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Effectiveness of patient decision aid supported shared decision-making intervention in in-person and virtual hybrid pulmonary rehabilitation in older adults with chronic obstructive pulmonary disease: A pilot randomized controlled trial. 患者决策辅助工具支持的共同决策干预对患有慢性阻塞性肺病的老年人进行面对面和虚拟混合肺康复治疗的效果:随机对照试验。
IF 3.5 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-01 Epub Date: 2023-03-15 DOI: 10.1177/1357633X231156631
Yuyu Jiang, Baiyila Nuerdawulieti, Zhongyi Chen, Jianlan Guo, Pingping Sun, Mengjie Chen, Jinping Li

Introduction: Tele-pulmonary rehabilitation is increasingly advocated but cannot completely substitute for in-person services for chronic conditions. Adherence to Pulmonary rehabilitation (PR) remains low in chronic obstructive pulmonary disease (COPD) patients. Shared decision-making (SDM) promotes patients' participation in PR decisions and helps patients and healthcare providers to jointly make decisions that patients are informed and aligned with patient preferences and values, which are critical for patient adherence to PR.

Objective: This study aimed to develop a hybrid in-person and virtual model of home-based PR services for older COPD patients and study the effectiveness of the patient decision aid (PDA)-supported recurring SDM intervention on patient adherence to PR, rehabilitation outcomes, and decision-related outcomes, as well as to explore the mechanisms of the intervention on PR adherence.

Methods: A total of 78 older COPD patients were randomly assigned to the PR group (n = 39) or PDA-PR group (n = 39). Both groups were conducted hybrid in-person and virtual PR intervention for 3 months. The primary outcomes were patients' quality of life and PR adherence. The secondary outcomes were dyspnea symptoms, exercise self-efficacy, knowledge, and decision-related outcomes.

Results: A total of 72 participants completed the 3-month PR program. There were statistically significant differences in PR adherence (p = 0.033), COPD assessment test (CAT) scores (p = 0.016), PR knowledge (p < 0.001), decision self-efficacy (p < 0.001), decision conflict (p < 0.001), and decision regret scores (p = 0.027) between the two groups. The modified Medical Research Council Dyspnoea scale (mMRC) score was significantly decreased only in PDA-PR group (p = 0.011). No statistically significant differences were observed in St George's Respiratory Questionnaire (SGRQ) score (p = 0.078), Exercise Self-Regulatory Efficacy Scale (Ex-SRES) score (p = 0.29) and COPD knowledge (p = 0.086) between the two groups. PR value score had a significant effect on adherence to PR (p = 0.007) and CAT score (p = 0.028).

Conclusions: PDA supported recurring SDM intervention was helpful in maintaining older COPD patients' PR adherence and had advantages in improving quality of life, enhancing PR knowledge, decision self-efficacy, and reducing decision conflict and decision regret, but did not improve SGRQ and Ex-SRES. PR value score influenced patients' rehabilitation adherence and quality of life.

Trial registration: Chinese Clinical Trial Registry (ChiCTR): ChiCTR1900028563; http://apps.who.int/trialsearch/default.aspx.

