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Pediatric Clinics of North America Aug 2020Pediatric patients with uncontrolled asthma often live in underserved areas such as rural communities where few pediatric asthma specialists exist. There are significant... (Review)
Review
Pediatric patients with uncontrolled asthma often live in underserved areas such as rural communities where few pediatric asthma specialists exist. There are significant costs associated with acute asthma exacerbations, which are increasingly prevalent in these high-risk populations. Telemedicine is a viable option when addressing barriers in access to care and cost-efficiency. Implementing telemedicine in schools and other local community settings, as well as implementing innovative technology such as smartphone applications, can reduce the burden of asthma; increase patient satisfaction; and, most importantly, improve pediatric asthma outcomes.
Topics: Asthma; Child; Delivery of Health Care; Humans; Mobile Applications; Rural Population; Schools; Symptom Flare Up; Telemedicine
PubMed: 32650858
DOI: 10.1016/j.pcl.2020.04.003 -
Revista de Neurologia Sep 2020The stress that the coronavirus pandemic has produced on the health services and the disruption it has caused in the care of other pathologies and their follow-up in... (Review)
Review
The stress that the coronavirus pandemic has produced on the health services and the disruption it has caused in the care of other pathologies and their follow-up in outpatient visits have led us to promote and incorporate telemedicine in our routine medical practice. Telemedicine refers to remote or non-face-to-face medical attention, a new method of administering medical care by accredited professionals, which optimises resources and increases their scope. One drawback for child teleneurology is that our diagnoses require direct observation of the child and carrying out an examination as though playing a game. Mainly in the youngest stages, a new patient evaluated by telemedicine can be more difficult to diagnose and manage, and therefore some neuropaediatricians have chosen to carry out only follow-up visits, medication management and outcome reviews. Telemedicine, however, also has many benefits, such as the possibility of giving rapid advice, coordination among professionals and reaching the patient where and when it is difficult for classical medicine to do so. The aim of this article is to review the possible indications of telemedicine in child neurology, starting out from the fact that we should never delay the diagnosis of something that can be treated, both at the present time and in an eventual situation of resurgence of the pandemic. The advance of telemedicine will depend on the implementation of technology, on solving legal and security/privacy issues, on its clinical outcomes and on the extent to which patients demand and accept these virtual visits.
Topics: Adolescent; Aftercare; Child; Child, Preschool; Disease Management; Humans; Infant; Interdisciplinary Communication; Length of Stay; Neurology; Neuropsychiatry; Patient Care Team; Patient Education as Topic; Pediatrics; Telemedicine
PubMed: 32729111
DOI: 10.33588/rn.7105.2020304 -
Dermatologic Clinics Jan 2021Telemedicine has the potential to deliver high-quality, affordable health care to underserved populations that otherwise would not have adequate access to care. The... (Review)
Review
Telemedicine has the potential to deliver high-quality, affordable health care to underserved populations that otherwise would not have adequate access to care. The authors provide a snapshot of several telemedicine initiatives that have used information and communication technologies to connect patients with health care providers across various Asian countries with differing socioeconomic statuses. They highlight several factors thought to contribute to the success of telemedicine programs, such as financial sustainability, ease of use, and utilization of existing resources. Challenges these programs have faced include lack of technological infrastructure, limitations in funding, and conflicting health system priorities.
Topics: Asia; Dermatology; Developed Countries; Developing Countries; Humans; Program Evaluation; Remote Consultation; Telemedicine; Videoconferencing
PubMed: 33228859
DOI: 10.1016/j.det.2020.08.003 -
The Milbank Quarterly Jun 2021Policy Points Telehealth has many potential advantages during an infectious disease outbreak such as the COVID-19 pandemic, and the COVID-19 pandemic has accelerated the...
UNLABELLED
Policy Points Telehealth has many potential advantages during an infectious disease outbreak such as the COVID-19 pandemic, and the COVID-19 pandemic has accelerated the shift to telehealth as a prominent care delivery mode. Not all health care providers and patients are equally ready to take part in the telehealth revolution, which raises concerns for health equity during and after the COVID-19 pandemic. Without proactive efforts to address both patient- and provider-related digital barriers associated with socioeconomic status, the wide-scale implementation of telehealth amid COVID-19 may reinforce disparities in health access in already marginalized and underserved communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them.
