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BMC Primary Care Nov 2023Given the increasing integration of digital health technologies in team-based primary care, this review aimed at understanding the impact of eHealth on patient-provider... (Review)
Review
BACKGROUND
Given the increasing integration of digital health technologies in team-based primary care, this review aimed at understanding the impact of eHealth on patient-provider and provider-provider relationships.
METHODS
A review of reviews was conducted on three databases to identify papers published in English from 2008 onwards. The impact of different types of eHealth on relationships and trust and the factors influencing the impact were thematically analyzed.
RESULTS
A total of 79 reviews were included. Patient-provider relationships were discussed more frequently as compared to provider-provider relationships. Communication systems like telemedicine were the most discussed type of technology. eHealth was found to have both positive and negative impacts on relationships and/or trust. This impact was influenced by a range of patient-related, provider-related, technology-related, and organizational factors, such as patient sociodemographics, provider communication skills, technology design, and organizational technology implementation, respectively.
CONCLUSIONS
Recommendations are provided for effective and equitable technology selection, application, and training to optimize the impact of eHealth on relationships and trust. The review findings can inform providers' and policymakers' decision-making around the use of eHealth in primary care delivery to facilitate relationship-building.
Topics: Humans; Trust; Telemedicine; Delivery of Health Care; Professional-Patient Relations; Primary Health Care
PubMed: 37919688
DOI: 10.1186/s12875-023-02176-5 -
Journal of Medical Internet Research Jul 2023Video-based telemedicine (vs audio only) is less frequently used in diverse, low socioeconomic status settings. Few prior studies have evaluated the impact of...
BACKGROUND
Video-based telemedicine (vs audio only) is less frequently used in diverse, low socioeconomic status settings. Few prior studies have evaluated the impact of telemedicine modality (ie, video vs audio-only visits) on clinical quality metrics.
OBJECTIVE
The aim of this study was to assess telemedicine uptake and impact of visit modality (in-person vs video and phone visits) on primary care quality metrics in diverse, low socioeconomic status settings through an implementation science lens.
METHODS
Informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, we evaluated telemedicine uptake, assessed targeted primary care quality metrics by visit modality, and described provider-level qualitative feedback on barriers and facilitators to telemedicine implementation.
RESULTS
We found marginally better quality metrics (ie, blood pressure and depression screening) for in-person care versus video and phone visits; de-adoption of telemedicine was marked within 2 years in our population.
CONCLUSIONS
Following the widespread implementation of telemedicine during the COVID-19 pandemic, the impact of visit modality on quality outcomes, provider and patient preferences, as well as technological barriers in historically marginalized settings should be considered.
Topics: Humans; Benchmarking; COVID-19; Implementation Science; Pandemics; Retrospective Studies; Telemedicine
PubMed: 37494087
DOI: 10.2196/47670 -
Sensors (Basel, Switzerland) Jul 2023Wearable devices and fitness trackers have gained popularity in healthcare and telemedicine as tools to reduce hospitalization costs, improve personalized health...
Wearable devices and fitness trackers have gained popularity in healthcare and telemedicine as tools to reduce hospitalization costs, improve personalized health management, and monitor patients in remote areas. Smartwatches, particularly, offer continuous monitoring capabilities through step counting, heart rate tracking, and activity monitoring. However, despite being recognized as an emerging technology, the adoption of smartwatches in patient monitoring systems is still at an early stage, with limited studies delving beyond their feasibility. Developing healthcare applications for smartwatches faces challenges such as short battery life, wearable comfort, patient compliance, termination of non-native applications, user interaction difficulties, small touch screens, personalized sensor configuration, and connectivity with other devices. This paper presents a case study on designing an Android smartwatch application for remote monitoring of geriatric patients. It highlights obstacles encountered during app development and offers insights into design decisions and implementation details. The aim is to assist programmers in developing more efficient healthcare applications for wearable systems.
Topics: Humans; Aged; Mobile Applications; Wearable Electronic Devices; Fitness Trackers; Monitoring, Physiologic; Telemedicine
PubMed: 37571436
DOI: 10.3390/s23156652 -
BMC Medical Informatics and Decision... Nov 2023Despite the fact that telemedicine can eliminate geographical and time limitations and offer the possibility of diagnosing, treating, and preventing diseases by sharing...
INTRODUCTION
Despite the fact that telemedicine can eliminate geographical and time limitations and offer the possibility of diagnosing, treating, and preventing diseases by sharing reliable information, many individuals still prefer to visit medical centers for in-person consultations. The aim of this study was to determine the level of acceptance of telemedicine compared to in-person visits, identify the perceived advantages of telemedicine over in-person visits, and to explore the reasons why patients choose either of these two types of visits.