导言:越来越多的人提倡远程肺康复,但远程肺康复并不能完全取代慢性病患者的现场服务。慢性阻塞性肺病(COPD)患者对肺康复(PR)的依从性仍然很低。共同决策(SDM)可促进患者参与肺康复决策,帮助患者和医疗服务提供者共同做出符合患者偏好和价值观的知情决策,这对患者坚持肺康复至关重要:本研究旨在为老年慢性阻塞性肺病患者开发一种基于家庭的公关服务的现场和虚拟混合模式,研究患者决策辅助工具(PDA)支持的经常性 SDM 干预对患者坚持公关、康复结果和决策相关结果的有效性,并探索干预对坚持公关的作用机制:共有 78 名老年慢性阻塞性肺病患者被随机分配到 PR 组(39 人)或 PDA-PR 组(39 人)。两组患者均接受了为期 3 个月的面对面和虚拟混合公关干预。主要结果是患者的生活质量和坚持公关的情况。次要结果为呼吸困难症状、运动自我效能、知识和决策相关结果:共有 72 名参与者完成了为期 3 个月的 PR 计划。两组在坚持 PR(p = 0.033)、COPD 评估测试 (CAT) 分数(p = 0.016)和 PR 知识(p p p p = 0.027)方面存在统计学差异。只有 PDA-PR 组的改良医学研究委员会呼吸困难量表(mMRC)评分明显下降(p = 0.011)。两组之间在圣乔治呼吸问卷(SGRQ)得分(p = 0.078)、运动自我调节效能量表(Ex-SRES)得分(p = 0.29)和慢性阻塞性肺病知识(p = 0.086)方面未观察到有统计学意义的差异。PR值得分对坚持PR(p = 0.007)和CAT得分(p = 0.028)有显著影响:结论:PDA支持的复发性SDM干预有助于维持老年COPD患者的PR依从性,在改善生活质量、提高PR知识、决策自我效能、减少决策冲突和决策后悔方面具有优势,但不能改善SGRQ和Ex-SRES。PR值评分影响患者的康复依从性和生活质量:试验注册:中国临床试验注册中心(ChiCTR):试验注册:中国临床试验注册中心(ChiCTR):ChiCTR1900028563;http://apps.who.int/trialsearch/default.aspx。
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引用次数: 0
Satisfaction with videoconference-delivered CBT provided as part of a blended treatment approach for children and adolescents with mental disorders and their families during the COVID-19 pandemic: A follow-up survey among caregivers and therapists. 在 COVID-19 大流行期间,作为混合治疗方法的一部分,为患有精神障碍的儿童和青少年及其家庭提供了视频会议式 CBT,其满意度如何?对护理人员和治疗师的跟踪调查。
IF 3.5 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-01 Epub Date: 2023-03-07 DOI: 10.1177/1357633X231157103
Elena von Wirth, Lea Meininger, Julia Adam, Katrin Woitecki, Anne-Katrin Treier, Manfred Döpfner

Introduction: Psychotherapy delivered via videoconferencing (teletherapy) was a well-accepted treatment option for children and adolescents during the early phases of the COVID-19 pandemic. Information on the long-term satisfaction with teletherapy in routine clinical practice is missing.

Methods: Caregivers (parents) and psychotherapists of n  =  228 patients (4-20 years) treated in a university outpatient clinic completed a follow-up survey on satisfaction with videoconference-delivered cognitive-behavioral treatment (CBT). The follow-up survey (T2) was conducted about 1 year after initial assessment of treatment satisfaction in 2020 (T1).

Results: At follow up, therapists reported that 79% of families had received teletherapy as part of a blended treatment approach including in-person and videoconference delivery of CBT. Wilcoxon tests revealed that satisfaction with teletherapy was stable over time. In addition, parent ratings of the impact of teletherapy on treatment satisfaction and the therapeutic relationship did not change over time. Therapists' ratings of the impact of teletherapy on the therapeutic relationship with the caregiver were more negative at T2 compared to T1. Satisfaction with teletherapy was higher for patients with less pandemic-related stress, less externalizing behavior problems, and older age (all r < .35).

Conclusion: The high level of satisfaction with teletherapy for children and adolescents treated in routine clinical practice reported in 2020 was maintained after social distancing regulations were eased in 2021. Teletherapy provided as part of a blended treatment approach is a well-accepted method of treatment delivery for youths with mental health problems. The study was registered in the German Clinical Trials Register (DRKS00028639).