CONTEXT
The COVID-19 pandemic has catalyzed fundamental shifts across the US health care delivery system, including a rapid transition to telehealth. Telehealth has many potential advantages, including maintaining critical access to care while keeping both patients and providers safe from unnecessary exposure to the coronavirus. However, not all health care providers and patients are equally ready to take part in this digital revolution, which raises concerns for health equity during and after the COVID-19 pandemic.
METHODS
The study analyzed data about small primary care practices' telehealth use and barriers to telehealth use collected from rapid-response surveys administered by the New York City Department of Health and Mental Hygiene's Bureau of Equitable Health Systems and New York University from mid-April through mid-June 2020 as part of the city's efforts to understand how primary care practices were responding to the COVID-19 pandemic following New York State's stay-at-home order on March 22. We focused on small primary care practices because they represent 40% of primary care providers and are disproportionately located in low-income, minority or immigrant areas that were more severely impacted by COVID-19. To examine whether telehealth use and barriers differed based on the socioeconomic characteristics of the communities served by these practices, we used the Centers for Disease Control and Prevention Social Vulnerability Index (SVI) to stratify respondents as being in high-SVI or low-SVI areas. We then characterized respondents' telehealth use and barriers to adoption by using means and proportions with 95% confidence intervals. In addition to a primary analysis using pooled data across the five waves of the survey, we performed sensitivity analyses using data from respondents who only took one survey, first wave only, and the last two waves only.
FINDINGS
While all providers rapidly shifted to telehealth, there were differences based on community characteristics in both the primary mode of telehealth used and the types of barriers experienced by providers. Providers in high-SVI areas were almost twice as likely as providers in low-SVI areas to use telephones as their primary telehealth modality (41.7% vs 23.8%; P <.001). The opposite was true for video, which was used as the primary telehealth modality by 18.7% of providers in high-SVI areas and 33.7% of providers in low-SVI areas (P <0.001). Providers in high-SVI areas also faced more patient-related barriers and fewer provider-related barriers than those in low-SVI areas.
CONCLUSIONS
Between April and June 2020, telehealth became a prominent mode of primary care delivery in New York City. However, the transition to telehealth did not unfold in the same manner across communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them.
Topics: Attitude of Health Personnel; COVID-19; Female; Health Equity; Humans; Male; Pandemics; Patient Acceptance of Health Care; Primary Health Care; SARS-CoV-2; Surveys and Questionnaires; Telemedicine
PubMed: 34075622
DOI: 10.1111/1468-0009.12509 -
Pediatric Annals Mar 2024Although use of telehealth may have begun centuries ago and has grown considerably through the 20th century, the coronavirus disease 2019 pandemic skyrocketed... (Review)
Review
Although use of telehealth may have begun centuries ago and has grown considerably through the 20th century, the coronavirus disease 2019 pandemic skyrocketed telemedicine's reach, including its use in pediatrics. The American Academy of Pediatrics endorses telehealth as a "critical infrastructure to efficiently implement the medical home model of care." Particularly for children with medical complexity (CMC), telehealth offers great promise to improve access to continuous, coordinated primary care, reduce time to pediatric subspecialty care, and support distance education for both pediatric providers and patients and their families. This article details the numerous benefits of telehealth to CMC with an emphasis on its use as an extender of the medical home, describes the venues in which telehealth augments access to safe, high-quality care, presents best practices in engaging in telehealth encounters, and enumerates barriers that may exacerbate current health inequities. We review current published telehealth patient-/caregiver-level, clinician-level, and payor-level outcomes while revealing research gaps and opportunities. .
