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Graefe's Archive For Clinical and... Nov 2020Technological advances in recent years have resulted in the development and implementation of various modalities and techniques enabling medical professionals to... (Review)
Review
PURPOSE
Technological advances in recent years have resulted in the development and implementation of various modalities and techniques enabling medical professionals to remotely diagnose and treat numerous medical conditions in diverse medical fields, including ophthalmology. Patients who require prolonged isolation until recovery, such as those who suffer from COVID-19, present multiple therapeutic dilemmas to their caregivers. Therefore, utilizing remote care in the daily workflow would be a valuable tool for the diagnosis and treatment of acute and chronic ocular conditions in this challenging clinical setting. Our aim is to review the latest technological and methodical advances in teleophthalmology and highlight their implementation in screening and managing various ocular conditions. We present them as well as potential diagnostic and treatment applications in view of the recent SARS-CoV-2 virus outbreak.
METHODS
A computerized search from January 2017 up to March 2020 of the online electronic database PubMed was performed, using the following search strings: "telemedicine," "telehealth," and "ophthalmology." More generalized complementary contemporary research data regarding the COVID-19 pandemic was also obtained from the PubMed database.
RESULTS
A total of 312 records, including COVID-19-focused studies, were initially identified. After exclusion of non-relevant, non-English, and duplicate studies, a total of 138 records were found eligible. Ninety records were included in the final qualitative analysis.
CONCLUSION
Teleophthalmology is an effective screening and management tool for a range of adult and pediatric acute and chronic ocular conditions. It is mostly utilized in screening of retinal conditions such as retinopathy of prematurity, diabetic retinopathy, and age-related macular degeneration; in diagnosing anterior segment condition; and in managing glaucoma. With improvements in image processing, and better integration of the patient's medical record, teleophthalmology should become a more accepted modality, all the more so in circumstances where social distancing is inflicted upon us.
Topics: Betacoronavirus; COVID-19; Communicable Diseases, Emerging; Coronavirus Infections; Disease Outbreaks; Humans; Ophthalmology; Pandemics; Pneumonia, Viral; SARS-CoV-2; Telemedicine
PubMed: 32813110
DOI: 10.1007/s00417-020-04879-2 -
World Journal of Gastroenterology Aug 2019Decompensated cirrhosis is a condition associated with significant morbidity and mortality. While there have been significant efforts to develop quality metrics that... (Review)
Review
Decompensated cirrhosis is a condition associated with significant morbidity and mortality. While there have been significant efforts to develop quality metrics that ensure high-value care of these patients, wide variations in clinical practice exist. In this opinion review, we discuss the quality gap in the care of patients with cirrhosis, including low levels of compliance with recommended cancer screening and other clinical outcome and patient-reported outcome measures. We posit that innovations in telemedicine and mobile health (mHealth) should play a key role in closing the quality gaps in liver disease management. We highlight interventions that have been performed to date in liver disease and heart failure-from successful teleconsultation interventions in the care of veterans with cirrhosis to the use of telemonitoring to reduce hospital readmissions and decrease mortality rates in heart failure. Telemedicine and mHealth can effectively address unmet needs in the care of patients with cirrhosis by increasing preventative care, expanding outreach to rural communities, and increasing high-value care. We aim to highlight the benefits of investing in innovative solutions in telemedicine and mHealth to improve care for patients with cirrhosis and create downstream cost savings.
Topics: Cell Phone; Computers, Handheld; Gastroenterology; Health Plan Implementation; Humans; Liver Cirrhosis; Mobile Applications; Patient Reported Outcome Measures; Professional Practice Gaps; Quality Improvement; Telemedicine
PubMed: 31413523
DOI: 10.3748/wjg.v25.i29.3849 -
Rhode Island Medical Journal (2013) Feb 2020
Topics: Humans; Rhode Island; Telemedicine
PubMed: 32013295
DOI: No ID Found -
Canadian Journal of Rural Medicine :... 2020
Topics: Canada; Humans; Rural Health Services; Telemedicine
PubMed: 32611870
DOI: 10.4103/CJRM.CJRM_33_20 -
Developmental Medicine and Child... Feb 2021
Topics: Cerebral Palsy; Child; Disabled Children; Humans; Nervous System Diseases; Neurological Rehabilitation; Parents; Professional Competence; Telemedicine
PubMed: 33393700
DOI: 10.1111/dmcn.14734 -
Arquivos de Neuro-psiquiatria Aug 2022Neurology is a high-demand specialty with long waiting lines. Some pathologies require rapid decision-making. Through technology, telemedicine can allow neurological...