简介在 COVID-19 大流行的早期阶段,通过视频会议提供心理治疗(远程治疗)是一种广为儿童和青少年接受的治疗方法。但在常规临床实践中,有关远程治疗长期满意度的信息尚缺:在一所大学门诊部接受治疗的 n = 228 名患者(4-20 岁)的护理者(父母)和心理治疗师完成了一项关于视频会议认知行为治疗(CBT)满意度的跟踪调查。随访调查(T2)是在 2020 年对治疗满意度进行初步评估(T1)约 1 年后进行的:在随访过程中,治疗师报告说,79%的家庭接受了远程治疗,这是一种混合治疗方法的一部分,包括面对面和视频会议提供的 CBT。Wilcoxon 检验显示,远程治疗的满意度随着时间的推移保持稳定。此外,家长对远程治疗对治疗满意度和治疗关系的影响的评价也没有随着时间的推移而改变。治疗师对远程治疗对治疗关系的影响的评分在第二阶段比第一阶段更负面。与大流行相关的压力较小、外化行为问题较少和年龄较大的患者对远程治疗的满意度较高(均为 r 结论):在 2021 年放宽社会隔离规定后,2020 年报告的在常规临床实践中接受远程治疗的儿童和青少年对远程治疗的高满意度得以保持。作为混合治疗方法的一部分,远程治疗是一种广为接受的治疗方法,适用于有心理健康问题的青少年。该研究已在德国临床试验注册中心注册(DRKS00028639)。
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引用次数: 0
Corrigendum to ''The clinical effectiveness of telehealth: A systematic review of meta-analyses from 2010 to 2019.''. 远程保健的临床效果:2010年至2019年荟萃分析的系统回顾》。
IF 3.5 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-01 Epub Date: 2024-06-11 DOI: 10.1177/1357633X241262510
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引用次数: 0
A review of questionnaires used for the assessment of telemedicine. 对用于评估远程医疗的调查问卷进行审查。
IF 3.5 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-01 Epub Date: 2023-04-09 DOI: 10.1177/1357633X231166161
Raphael A Agbali, E Andrew Balas, Francesco Beltrame, Vahe Heboyan, Gianluca De Leo

Introduction: Telemedicine is the exchange of medical information from one site to another via electronic communications with the goal of improving a patient's clinical health status. Prior studies have identified the absence of a standardized assessment tool for evaluating telemedicine encounters. This study aims to collect and to analyze questionnaires used for the assessment of audiovisual telemedicine encounters from a patient perspective and aims to identify reasons driving the use of self-developed questionnaires.

Methods: We conducted a systematic search in PubMed for studies that used survey questionnaires to assess synchronous audiovisual telemedicine encounters from 2016 to 2021. We categorized questionnaires used into validated and non-validated types, and for each of them, collected questions, response format, author, year, specialty, and country of publication.

Results and discussion: We analyzed a total of 71 articles. We found that only 16 studies used three validated questionnaires. The remaining 55 studies used non-validated questionnaires. Non-validated questionnaires had a high variability in length and used Likert scales, binary responses, multiple choice, and open-ended answers. We found only eight studies in which the authors gave a reason for resorting to designing their own questionnaires. This review reveals insufficient standardized survey questionnaires to be used for the assessment of audiovisual telemedicine encounters. Future research initiatives should focus on developing a standardized and validated instrument well accepted by researchers.

简介远程医疗是指通过电子通信从一个地点到另一个地点交换医疗信息,目的是改善病人的临床健康状况。先前的研究发现,目前还没有用于评估远程医疗会诊的标准化评估工具。本研究旨在从患者的角度收集和分析用于评估视听远程医疗会诊的调查问卷,并找出使用自行开发的调查问卷的原因:我们在PubMed上对2016年至2021年期间使用调查问卷评估同步视听远程医疗会诊的研究进行了系统检索。我们将所使用的问卷分为经过验证和未经验证两种类型,并收集了每种问卷的问题、回答格式、作者、年份、专业和发表国家:我们共分析了 71 篇文章。我们发现,只有 16 项研究使用了三种经过验证的问卷。其余 55 项研究使用的是未经验证的问卷。未经验证的问卷长度差异较大,并使用了李克特量表、二元回答、多项选择和开放式答案。我们发现只有 8 项研究的作者说明了自己设计问卷的原因。本综述显示,用于评估视听远程医疗会诊的标准化调查问卷不足。未来的研究计划应侧重于开发一种标准化的、经过验证的、被研究人员广泛接受的工具。
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引用次数: 0
Ear Portal: An urban-based ear, nose, and throat, and audiology referral telehealth portal to improve access to specialist ear health services for children. 耳科门户网站:一个基于城市的耳鼻喉和听力转诊远程保健门户网站,以改善儿童获得耳科专科保健服务的途径。
IF 3.5 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-01 Epub Date: 2023-03-14 DOI: 10.1177/1357633X231158839
Eman Ma Alenezi, Tamara Veselinović, Karina Fm Tao, Ali Ah Altamimi, Tu Trang Tran, Hayley Herbert, Jafri Kuthubutheen, Daniel McAullay, Peter C Richmond, Robert H Eikelboom, Christopher G Brennan-Jones

Introduction: Shortage of ear, nose, and throat specialists in public hospitals can result in delays in the detection and management of otitis media. This study introduced a new hospital-based telehealth service, named the Ear Portal, and investigated its role in improving access to specialist care.

