Introduction: Interest in the use of patient portals to support prenatal and postpartum care is growing. This study was conducted to understand patient and provider perspectives about the impact of portal use during pregnancy and the postpartum period.
Methods: Interviews were conducted with 30 pregnant or postpartum patients and 15 obstetric care providers at an academic medical center that offers its patients access to an outpatient portal. Interview transcripts were analyzed deductively and inductively to categorize findings and identify emergent themes.
Results: Patients and providers described how use of a patient portal during pregnancy and postpartum impacted communication (by supporting convenient communication and access to information), care processes (by aiding appointment attendance and helping with medication management), and care experience (by reducing anxiety and promoting patient involvement). Interviewees provided suggestions to improve patient portal use in obstetric care including using portals to increase access to educational materials and supportive resources, to collect patient-generated data, and to increase patient involvement in postpartum care.
Discussion: Patient portals have particular value for patients' use during pregnancy and the postpartum period due to the frequency of healthcare visits and the heightened attention to one's health during this time. There are opportunities to tailor portal content and functions to patients' needs to improve communication, care processes, and care experiences for this patient population. Further improving the functionality of patient portals for patients' use during pregnancy and the postpartum period has the potential to positively impact patient experiences and health outcomes.
Objectives: To assess the cost-effectiveness of a digital Diabetes Prevention Program (dDPP) in preventing type 2 diabetes mellitus among prediabetic patients from a health system perspective over a 10-year time horizon.
Methods: A Markov cohort model was constructed to assess the cost-effectiveness of dDPP compared to a small group education (SGE) intervention. Transition probabilities for the first year of the model were derived from two clinical trials on dDPP. Transition probabilities for longer-term effects were derived from meta-analyses on lifestyle and Diabetes Prevention Program interventions. Cost and health utilities were derived from published literature. Partial completion of interventions was incorporated to provide a robust prediction of a real-world deployment. Parameter uncertainties were assessed using univariate and probabilistic sensitivity analyses. Cost-effectiveness was measured by an incremental cost-effectiveness ratio (ICER) between dDPP and SGE from a health system perspective over a 10-year time horizon.
Results: The dDPP dominated the SGE at the $50,000, $100,000, and $150,000 willingness-to-pay thresholds per quality-adjusted life years (QALYs). The base case analysis at the $100,000 willingness-to-pay threshold (WTP) revealed a dominated ICER, with the SGE costing $1332 more and accruing an average of 0.04 fewer QALYs. Probabilistic sensitivity analysis showed that the dDPP was preferred in 64.4% of simulations across the $100,000 WTP thresholds.
Conclusions: The findings comparing a dDPP to an SGE suggest that a dDPP can be cost-effective for patients with a high risk of developing type 2 diabetes.
Introduction: Telecare can be an effective way to deliver healthcare to patients' homes. Avatar or virtual agent-equipped technologies have the potential to increase user engagement and adherence to telecare. This study aimed to identify telecare interventions assisted by avatars/virtual agents, reflect the concepts of telecare and give an overview on its outcomes.
Methods: A scoping review guided by the PRISMA-ScR checklist was conducted. MEDLINE, CINAHL, PsycINFO and grey literature were searched through 12 July 2022. Studies were included if patients were remotely cared for by healthcare professionals and received telecare interventions assisted by avatars/virtual agents in their homes. Studies underwent quality appraisal, and were synthesized along the dimensions 'study characteristics', 'intervention' and 'outcomes'.
Results: Out of 535 records screened, 14 studies were included, reporting the effects of avatar/virtual agent-assisted telecare interventions, tailored to specific patient groups. Telecare interventions mainly focused on teletherapy and telemonitoring. Telecare services were rehabilitative, preventive, palliative, promotive and curative. Modes of communication were asynchronous, synchronous or a mix of both. Tasks of the implemented avatars/virtual agents comprised delivering health interventions, monitoring, assessment, guidance and strengthening agency. Telecare interventions led to improved clinical outcomes and higher adherence. Most studies reported sufficient system usability and high satisfaction among participants.
