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Telemedicine use in Sub-Saharan Africa: Barriers and policy recommendations for Covid-19 and beyond.International Journal of Medical... Jul 2021Telemedicine has been a useful healthcare alternative in the fight to contain the recent Covid-19 global pandemic. Yet the extent of its application and efficacy as an... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Telemedicine has been a useful healthcare alternative in the fight to contain the recent Covid-19 global pandemic. Yet the extent of its application and efficacy as an alternative route for healthcare provision remains a major concern for clinicians and patients.
OBJECTIVE
This study sought to identify barriers to the successful implementation of telemedicine in Sub-Saharan African (SSA) countries.
METHOD
A systematic review of the literature was conducted by applying the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for identifying, selecting, evaluating and interpreting findings.
RESULTS
Our results from 66 empirical studies revealed a wide usage of telemedicine technology across SSA countries but also showed insufficient evidence of usage for fighting Covid-19 infection. Further, technological, organisational, legal and regulatory, individual, financial, and cultural aspects were identified as the major barriers to the successful implementation of telemedicine in SSA. A list of recommendations was produced for each telemedicine barrier.
CONCLUSION
Our review shows current trends in telemedicine application, as well as highlighting critical barriers for consideration by healthcare decision makers. This review offers a number of recommendations to support wider implementation and sustainable usage of telemedicine in SSA.
Topics: Africa South of the Sahara; COVID-19; Humans; Policy; SARS-CoV-2; Telemedicine
PubMed: 33915421
DOI: 10.1016/j.ijmedinf.2021.104467 -
Toolkits for implementing and evaluating digital health: A systematic review of rigor and reporting.Journal of the American Medical... Jun 2021Toolkits are an important knowledge translation strategy for implementing digital health. We studied how toolkits for the implementation and evaluation of digital health... (Review)
Review
OBJECTIVE
Toolkits are an important knowledge translation strategy for implementing digital health. We studied how toolkits for the implementation and evaluation of digital health were developed, tested, and reported.
MATERIALS AND METHODS
We conducted a systematic review of toolkits that had been used, field tested or evaluated in practice, and published in the English language from 2009 to July 2019. We searched several electronic literature sources to identify both peer-reviewed and gray literature, and records were screened as per systematic review conventions.
RESULTS
Thirteen toolkits were eventually identified, all of which were developed in North America, Europe, or Australia. All reported their intended purpose, as well as their development process. Eight of the 13 toolkits involved a literature review, 3 did not, and 2 were unclear. Twelve reported an underlying conceptual framework, theory, or model: 3 cited the normalization process theory and 3 others cited the World Health Organization and International Telecommunication Union eHealth Strategy. Seven toolkits were reportedly evaluated, but details were unavailable. Forty-three toolkits were excluded for lack of field-testing.
DISCUSSION
Despite a plethora of published toolkits, few were tested, and even fewer were evaluated. Methodological rigor was of concern, as several did not include an underlying conceptual framework, literature review, or evaluation and refinement in real-world settings. Reporting was often inconsistent and unclear, and toolkits rarely reported being evaluated.
CONCLUSION
Greater attention needs to be paid to rigor and reporting when developing, evaluating, and reporting toolkits for implementing and evaluating digital health so that they can effectively function as a knowledge translation strategy.
Topics: Australia; Delivery of Health Care; Europe; Telemedicine; Translational Research, Biomedical
PubMed: 33619519
DOI: 10.1093/jamia/ocab010 -
International Wound Journal May 2023Based on initially identified needs for further telemedicine (TM) and chronic wound management research, the objective of this article is twofold: to conduct a... (Review)
Review
Based on initially identified needs for further telemedicine (TM) and chronic wound management research, the objective of this article is twofold: to conduct a systematic review of existing knowledge on TM interventions in chronic wound management-including barriers and opportunities-across the specialist and primary care sectors, and to incorporate the review findings into a system framework that can be further developed and validated through empirical data. We conclude that there is a pressing need for broader and more comprehensive empirical explorations into quality improvement and integration of TM in chronic wound management, including using system frameworks that can capture cross-sector system perspectives and associated implications. Of practical consideration, we suggest that the design and execution of TM improvement interventions and associated research projects should be conducted in close cooperation with managers and practitioners knowledgeable about barriers and opportunities that can influence the implementation of important interventions within chronic wound management.