Methods: The study included 87 children (aged 6 months to 6 years) referred to a tertiary children's hospital due to otitis media-related concerns. A specialist multidisciplinary team met fortnightly to review pre-recorded data and provide care plans.

Results: The service resulted in a median waiting time of 28 days to receive a diagnosis and care plan by the multidisciplinary team, compared to a mean waiting time of 450 days for a reference group receiving standard healthcare services. Most children (90.3%) received bilateral ear diagnosis. Normal findings were found in 43.9%. However, the majority required further ear, nose, and throat with or without audiology face-to-face follow-up due to a diagnosis of middle-ear disease, unknown hearing status, or concerns not related to ears. The mean time required for clinical assessments completion by research assistants and multidisciplinary team review was 37.6 and 5.1 min per participant, respectively.

Discussion: Children in the Ear Portal service received a diagnosis and care plan in a median of 28 days, which is within the clinically recommended timeframes. With sufficient clinical information, this service can provide faster access to specialist care than the standard healthcare pathway. The service can reduce the time required by the specialist to provide a diagnosis and care plan which may help increase the specialists' capacity.

简介公立医院耳鼻喉专科医生短缺会导致中耳炎的检测和治疗出现延误。本研究引入了一项新的医院远程医疗服务,名为 "耳科门户",并调查了该服务在改善专科医疗服务方面的作用:研究对象包括 87 名因中耳炎相关问题转诊至一家三级儿童医院的儿童(6 个月至 6 岁)。多学科专家团队每两周召开一次会议,审查预先记录的数据并提供护理计划:这项服务的结果是,接受多学科团队诊断和护理计划的中位等待时间为 28 天,而接受标准医疗服务的参照组的平均等待时间为 450 天。大多数儿童(90.3%)接受了双耳诊断。43.9%的儿童检查结果正常。然而,由于中耳疾病诊断、听力状况不明或与耳朵无关的问题,大多数儿童需要进一步接受耳鼻喉科或听力科面对面随访。研究助理完成临床评估和多学科团队审查所需的平均时间分别为 37.6 分钟和 5.1 分钟:讨论:接受耳科门户网站服务的儿童在 28 天内获得诊断和护理计划,符合临床建议的时限。如果有足够的临床信息,该服务可以比标准医疗路径更快地提供专科护理。该服务可缩短专科医生提供诊断和护理计划所需的时间,从而有助于提高专科医生的能力。
{"title":"Ear Portal: An urban-based ear, nose, and throat, and audiology referral telehealth portal to improve access to specialist ear health services for children.","authors":"Eman Ma Alenezi, Tamara Veselinović, Karina Fm Tao, Ali Ah Altamimi, Tu Trang Tran, Hayley Herbert, Jafri Kuthubutheen, Daniel McAullay, Peter C Richmond, Robert H Eikelboom, Christopher G Brennan-Jones","doi":"10.1177/1357633X231158839","DOIUrl":"10.1177/1357633X231158839","url":null,"abstract":"<p><strong>Introduction: </strong>Shortage of ear, nose, and throat specialists in public hospitals can result in delays in the detection and management of otitis media. This study introduced a new hospital-based telehealth service, named the Ear Portal, and investigated its role in improving access to specialist care.</p><p><strong>Methods: </strong>The study included 87 children (aged 6 months to 6 years) referred to a tertiary children's hospital due to otitis media-related concerns. A specialist multidisciplinary team met fortnightly to review pre-recorded data and provide care plans.</p><p><strong>Results: </strong>The service resulted in a median waiting time of 28 days to receive a diagnosis and care plan by the multidisciplinary team, compared to a mean waiting time of 450 days for a reference group receiving standard healthcare services. Most children (90.3%) received bilateral ear diagnosis. Normal findings were found in 43.9%. However, the majority required further ear, nose, and throat with or without audiology face-to-face follow-up due to a diagnosis of middle-ear disease, unknown hearing status, or concerns not related to ears. The mean time required for clinical assessments completion by research assistants and multidisciplinary team review was 37.6 and 5.1 min per participant, respectively.</p><p><strong>Discussion: </strong>Children in the Ear Portal service received a diagnosis and care plan in a median of 28 days, which is within the clinically recommended timeframes. With sufficient clinical information, this service can provide faster access to specialist care than the standard healthcare pathway. The service can reduce the time required by the specialist to provide a diagnosis and care plan which may help increase the specialists' capacity.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9103567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Congenital Cardiology Cloud: Proof of feasibility of Germany's first tele-medical network for pediatric cardiology. 先天性心脏病学云:德国首个儿科心脏病远程医疗网络的可行性验证。
IF 3.5 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-01 Epub Date: 2023-03-20 DOI: 10.1177/1357633X231158838
Marko Klais, Ulrike Doll, Ariawan Purbojo, Sven Dittrich, Kathrin Rottermann