BACKGROUND
Neurology is a high-demand specialty with long waiting lines. Some pathologies require rapid decision-making. Through technology, telemedicine can allow neurological patients to have faster access to specialized assessment. In store-and-forward telemedicine, the specialist physician evaluates data collected by a general practitioner and optimizes screening.
OBJECTIVE
The aim of the present study is to evaluate the effectiveness of asynchronous telemedicine, used to refer patients from primary care to neurology, in the city of Curitiba, in southern Brazil.
METHODS
A retrospective analysis of all patients referred from primary care to neurology between September 2019 and February 2020. After a request is made by a general medical doctor for a specialist's opinion, 5 neurologists with complete access to patients' records are tasked with the decision-making. The main variables analyzed were clinical reasons for telemedicine request, neurologist decision, final diagnosis, indication for diagnostic procedures, and subsequent follow-up.
RESULTS
Between September 2019 and February 2020, 1,035 asynchronous telemedicine consultations were performed. Headache (30.43%), epilepsy (19.03%), and dementia (15.85%) accounted for almost two-thirds of the primary care requests; one-third of the cases (33.62%) required a complementary diagnostic procedure. More than 70% of the cases did not require face-to-face assessment by a neurologist.
CONCLUSIONS
In this study, store-and-forward teleneurology successfully reduced the need for in-visit consultation in 70% of cases. Further studies should identify the best opportunities for teleneurology in the city of Curitiba to facilitate better integrated care between primary care providers and neurologists.
Topics: Brazil; Humans; Neurologists; Neurology; Retrospective Studies; Telemedicine
PubMed: 36252588
DOI: 10.1055/s-0042-1755204 -
Journal of Medical Internet Research Mar 2023Hypertension and diabetes are becoming increasingly prevalent worldwide. Telemedicine is an accessible and cost-effective means of supporting hypertension and diabetes... (Review)
Review
BACKGROUND
Hypertension and diabetes are becoming increasingly prevalent worldwide. Telemedicine is an accessible and cost-effective means of supporting hypertension and diabetes management, especially as the COVID-19 pandemic has accelerated the adoption of technological solutions for care. However, to date, no review has examined the contextual factors that influence the implementation of telemedicine interventions for hypertension or diabetes worldwide.
OBJECTIVE
We adopted a comprehensive implementation research perspective to synthesize the barriers to and facilitators of implementing telemedicine interventions for the management of hypertension, diabetes, or both.
METHODS
We performed a scoping review involving searches in Ovid MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, and Google Scholar to identify studies published in English from 2017 to 2022 describing barriers and facilitators related to the implementation of telemedicine interventions for hypertension and diabetes management. The coding and synthesis of barriers and facilitators were guided by the Consolidated Framework for Implementation Research.
RESULTS
Of the 17,687 records identified, 35 (0.2%) studies were included in our scoping review. We found that facilitators of and barriers to implementation were dispersed across the constructs of the Consolidated Framework for Implementation Research. Barriers related to cost, patient needs and resources (eg, lack of consideration of language needs, culture, and rural residency), and personal attributes of patients (eg, demographics and priorities) were the most common. Facilitators related to the design and packaging of the intervention (eg, user-friendliness), patient needs and resources (eg, personalized information that leveraged existing strengths), implementation climate (eg, intervention embedded into existing infrastructure), knowledge of and beliefs about the intervention (eg, convenience of telemedicine), and other personal attributes (eg, technical literacy) were the most common.
CONCLUSIONS
Our findings suggest that the successful implementation of telemedicine interventions for hypertension and diabetes requires comprehensive efforts at the planning, execution, engagement, and reflection and evaluation stages of intervention implementation to address challenges at the individual, interpersonal, organizational, and environmental levels.
Topics: Humans; Diabetes Mellitus; Hypertension; Implementation Science; Telemedicine; Health Services Accessibility; Patient Care Management
PubMed: 36917174
DOI: 10.2196/42134 -
Osteoporosis International : a Journal... Sep 2020The COVID-19 pandemic is influencing methods of healthcare delivery. In this short review, we discuss the evidence for remote healthcare delivery in the context of... (Review)
Review
UNLABELLED
The COVID-19 pandemic is influencing methods of healthcare delivery. In this short review, we discuss the evidence for remote healthcare delivery in the context of osteoporosis.
INTRODUCTION
The COVID-19 pandemic has undoubtedly had, and will continue to have, a significant impact on the lives of people living with, and at risk of, osteoporosis and those caring for them. With osteoporosis outpatient and Fracture Liaison Services on pause, healthcare organisations have already moved to delivering new and follow-up consultations remotely, where staffing permits, by telephone or video.