Topics: Humans; Telemedicine; Wounds and Injuries
PubMed: 36261052
DOI: 10.1111/iwj.13986 -
Journal of Medical Internet Research Aug 2021One of the most promising health care development areas is introducing telemedicine services and creating solutions based on blockchain technology. The study of systems... (Review)
Review
BACKGROUND
One of the most promising health care development areas is introducing telemedicine services and creating solutions based on blockchain technology. The study of systems combining both these domains indicates the ongoing expansion of digital technologies in this market segment.
OBJECTIVE
This paper aims to review the feasibility of blockchain technology for telemedicine.
METHODS
The authors identified relevant studies via systematic searches of databases including PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar. The suitability of each for inclusion in this review was assessed independently. Owing to the lack of publications, available blockchain-based tokens were discovered via conventional web search engines (Google, Yahoo, and Yandex).
RESULTS
Of the 40 discovered projects, only 18 met the selection criteria. The 5 most prevalent features of the available solutions (N=18) were medical data access (14/18, 78%), medical service processing (14/18, 78%), diagnostic support (10/18, 56%), payment transactions (10/18, 56%), and fundraising for telemedical instrument development (5/18, 28%).
CONCLUSIONS
These different features (eg, medical data access, medical service processing, epidemiology reporting, diagnostic support, and treatment support) allow us to discuss the possibilities for integration of blockchain technology into telemedicine and health care on different levels. In this area, a wide range of tasks can be identified that could be accomplished based on digital technologies using blockchains.
Topics: Blockchain; Delivery of Health Care; Electronic Health Records; Humans; Technology; Telemedicine
PubMed: 34407924
DOI: 10.2196/17475 -
BioMed Research International 2022Telerehabilitation offers an alternative healthcare delivery remotely in a patient's environment at a lower cost, better accessibility, and equivalent quality to the... (Review)
Review
Telerehabilitation offers an alternative healthcare delivery remotely in a patient's environment at a lower cost, better accessibility, and equivalent quality to the standard approach. Several studies had examined the effectiveness of telerehabilitation inpatients with musculoskeletal disorders, and although there is evidence that it is at least equally effective as the standard care, the patient and rehabilitation professional satisfaction with the delivery method is not conclusive. A systematic review was conducted to study the patients' and rehabilitation professionals' satisfaction with telerehabilitation for musculoskeletal disorders. A search for relevant studies on 29 April 2021 was carried out in Medline/PubMed, Scopus, and Web of Science (WOS). The search terms included "telerehabilitation," AND "satisfaction" AND "musculoskeletal disorders," "telehealth," "telemedicine," "patient experience," and "pain". Fifteen eligible studies with 12,341 patients were included in this systematic review. A report was included if it (a) assessed the satisfaction of patients or professionals or both as one of the outcomes of a telerehabilitation intervention, (b) included adults 18 years and above with musculoskeletal disorders, and (c) is an intervention study using a quantitative approach. The quality of studies was assessed using the critical appraisal checklist tool developed by Joanna Briggs Institute (JBI). Most of the studies reported that patients were satisfied with both telerehabilitation and face-to-face intervention. However, few studies reported that patients were more satisfied with telerehabilitation compared to face-to-face of intervention. Patients in one study had preferred the incorporation of telerehabilitation and face-to-face sessions. Two of three studies had reported overall satisfaction with telerehabilitation by the professionals. Overall, there is evidence that patients and rehabilitation professional are satisfied with telerehabilitation compared to face-to-face consultation.
Topics: Adult; Humans; Musculoskeletal Diseases; Patient Satisfaction; Personal Satisfaction; Telemedicine; Telerehabilitation
PubMed: 35958819
DOI: 10.1155/2022/7366063 -
The Journal of Nursing Education Nov 2021Telehealth encompasses a broad variety of technologies and methods to deliver virtual medical, health, and education services. This systematic review examined the...
BACKGROUND
Telehealth encompasses a broad variety of technologies and methods to deliver virtual medical, health, and education services. This systematic review examined the research completed in the past 10 years to determine the prevailing state of the science related to nursing education and telehealth.