Background: For an optimal interplay based on the data-secure exchange of diagnostic data between patients, ambulatory care, and hospital care, we implemented the first tele-medical network for pediatric cardiology in Germany, the Congenital Cardiology Cloud. This study focuses on its feasibility, technical characteristics, and implementation in routine clinical work.

Methods: Tele-medical traffic comprised numbers of incoming/outgoing data, related file types, treatment options for tele-medically processed patients, and patient classification with respect to the severity of disease. Proof of feasibility was related to the number of successful tele-medical transmissions of discharge documents at the end of the observation period (02/2020-10/2020).

Results: Analysis of Congenital Cardiology Cloud's data communication showed a number of 1178 files for a total of 349 patients, favoring transmissions towards the clinic. Incoming traffic was predominantly characterized by diagnostic data regarding tele-consultations (76.6%), consisting of a multitude of file types, whereas 93.4% of the dispatched data corresponded to discharge letters. The number of tele-consultations counted up to 61, with a necessary subsequent treatment or diagnostic procedure in 90.2% of the presented cases. Tele-medically processed patients generally showed to be more complex (severe chronic heart disease 42.4% vs. 23.7%). At the end of the observation period, 97.6% of the discharge documents were transmitted via telemedicine.

Discussion: The implementation of the first tele-medical network for pediatric cardiology in Germany proves recent technological developments to successfully enable innovative patient care, connecting the ambulatory and hospital sector for a joint patient advice, predominantly in more complex cases. Possible governmentally guided refinancing concepts will show its long-term feasibility.

背景:为了在患者、非住院医疗和医院医疗之间实现基于数据安全的诊断数据交换的最佳互动,我们在德国实施了首个儿科心脏病学远程医疗网络--先天性心脏病学云。本研究的重点是其可行性、技术特点以及在常规临床工作中的实施情况:远程医疗流量包括输入/输出数据的数量、相关文件类型、远程医疗处理患者的治疗方案以及根据疾病严重程度对患者进行的分类。在观察期(2020 年 2 月至 2020 年 10 月)结束时,出院文件的远程医疗传输成功次数是可行性的证明:先天性心脏病学云数据通信分析显示,共有 349 名患者的 1178 份文件向诊所传输。传入流量的主要特点是与远程会诊有关的诊断数据(76.6%),包括多种文件类型,而93.4%的发送数据与出院信相对应。远程会诊次数高达 61 次,其中 90.2% 的病例需要进行必要的后续治疗或诊断程序。经远程医疗处理的病人一般病情较为复杂(重症慢性心脏病 42.4% 对 23.7%)。在观察期结束时,97.6%的出院文件是通过远程医疗传送的:德国首个小儿心脏科远程医疗网络的实施证明,最近的技术发展成功实现了创新性的病人护理,将门诊和医院部门连接起来,共同为病人提供建议,主要针对较复杂的病例。政府可能引导的再融资概念将显示其长期可行性。
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引用次数: 0
Knowledge, perceptions, and readiness of telepharmacy (KPR-TP) questionnaire among pharmacists: Development and psychometric evaluation. 药剂师对远程药学(KPR-TP)的了解、看法和准备程度问卷:开发与心理测量评估。
IF 3.5 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-01 Epub Date: 2023-03-22 DOI: 10.1177/1357633X231163354
Ikhwan Yuda Kusuma, Hening Pratiwi, Afriza Umami, Khamdiyah Indah Kurniasih, Dian Ayu Eka Pitaloka, Suherman Suherman, Marcell Juhász

Introduction: The pandemic increased pressure on healthcare services and forced limited care in all health facilities to ensure the care of all patients. Telepharmacy appears as an alternative to the remote pharmacy practice approach through information and communication technologies, but there are no comprehensive tools to measure pharmacists' knowledge, perception, and readiness to implement telepharmacy. This study developed and validated a questionnaire version of the Knowledge, Perceptions, and Readiness of Telepharmacy (KPR-TP) for pharmacists.

