634 -
Current Pain and Headache Reports Mar 2024This review provides medical practitioners with an overview of the present and emergent roles of telehealth and associated virtual reality (VR) applications in chronic... (Review)
Review
PURPOSE OF REVIEW
This review provides medical practitioners with an overview of the present and emergent roles of telehealth and associated virtual reality (VR) applications in chronic pain (CP) management, particularly in the post-COVID-19 healthcare landscape.
RECENT FINDINGS
Accumulated evidence points to the efficacy of now well-established telehealth modalities, such as videoconferencing, short messaging service (SMS), and mobile health (mHealth) applications in complementing remote CP care. More recently, and although still in early phases of clinical implementation, a wide range of VR-based interventions have demonstrated potential for improving the asynchronous remote management of CP. Additionally, VR-associated technologies at the leading edge of science and engineering, such as VR-assisted biofeedback, haptic technology, high-definition three-dimensional (HD3D) conferencing, VR-enabled interactions in a Metaverse, and the use of wearable monitoring devices, herald a new era for remote, synchronous patient-physician interactions. These advancements hold the potential to facilitate remote physical examinations, personalized remote care, and innovative interventions such as ultra-realistic biofeedback. Despite the promise of VR-associated technologies, several limitations remain, including the paucity of robust long-term effectiveness data, heterogeneity of reported pain-related outcomes, challenges with scalability and insurance coverage, and demographic-specific barriers to patient acceptability. Future research efforts should be directed toward mitigating these limitations to facilitate the integration of telehealth-associated VR into the conventional management of CP. Despite ongoing barriers to widespread adoption, recent evidence suggests that VR-based interventions hold an increasing potential to complement and enhance the remote delivery of CP care.
Topics: Humans; Chronic Pain; Telemedicine; Virtual Reality; COVID-19
PubMed: 38175490
DOI: 10.1007/s11916-023-01205-3 -
Health Communication Apr 2024Effective communication between patients and doctors is fundamental to high-quality healthcare, patient safety, and overall satisfaction. However, the onset of COVID-19... (Review)
Review
Effective communication between patients and doctors is fundamental to high-quality healthcare, patient safety, and overall satisfaction. However, the onset of COVID-19 has prompted significant shifts in communication from in-room and face-to-face interactions to virtual consults. The impact of this pandemic-related change on patient-doctor communication goals, processes, attributes, and environment remains unclear. We undertook a scoping review involving the systematic search of seven academic databases for relevant articles published up to and including June 2021. In total, 47 articles were identified that met the inclusion criteria. We applied the patient-doctor communication framework to guide our deductive thematic analysis of articles included, sorting results from reported studies and position papers into themes and sub-themes. The theme of highlighted sub-themes related to patient safety, convenience, affordability, and satisfaction; included sub-themes on technology interventions, workforce training, and digital literacy; included compassion for doctors and rebuilding trust among patients; and included issues related to telemedicine or video conferencing, challenges with diminished patient privacy, and distractions in the patient's home setting. Finally, the theme included insights into doctors' workload, isolation, and anxiety and how changes requiring increases in virtual consults iteratively altered confidence in care provision and communication with patients. Results of the scoping review provide important insights for strengthening virtual patient-doctor interactions, including target areas for training and professional development during and beyond the current pandemic.
Topics: Humans; Communication; COVID-19; Empathy; Quality of Health Care; Telemedicine
PubMed: 36522301
DOI: 10.1080/10410236.2022.2152225 -
JAMA Health Forum Oct 2023
Topics: Controlled Substances; Sulfadiazine; Telemedicine
PubMed: 37862032
DOI: 10.1001/jamahealthforum.2023.3251