METHOD
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was followed. The criteria for inclusion were nursing education research related to telehealth in an academic setting.
RESULTS
A total of 13 articles met the inclusion criteria. A lack of rigorous research design, valid and reliable instrumentation, and measurable outcomes were noted.
CONCLUSION
This review found a lack of research focused on nursing education associated with telehealth. One article validating 14 nursing telehealth entrustable professional activities with 52 corresponding competencies was found to have the potential to guide curricular integration, measure outcomes, and build a program of telehealth nursing education research. .
Topics: Education, Nursing; Humans; Nursing Education Research; Telemedicine
PubMed: 34723739
DOI: 10.3928/01484834-20210913-06 -
Wilderness & Environmental Medicine Mar 2021Telemedicine potentially offers enormous value to expeditions to remote environments. For healthcare professionals, telemedicine can provide access to specialist advice....
Telemedicine potentially offers enormous value to expeditions to remote environments. For healthcare professionals, telemedicine can provide access to specialist advice. Where no healthcare professionals are present, telemedicine may be the sole source of expert care. This systematic review appraises and summarizes the current literature regarding telemedicine in patient management on expeditions to remote locations and identifies areas for future research. MEDLINE and EMBASE were systematically searched for relevant articles from 1980 through February 2018. Data were handled according to the PRISMA process and analyzed using type-specific critical appraisal checklists where possible. Two hundred twenty-five articles were identified, 33 of which were included in this systematic review. They encompassed a variety of remote environments, including maritime (13), polar (9), mountainous (5), jungle (1), and multiple austere environments (6). Although some environments were better reported than others, many overarching concepts were generalizable. Through channels of communication that included telephone, radio, videoconferencing, and email, telemedicine has been used effectively in a range of environments to initiate treatment, follow up with patients, and determine the appropriateness of evacuation. Telementoring, in which a remote expert guides a local care provider in performing a procedure or task, is a promising aspect of telemedicine that is currently being developed. As technology advances, the scope of telemedicine will continue to expand. However, each new telemedical development must be shown to do more than simply function in a remote environment. Instead, new technologies should be tested for improved patient, practitioner, or expedition outcomes, within a telemedical system.
Topics: Expeditions; Humans; Telemedicine; Videoconferencing; Wilderness Medicine
PubMed: 33423896
DOI: 10.1016/j.wem.2020.09.009 -
Journal of the American Medical... Nov 2022Integration of environmentally sustainable digital health interventions requires robust evaluation of their carbon emission life-cycle before implementation in... (Review)
Review
OBJECTIVE
Integration of environmentally sustainable digital health interventions requires robust evaluation of their carbon emission life-cycle before implementation in healthcare. This scoping review surveys the evidence on available environmental assessment frameworks, methods, and tools to evaluate the carbon footprint of digital health interventions for environmentally sustainable healthcare.
MATERIALS AND METHODS
Medline (Ovid), Embase (Ovid). PsycINFO (Ovid), CINAHL, Web of Science, Scopus (which indexes IEEE Xplore, Springer Lecture Notes in Computer Science and ACM databases), Compendex, and Inspec databases were searched with no time or language constraints. The Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA_SCR), Joanna Briggs Scoping Review Framework, and template for intervention description and replication (TiDiER) checklist were used to structure and report the findings.
RESULTS
From 3299 studies screened, data was extracted from 13 full-text studies. No standardised methods or validated tools were identified to systematically determine the environmental sustainability of a digital health intervention over its full life-cycle from conception to realisation. Most studies (n = 8) adapted publicly available carbon calculators to estimate telehealth travel-related emissions. Others adapted these tools to examine the environmental impact of electronic health records (n = 2), e-prescriptions and e-referrals (n = 1), and robotic surgery (n = 1). One study explored optimising the information system electricity consumption of telemedicine. No validated systems-based approach to evaluation and validation of digital health interventions could be identified.
CONCLUSION
There is a need to develop standardised, validated methods and tools for healthcare environments to assist stakeholders to make informed decisions about reduction of carbon emissions from digital health interventions.