Methods: The KPR-TP assessed three domains: knowledge, perception, and readiness. Its factor structure, reliability, and validity were assessed using 7730 pharmacists from 34 Indonesian provinces. The validity of the model's three-factor structure was assessed using confirmatory factor analysis. Cronbach's alpha and composite reliability were used to validate the consistency of our factors, whereas convergent and discriminant validity established significant relationships between them.

Results: The goodness-of-fit index indicated that the model was economical and reasonable. Furthermore, the correlation between the three domains revealed a significant positive relationship. KRP-TP is a viable instrument for assessing pharmacists' perceptions of telepharmacy in Indonesia.

Conclusion: Overall, we discovered that our questionnaire contains critical constructs for assessing a pharmacist's knowledge, perception, and level of readiness to implement telepharmacy. This study will help pharmacists identify appropriate strategies for skill improvement.

导言:大流行病增加了医疗保健服务的压力,迫使所有医疗机构提供有限的护理,以确保对所有患者的护理。远程药学似乎是通过信息和通信技术进行远程药学实践的一种替代方法,但目前还没有全面的工具来衡量药剂师对实施远程药学的知识、认知和准备程度。本研究开发并验证了针对药剂师的远程药学知识、认知和准备程度(KPR-TP)问卷版本:KPR-TP 评估了三个领域:知识、感知和准备程度。来自印尼 34 个省的 7730 名药剂师对其因子结构、信度和效度进行了评估。使用确认性因子分析评估了模型三因子结构的有效性。Cronbach's alpha 和复合信度用于验证各因子的一致性,而收敛效度和区分效度则确定了各因子之间的显著关系:拟合优度指数表明,该模型是经济合理的。此外,三个领域之间的相关性显示出显著的正相关关系。KRP-TP 是评估印尼药剂师对远程药学看法的可行工具:总之,我们发现我们的问卷包含了评估药剂师对实施远程药学的知识、看法和准备程度的关键结构。这项研究将帮助药剂师确定提高技能的适当策略。
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引用次数: 0
Care trajectories for patients utilizing electronic visits for COVID-like symptoms in a large healthcare delivery system: May 2020-December 2021. 在一个大型医疗保健服务系统中,对因 COVID 类似症状而使用电子就诊的患者进行护理追踪:2020 年 5 月至 2021 年 12 月。
IF 3.5 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-01 Epub Date: 2023-03-22 DOI: 10.1177/1357633X231162874
Holly C Groom, Phil Crawford, Eduardo Azziz-Baumgartner, Michelle L Henninger, Ning Smith, Bianca Salas, Judy Donald, Allison L Naleway

Background: There is limited information about how on-line screening tools developed by integrated systems facilitated management of COVID-like illness patients.

Methods: Using the Kaiser Permanente Northwest (KPNW) Electronic Health Record, we identified adult plan members who accessed online COVID-19 screening e-visits and enumerated their subsequent medical encounters, tests for SARS-CoV-2, and test outcomes.

Results: Between May 2020 and December 2021, members completed 55,139 e-visits, with disproportionate representation among females (65% vs. 53% in the overall membership) and members aged <45 years (61% vs. 39%). Thirty percent of patients (16,953) were managed entirely through e-visits and 70% received subsequent in-person care. The percent of SARS-CoV-2 positive individuals was highest among the 1055 individuals triaged to inpatient care (17.9%), compared to 9.5% among those escalated to additional ambulatory care.

Conclusions: The e-visit on-line screening tool helped KPNW assist thousands of patients with COVID-19 symptoms, avoid unnecessary in-person patient encounters, and preserved KPNW infection control and pandemic surge capacity.