METHODS
In this review, we consider different models of remote care delivery, the evidence for their use, and the possible implications of COVID-19 on osteoporosis services.
RESULTS
Telemedicine is a global term used to describe any use of telecommunication systems to deliver healthcare from a distance and encompasses a range of different scenarios from remote clinical data transfer to remote clinician-patient interactions. Across a range of conditions and contexts, there remains unclear evidence on the acceptability of telemedicine and the effect on healthcare costs. Within the context of osteoporosis management, there is some limited evidence to suggest telemedicine approaches are acceptable to patients but unclear evidence on whether telemedicine approaches support informed drug adherence. Gaps in the evidence pertain to the acceptability and benefits of using telemedicine in populations with hearing, cognitive, or visual impairments and in those with limited health literacy.
CONCLUSION
There is an urgent need for further health service evaluation and research to address the impact of remote healthcare delivery during COVID-19 outbreak on patient care, and in the longer term, to identify acceptability and cost- and clinical-effectiveness of remote care delivery on outcomes of relevance to people living with osteoporosis.
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Delivery of Health Care; Health Care Costs; Humans; Osteoporosis; Pandemics; Pneumonia, Viral; Remote Consultation; SARS-CoV-2; Telemedicine; Telephone
PubMed: 32548787
DOI: 10.1007/s00198-020-05465-2 -
Journal of Medical Internet Research Nov 2020Telemedicine refers to the delivery of medical care and provision of general health services from a distance. Telemedicine has been practiced for decades with increasing...
Telemedicine refers to the delivery of medical care and provision of general health services from a distance. Telemedicine has been practiced for decades with increasing evidence proving its potential for enhanced quality of care for patients, reduction in hospital readmissions, and increase in savings for both patients and providers. The COVID-19 pandemic has resulted in a significant increase in the reliance on telemedicine and telehealth for provision of health care services. Developments in telemedicine should be structured as complements to current health care procedures, not with the goal of completely digitizing the entire health care system, but rather to use the power of technology to enhance areas that may not be working at their full potential. At the same time, it is also clear that further research is needed on the effectiveness of telemedicine in terms of both financial and patient benefits. We discuss the current and rapidly increasing knowledge about the use of telemedicine in the United States, and identify the gaps in knowledge and opportunities for further research. Beginning with telemedicine's origins in the United States to its widespread use during the COVID-19 pandemic, we highlight recent developments in legislation, accessibility, and acceptance of telemedicine.
Topics: COVID-19; Humans; SARS-CoV-2; Students; Telemedicine; United States
PubMed: 33215999
DOI: 10.2196/20839 -
International Journal of Medical... Jun 2023The role of startups has been growing in healthcare delivery, particularly in telehealth and telemedicine. Yet, little has been published about their role in evolving... (Review)
Review
OBJECTIVES
The role of startups has been growing in healthcare delivery, particularly in telehealth and telemedicine. Yet, little has been published about their role in evolving digital healthcare ecosystem. This study aimed to review the literature on telehealth startups to understand their roles, challenges, business models, and directions for sustainable innovation and commercialization.
METHODS
Ten databases were screened: PubMed, Scopus, Web of Science, IEEE Xplore, ACM digital library, EBSCOhost, Embase, Medline, Cochrane review, and PsycINFO. The articles were shortlisted based on pre-determined screening criteria, and qualitative synthesis was performed. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. Cohen's K was calculated to ensure the reliability of the authors scoring on the quality appraisal test and qualitative synthesis.
RESULTS
26 articles were included in the review. Findings are clubbed under five themes: remote and on-demand healthcare; healthcare data management; digital therapeutics; high-tech driven personalized care; and information integration and exchange. Technical infrastructure, regulation, and revenue generation were identified as major challenges for telehealth start-ups. Osterwalder business canvas was the predominantly used model. Value perspectives were recognized for a sustainable telehealth innovation and its commercialization.
CONCLUSION
Telehealth startups are evolving to meet digital healthcare needs and playing a significant role in teleconsultations, telemonitoring, and electronic health record solutions. Recently, their focus has shifted towards smartphone-enabled AI-driven personalized care, including digital therapeutics and wearable device innovation. They have significant technical and operational challenges in innovation and commercialization to optimize their role. The review also provides researchers with a new understanding of telehealth startups' sustainable innovation and commercialization through the systematic direction of value proposition, creation, and capture.
Topics: Humans; Reproducibility of Results; Ecosystem; Delivery of Health Care; Telemedicine; Remote Consultation
PubMed: 36963322
DOI: 10.1016/j.ijmedinf.2023.105048