METHODS
We developed a questionnaire using the rational method. The questionnaire consisted of multiple-choice questions and one open-ended question. A total of 2059 patients were invited to participate in the study. Chi-square tests and descriptive statistics were employed for data analysis. To analyze the data from the open-ended question, we conducted qualitative content analysis using MAXQDA 18.
RESULTS
Out of the 1226 participants who completed the questionnaire, 865 (71%) preferred in-person visits, while 361 (29%) preferred telemedicine. Factors such as education level, specific health conditions, and prior experience with telemedicine influenced the preference for telemedicine. The participants provided a total of 183 different reasons for choosing either telemedicine (108 reasons) or in-person visits (75 reasons). Avoiding infectious diseases, saving cost, and eliminating and overcoming geographical distance barriers were three primary telemedicine benefits. The primary reasons for selecting an in-person visit were: more accurate diagnosis of the disease, more accurate and better examination of the patient by the physician, and more accurate and better treatment of the disease.
CONCLUSION
The results demonstrate that despite the numerous benefits offered by telemedicine, the majority of patients still exhibit a preference for in-person visits. In order to promote broader acceptance of telemedicine, it becomes crucial for telemedicine services to address patient preferences and concerns effectively. Employing effective change management strategies can aid in overcoming resistance and facilitating the widespread adoption of telemedicine within the population.
Topics: Humans; Data Analysis; Hospitals; Patient Preference; Patients; Telemedicine; Pandemics
PubMed: 37968639
DOI: 10.1186/s12911-023-02348-4 -
Ceska a Slovenska Oftalmologie :... 2023Diabetic retinopathy (DR) and diabetic macular edema (DME) are leading causes of severe visual loss in the working population. Therefore, both DR and DME have a...
Diabetic retinopathy (DR) and diabetic macular edema (DME) are leading causes of severe visual loss in the working population. Therefore, both DR and DME have a significant socioeconomic and health impact, which taking into account the epidemiologic predictions is expected to increase. A crucial role in the management of DR and DME (not only for individuals, but also for the population) is played by an adequate screening program. This is based on the structure and organization of the healthcare system, the latest scientific developments in diagnostics (imaging) as well as technological advancements in computing (artificial intelligence, telemedicine) and their practical use. The recommendation presented by World Health Organization is also important. This paper evaluates all these factors, including evidence-based medicine reports and experience from existing DR and DME screening programs in comparable countries. Based on an evaluation of these parameters, recommended guidelines have been formulated for screening for DR and DME in the Czech Republic, including linkage to the Czech National Screening Center and the organization of the healthcare system.
Topics: Humans; Diabetic Retinopathy; Macular Edema; Artificial Intelligence; Telemedicine; Tomography, Optical Coherence; Diabetes Mellitus
PubMed: 37993273
DOI: 10.31348/2023/29 -
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 -
Canadian Journal of Surgery. Journal... 2023Delivering trauma and surgical care to Northern Quebec presents unique challenges owing to the region's remoteness, extreme weather and limited transport; the expansion...
BACKGROUND
Delivering trauma and surgical care to Northern Quebec presents unique challenges owing to the region's remoteness, extreme weather and limited transport; the expansion of telehealth could help address these difficulties. We aimed to evaluate current surgical, trauma and telemedicine capacity in Nunavik, Quebec.
METHODS
We used validated assessment tools, including the Personnel, Infrastructure, Procedures, Equipment and Supplies survey, the International Assessment of Capacity for Trauma index and the Maryland Health Care Commission Telemedicine Readiness tool to evaluate surgical, trauma and telemedicine capacity, respectively. We adapted these tools to the Northern Quebec context through discussions with local leadership. Data were collected in 2 regional hospitals - the Ungava Tulattavik Health Centre (UTHC) and the Inuulitsivik Health Centre (IHC) - and 12 Centres locaux de services communautaires (CLSCs; local community services centres) in 6 villages along the Hudson Bay coast and 6 villages along the Ungava Bay coast through iterative discussions with 4 chief nurses from each regional hospital and set of CLSCs; resources were confirmed through on-site evaluation by the respondents. We performed a descriptive analysis of the data.