Topics: Humans; Child; Telemedicine; COVID-19; Pandemics; Patient-Centered Care; Quality of Health Care
PubMed: 38466329
DOI: 10.3928/19382359-20240109-01 -
International Journal of Technology... Dec 2023Telemedicine may improve healthcare access and efficiency if it demands less clinician time than usual care. We sought to describe the degree to which telemedicine... (Review)
Review
OBJECTIVES
Telemedicine may improve healthcare access and efficiency if it demands less clinician time than usual care. We sought to describe the degree to which telemedicine trials assess the effect of telemedicine on clinicians' time and to discuss how including the time needed to treat (TNT) in health technology assessment (HTA) could affect the design of telemedicine services and studies.
METHODS
We conducted a scoping review by searching clinicaltrials.gov using the search term "telemedicine" and limiting results to randomized trials or observational studies registered between January 2012 and October 2023. We then reviewed trial registration data to determine if any of the outcomes assessed in the trials measured effect on clinicians' time.
RESULTS
We found 113 studies and of these 78 studies of telemedicine met the inclusion criteria and were included. Nine (12 percent) of the 78 studies had some measure of clinician time as a primary outcome, and 11 (14 percent) as a secondary outcome. Four studies compared direct measures of TNT with telemedicine versus usual care, but no statistically significant difference was found. Of the sixteen studies including indirect measures of clinician time, thirteen found no significant effects, two found a statistically significant reduction, and one found a statistically significant increase.
CONCLUSIONS
This scoping review found that clinician time is not commonly measured in studies of telemedicine interventions. Attention to telemedicine's TNT in clinical studies and HTAs of telemedicine in practice may bring attention to the organization of clinical workflows and increase the value of telemedicine.
Topics: Telemedicine; Technology Assessment, Biomedical; Time; Appointments and Schedules
PubMed: 38099431
DOI: 10.1017/S0266462323002830 -
Sleep Medicine Clinics Sep 2020Innovation in technology is redefining the world, including health care. Patients want convenient and quality interactions with their providers. The addition of... (Review)
Review
Innovation in technology is redefining the world, including health care. Patients want convenient and quality interactions with their providers. The addition of telemedicine technologies and asynchronous provider-to-patient communications is creating a more connected model of health care that will improve access and the value of care while decreasing costs, as well as enabling patients to participate more directly in their own care. As new technologies and new models of care continue to emerge, providers need to continue to monitor the rapidly changing landscape of telemedicine coding and reimbursement. Telehealth coding and reimbursement rules are payor and state dependent.
Topics: Communication; Humans; Insurance, Health, Reimbursement; Sleep Wake Disorders; Telemedicine
PubMed: 32762974
DOI: 10.1016/j.jsmc.2020.06.002 -
Multiple Sclerosis (Houndmills,... Apr 2020Advances in wearable and wireless biosensing technology pave the way for a brave new world of novel multiple sclerosis (MS) outcome measures. Our current tools for... (Review)
Review
Advances in wearable and wireless biosensing technology pave the way for a brave new world of novel multiple sclerosis (MS) outcome measures. Our current tools for examining patients date back to the 19th century and while invaluable to the neurologist invite accompaniment from these new technologies and artificial intelligence (AI) analytical methods. While the most common biosensor tool used in MS publications to date is the accelerometer, the landscape is changing quickly with multi-sensor applications, electrodermal sensors, and wireless radiofrequency waves. Some caution is warranted to ensure novel outcomes have clear clinical relevance and stand-up to the rigors of reliability, reproducibility, and precision, but the ultimate implementation of biosensing in the MS clinical setting is inevitable.
Topics: Biosensing Techniques; Humans; Monitoring, Ambulatory; Multiple Sclerosis; Telemedicine; Wearable Electronic Devices; Wireless Technology
PubMed: 31965896
DOI: 10.1177/1352458519888178 -
Pulmonology 2023
Topics: Humans; Remote Consultation; Telemedicine
PubMed: 36182660
DOI: 10.1016/j.pulmoe.2022.08.008 -
Journal of Pediatric Ophthalmology and... Sep 2020
Topics: Child; Eye Diseases; Humans; Ophthalmology; Telemedicine
PubMed: 32956476
DOI: 10.3928/01913913-20200722-01