背景:关于综合系统开发的在线筛查工具如何帮助管理 COVID-like 疾病患者的信息有限:关于综合系统开发的在线筛查工具如何促进对 COVID-like 疾病患者的管理,相关信息十分有限:方法:我们使用西北凯撒医疗保险公司(Kaiser Permanente Northwest,KPNW)的电子健康记录,确定了访问在线 COVID-19 筛查电子访问的成人计划成员,并统计了他们随后的就诊情况、SARS-CoV-2 检测和检测结果:在 2020 年 5 月至 2021 年 12 月期间,共有 55,139 名会员完成了电子就诊,其中女性(占 65%,整体会员中占 53%)和结论年龄段的会员比例偏高:电子就诊在线筛查工具帮助 KPNW 为数千名出现 COVID-19 症状的患者提供了帮助,避免了不必要的面对面就诊,并保持了 KPNW 的感染控制和大流行应急能力。
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引用次数: 0
How do consumers prefer their care delivered: In-person, telephone or videoconference? 消费者希望如何获得医疗服务?面谈、电话还是视频会议?
IF 3.5 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-01 Epub Date: 2023-03-17 DOI: 10.1177/1357633X231160333
Centaine L Snoswell, Helen M Haydon, Jaimon T Kelly, Emma E Thomas, Liam J Caffery, Anthony C Smith

Aim: To gain a better understanding of consumer experiences with and preferences for telephone and videoconference consultations (telehealth), and how these compare to traditional in-person consultations.

Methods: A national cross-sectional survey was administered to a representative sample of Australian adults who have received a telehealth service within the last year. Consumers were recruited by Qualtrics® through their online sampling service. The sample was representative of the broader Australian population according to gender, age, location (state/territory), and place of residence (urban or remote). Information on demographics (e.g., age, gender, employment status), recent telehealth experience, and preferences for consultation modality was collected. To measure preferences consumers were asked to indicate which modality they would prefer (in-person, telephone, or videoconference) for different scenarios. These included consultations of various time lengths, and for the top ten conditions for which individuals sought a general practitioner.

Results: A total of 1069 consumers completed the survey. When consumers were asked to describe their most recent telehealth appointment, most were for follow-up appointments (67%) and completed by telephone (77%) rather than by videoconference, and with a general practitioner (75%). In-person consultations at a clinic were the top preference in all clinical scenarios presented, except when needing a prescription or to receive test results. In these cases, a telephone consultation was the preferred modality. Inexperience with videoconference and duration of consultation influenced preference for consultation mode. Consumers preferred to have short consultations of around five minutes done by telehealth (telephone or videoconference), while they preferred in-person for longer consultations (up to 60 minutes).

Conclusions: Many Australians have used telehealth in the past year to access healthcare, with telephone being the most common form of communication. Given the option and the experience to date, consumers prefer telephone when consultations related to either prescriptions or test results. Experience with videoconference for consultations increased consumer preferences for using it for future consultations.

目的:更好地了解消费者对电话和视频会议咨询(远程医疗)的体验和偏好,以及与传统面对面咨询的比较:方法:我们对去年接受过远程医疗服务的澳大利亚成年人进行了一次全国性横断面调查。消费者是由 Qualtrics® 通过其在线抽样服务招募的。根据性别、年龄、地点(州/地区)和居住地(城市或偏远地区)的不同,样本在更广泛的澳大利亚人口中具有代表性。收集的信息涉及人口统计学(如年龄、性别、就业状况)、最近的远程医疗经验以及对咨询方式的偏好。为了衡量消费者的偏好,我们要求他们指出在不同情况下更喜欢哪种方式(面谈、电话或视频会议)。这些情景包括不同时间长度的咨询,以及个人寻求全科医生治疗的十大病症:共有 1069 名消费者完成了调查。当消费者被要求描述他们最近的远程医疗预约时,大多数是为了复诊(67%),并且是通过电话(77%)而不是视频会议完成的,而且是与全科医生(75%)进行的。在所有临床场景中,除了需要处方或获得测试结果外,到诊所进行面谈都是首选。在这些情况下,电话咨询是首选方式。对视频会议缺乏经验和会诊时间长短影响了对会诊方式的偏好。消费者更喜欢通过远程医疗(电话或视频会议)进行 5 分钟左右的简短咨询,而对于时间较长的咨询(长达 60 分钟),他们则更喜欢面对面咨询:结论:在过去的一年中,许多澳大利亚人使用远程医疗来获得医疗保健服务,其中电话是最常见的沟通方式。根据消费者的选择和迄今为止的经验,当咨询与处方或检验结果有关时,他们更愿意选择电话。使用视频会议进行咨询的经验增加了消费者对今后使用视频会议进行咨询的偏好。
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引用次数: 0
Implementation of deep learning artificial intelligence in vision-threatening disease screenings for an underserved community during COVID-19. 在 COVID-19 期间,为服务不足的社区实施深度学习人工智能视力威胁疾病筛查。
IF 3.5 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-01 Epub Date: 2023-03-13 DOI: 10.1177/1357633X231158832
Aretha Zhu, Priya Tailor, Rashika Verma, Isis Zhang, Brian Schott, Catherine Ye, Bernard Szirth, Miriam Habiel, Albert S Khouri