Topics: Humans; Carbon Footprint; Travel; Travel-Related Illness; Telemedicine; Carbon
PubMed: 36314391
DOI: 10.1093/jamia/ocac196 -
Reproductive Health Apr 2023Evidence suggests that COVID-19 may impair access to sexual and reproductive health services and safe abortion. The purpose of this systematic review was investigating... (Review)
Review
Evidence suggests that COVID-19 may impair access to sexual and reproductive health services and safe abortion. The purpose of this systematic review was investigating the changes of abortion services in the COVID-19 pandemic era. We searched PubMed, Web of Science and Scopus for relevant studies published as of August 2021, using relevant keywords. RCT and non-original studies were excluded from the analysis and 17 studies of 151 included in our review. Requests to access medication abortion by telemedicine and demand for self-managed abortion were the main findings of identified studies. Women requested an abortion earlier in their pregnancy, and were satisfied with tele-abortion care due to its flexibility, and ongoing telephone support. Presenting telemedicine services without ultrasound has also been reported. Visits to clinics were reduced based on the severity of the restrictions, and abortion clinics had less revenue, more costs, and more changes in the work style of their healthcare providers. Telemedicine was reported safe, effective, acceptable, and empowering for women. Reasons for using tele-abortion were privacy, secrecy, comfort, using modern contraception, employing of women, distance from clinics, travel restrictions, lockdowns, fear of COVID-19, and political reasons (abortion prohibition). Complications of women using tele-abortion were pain, lack of psychological support, bleeding, and need to blood transfusions. The results of this study showed that using telemedicine and teleconsultations for medical abortion in the pandemic conditions may be extended after pandemic. Findings can be used by reproductive healthcare providers and policy makers to address the complications of abortion services.Trail registration This study is registered in PROSPERO with number CRD42021279042.
Topics: Pregnancy; Humans; Female; Pandemics; COVID-19; Communicable Disease Control; Abortion, Induced; Contraception; Telemedicine
PubMed: 37055839
DOI: 10.1186/s12978-023-01582-3 -
Journal of Medical Internet Research Apr 2022Telemedicine is increasingly being leveraged, as the need for remote access to health care has been driven by the rising chronic disease incidence and the COVID-19... (Review)
Review
BACKGROUND
Telemedicine is increasingly being leveraged, as the need for remote access to health care has been driven by the rising chronic disease incidence and the COVID-19 pandemic. It is also important to understand patients' willingness to pay (WTP) for telemedicine and the factors contributing toward it, as this knowledge may inform health policy planning processes, such as resource allocation or the development of a pricing strategy for telemedicine services. Currently, most of the published literature is focused on cost-effectiveness analysis findings, which guide health care financing from the health system's perspective. However, there is limited exploration of the WTP from a patient's perspective, despite it being pertinent to the sustainability of telemedicine interventions.
OBJECTIVE
To address this gap in research, this study aims to conduct a systematic review to describe the WTP for telemedicine interventions and to identify the factors influencing WTP among patients with chronic diseases in high-income settings.
METHODS
We systematically searched 4 databases (PubMed, PsycINFO, Embase, and EconLit). A total of 2 authors were involved in the appraisal. Studies were included if they reported the WTP amounts or identified the factors associated with patients' WTP, involved patients aged ≥18 years who were diagnosed with chronic diseases, and were from high-income settings.
RESULTS
A total of 11 studies from 7 countries met this study's inclusion criteria. The proportion of people willing to pay for telemedicine ranged from 19% to 70% across the studies, whereas the values for WTP amounts ranged from US $0.89 to US $821.25. We found a statistically significant correlation of age and distance to a preferred health facility with the WTP for telemedicine. Higher age was associated with a lower WTP, whereas longer travel distance was associated with a higher WTP.
CONCLUSIONS
On the basis of our findings, the following are recommendations that may enhance the WTP: exposure to the telemedicine intervention before assessing the WTP, the lowering of telemedicine costs, and the provision of patient education to raise awareness on telemedicine's benefits and address patients' concerns. In addition, we recommend that future research be directed at standardizing the reporting of WTP studies with the adoption of a common metric for WTP amounts, which may facilitate the generalization of findings and effect estimates.
Topics: Adolescent; Adult; COVID-19; Chronic Disease; Cost-Benefit Analysis; Humans; Pandemics; Telemedicine
PubMed: 35416779
DOI: 10.2196/33372