RESULTS
Surgical capacity was highest in the IHC (6.76) and lowest in the Ungava Bay CLSCs (5.52). Personnel (0%-0%) and procedures (13%-33%) were the least available resources. Trauma capacity was highest in the IHC (7.25) and lowest in the Hudson Bay CLSCs (5.58). Although equipment (90%-100%) and supplies (100%-100%) were readily available, personnel (0%-0%) and procedures (25%-56%) were lacking. The UTHC was most prepared for telehealth (67.80%), and the Ungava Bay CLSCs achieved a lower score (51.13%). Underdeveloped telehealth criteria included funding, administrative support, quality improvement and physical spaces (all 33%-67%).
CONCLUSION
Acute care capacity in Nunavik appears heterogeneous, with readily available equipment and supplies, but a lack of personnel capable of performing lifesaving procedures. To address the need for telemedicine, future initiatives should focus on improving funding, administrative support, physical spaces and quality-improvement initiatives.
Topics: Humans; Quebec; Cross-Sectional Studies; Delivery of Health Care; Telemedicine; Hospitals
PubMed: 38016727
DOI: 10.1503/cjs.013822 -
Patient Education and Counseling Jun 2024This systematic review (PROSPERO ID: CRD42022226375) aimed to identify the eHealth literacy of men with prostate cancer, and their caregivers. (Review)
Review
OBJECTIVE
This systematic review (PROSPERO ID: CRD42022226375) aimed to identify the eHealth literacy of men with prostate cancer, and their caregivers.
METHODS
8 databases (MEDLINE, SCOPUS, EMBASE, Web Of Science, PsycINFO, ERIC, CINAHL, Cochrane CENTRAL) and grey literature sources (e.g. Google Scholar) were searched from inception to December 2023. Articles were included if assessing eHealth/digital literacy of men with prostate cancer, or their carers', and health outcome associations. Formats such as case reports, and review papers were excluded. Records and full texts underwent independent screening and data extraction. Author disagreements were resolved by discussion. The Mixed Methods Appraisal Tool (MMAT) was used to appraise included literature, with narrative synthesis of results.
RESULTS
21,581 records were retrieved, with 7 articles satisfying inclusion criteria. A heterogenous field was characterised with lack of modern eHealth literacy measurement tools identified. Results suggest novice eHealth literacy using web 1.0 technologies. Non-validated measures of literacy demonstrate mixed results, while health outcome effects limited in scope and reliability.
CONCLUSION
Prostate cancer survivors' eHealth literacy levels is likely novice, and requires further investigation.
PRACTICE IMPLICATIONS
Digital technologies/resources implemented as part of patient communication practices should be vetted for quality, and tailored to patients' eHealth literacy abilities and/or needs.
Topics: Male; Humans; Reproducibility of Results; Telemedicine; Prostatic Neoplasms; Health Literacy; Caregivers
PubMed: 38354430
DOI: 10.1016/j.pec.2024.108193 -
The American Journal of Managed Care May 2024To examine patient and provider perspectives on privacy and security considerations in telemedicine during the COVID-19 pandemic.
OBJECTIVE
To examine patient and provider perspectives on privacy and security considerations in telemedicine during the COVID-19 pandemic.
STUDY DESIGN
Qualitative study with patients and providers from primary care practices in 3 National Patient-Centered Clinical Research Network sites in New York, New York; North Carolina; and Florida.
METHODS
Semistructured interviews were conducted, audio recorded, transcribed verbatim, and coded using an inductive process. Data related to privacy and information security were analyzed.
RESULTS
Sixty-five patients and 21 providers participated. Patients and providers faced technology-related security concerns as well as difficulties ensuring privacy in the transformed shared space of telemedicine. Patients expressed increased comfort doing telemedicine from home but often did not like their providers to offer virtual visits from outside an office setting. Providers initially struggled to find secure and Health Insurance Portability and Accountability Act-compliant platforms and devices to host the software. Whereas some patients preferred familiar platforms such as FaceTime, others recognized potential security concerns. Audio-only encounters sometimes raised patient concerns that they would not be able to confirm the identity of the provider.
CONCLUSIONS
Telemedicine led to novel concerns about privacy because patients and providers were often at home or in public spaces, and they shared concerns about software and hardware security. In addition to technological safeguards, our study emphasizes the critical role of physical infrastructure in ensuring privacy and security. As telemedicine continues to evolve, it is important to address and mitigate concerns around privacy and security to ensure high-quality and safe delivery of care to patients in remote settings.
Topics: Humans; Telemedicine; COVID-19; Primary Health Care; Female; Computer Security; Male; Middle Aged; Confidentiality; Adult; Qualitative Research; Privacy; SARS-CoV-2; United States; Aged; Health Insurance Portability and Accountability Act
PubMed: 38820187
DOI: 10.37765/ajmc.2024.89553 -
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