Introduction: Age-related macular degeneration, diabetic retinopathy, and glaucoma are vision-threatening diseases that are leading causes of vision loss. Many studies have validated deep learning artificial intelligence for image-based diagnosis of vision-threatening diseases. Our study prospectively investigated deep learning artificial intelligence applications in student-run non-mydriatic screenings for an underserved, primarily Hispanic community during COVID-19.

Methods: Five supervised student-run community screenings were held in West New York, New Jersey. Participants underwent non-mydriatic 45-degree retinal imaging by medical students. Images were uploaded to a cloud-based deep learning artificial intelligence for vision-threatening disease referral. An on-site tele-ophthalmology grader and remote clinical ophthalmologist graded images, with adjudication by a senior ophthalmologist to establish the gold standard diagnosis, which was used to assess the performance of deep learning artificial intelligence.

Results: A total of 385 eyes from 195 screening participants were included (mean age 52.43  ±  14.5 years, 40.0% female). A total of 48 participants were referred for at least one vision-threatening disease. Deep learning artificial intelligence marked 150/385 (38.9%) eyes as ungradable, compared to 10/385 (2.6%) ungradable as per the human gold standard (p < 0.001). Deep learning artificial intelligence had 63.2% sensitivity, 94.5% specificity, 32.0% positive predictive value, and 98.4% negative predictive value in vision-threatening disease referrals. Deep learning artificial intelligence successfully referred all 4 eyes with multiple vision-threatening diseases. Deep learning artificial intelligence graded images (35.6  ±  13.3 s) faster than the tele-ophthalmology grader (129  ±  41.0) and clinical ophthalmologist (68  ±  21.9, p < 0.001).

Discussion: Deep learning artificial intelligence can increase the efficiency and accessibility of vision-threatening disease screenings, particularly in underserved communities. Deep learning artificial intelligence should be adaptable to different environments. Consideration should be given to how deep learning artificial intelligence can best be utilized in a real-world application, whether in computer-aided or autonomous diagnosis.

导言:老年黄斑变性、糖尿病视网膜病变和青光眼是威胁视力的疾病,也是导致视力丧失的主要原因。许多研究已经验证了深度学习人工智能在基于图像的视力威胁性疾病诊断中的应用。我们的研究前瞻性地调查了深度学习人工智能在 COVID-19 期间由学生负责的非眼底筛查中的应用,该筛查主要针对服务不足的西班牙裔社区:方法:在新泽西州西纽约市举行了五次由学生监督的社区筛查。参加者在医科学生的指导下进行了非眼球45度视网膜成像。图像被上传到基于云的深度学习人工智能,用于威胁视力的疾病转诊。一名现场远程眼科分级师和远程临床眼科医生对图像进行分级,并由一名资深眼科医生进行裁定,以建立金标准诊断,用于评估深度学习人工智能的性能:共纳入195名筛查参与者的385只眼睛(平均年龄(52.43±14.5)岁,女性占40.0%)。共有 48 名参与者因至少一种威胁视力的疾病而被转诊。深度学习人工智能将150/385(38.9%)只眼睛标记为不可分级,而根据人类金标准将10/385(2.6%)只眼睛标记为不可分级(p p 讨论:深度学习人工智能可以提高威胁视力疾病筛查的效率和可及性,尤其是在服务不足的社区。深度学习人工智能应能适应不同的环境。无论是在计算机辅助诊断还是自主诊断中,都应考虑如何在实际应用中更好地利用深度学习人工智能。
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引用次数: 0
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Journal of Telemedicine and Telecare
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