Conclusions: Telecare interventions were overall target group related and integrated in a service model. This combined with the use of avatars and virtual agents leads to improved adherence to telecare in the home setting. Further studies could account for relatives' experiences with telecare.
This article highlights the benefits of electronic-consultations and outlines steps for a primary care-centered approach to implementation. We include descriptions of traditional and electronic-consultation delivery models from the perspective of referring primary care provider. We describe five best practices for consultations regardless of modality, including clearly defined criteria that are best suited for electronic-consultation. Primary care teams must be equipped to explain the electronic-consultation process to the patient, including when and how results will be communicated. A successful electronic-consultation depends on clear questions and communication, flexibility in available data, a set-up that is easy-to-navigate and the ability to nimbly pivot if an alternative modality is needed. Electronic-consultation implementation may begin small with a single consult service and could include broader healthcare systems considerations including financial implications and service agreements. Based on increasing demand and increasing electronic-consultation familiarity and adoption, electronic-consultation will be a future necessity for primary care.
Objectives: Tele-orthodontics is an important medium to use for diagnosis and treatment planning and to refer patients for specific treatment when deemed necessary. The effectiveness of the Tele-orthodontics Education Model serves to improve resident's knowledge, confidence, and skills in delivering tele-orthodontic patient care. The purpose of this educational single-arm pre-test-post-test interventional study was to assess and educate orthodontic residents (6 year-one, and 6 year-two) to appropriately use tele-orthodontics.
Methods: The Tele-orthodontics Education Model utilizes three learning modules, a questionnaire before and after the training to assess participant knowledge, confidence and skills levels, three online multiple-choice questionnaires, three explanatory videos and an in-person simulation session. The Blackboard Learning Management System (virtual learning platform) facilitates access to the various modules of the program. Within each learning module, a participant's knowledge level was determined by utilizing five multiple-choice questions before and after each module. The various modules were introduced to the participants and then evaluated by reviewing the participant's responses to the multiple-choice questions.
Results: Twelve orthodontic residents completed the model in one session. Everyone fully completed the questionnaire. Post-test results showed higher mean scores for all questions addresses knowledge, the mean confidence, and skills score for post-test showed no change when compared to pre-test.
Conclusions: This education model was effective in improving basic knowledge in tele-orthodontics among first, and second-year orthodontic residents. We hypothesize that the residents are more informed and prepared for future tele-orthodontic practices.
Background: Measures used to prevent adverse events during the implementation of exercise sessions delivered via telerehabilitation can be varied, ranging from simple telephone monitoring to synchronous therapist-led sessions. However, this information is scattered in the literature, as evidence synthesis studies have only addressed the safety, satisfaction, and effectiveness aspects of exercise delivered via telerehabilitation.
Aims: This scoping review aims to describe that measures are used to ensure safety during exercise sessions delivered to people with stroke through telerehabilitation, as reported by authors of primary studies. Secondarily, it describes the designs most frequently used to notify the effects of telerehabilitation and evidence level, the characteristics of the participants and type of stroke, and the characteristics of telerehabilitation.
Summary of review: A scoping review was conducted according to the Joana Briggs Institute (JBI) recommendations. A systematic search of MEDLINE (Ovid), Embase (Ovid), CENTRAL, and CINHAL was conducted from inception to August 2022, and a review of systematic review references on the topic. We included primary studies that enrolled adults with stroke who underwent exercise delivered via telerehabilitation. Two independent reviewers performed study selection and data extraction, and disagreements were resolved by consensus or a third reviewer. A qualitative analysis of the information was performed. One hundred seven primary studies (3991 participants) published between 2002 and 2022 were included. Most studies were case series (43%) and rated with an Oxford level of evidence of "4" (55.3%). Regarding randomized clinical trials, half included 53 or more participants (IQR 26.75 to 81). Most studies applied the exercises via asynchronous telerehabilitation (55.1%), of which only ten reported measures to avoid adverse events. Some of the measures included assessing the location where exercises are to be performed, only using a seated position, and using live warning systems that prevent or stop exercises when they are risky.
Conclusions: Reporting of measures implemented to prevent adverse events during exercise delivery via asynchronous telerehabilitation is scarce. Future primary studies should always consider reporting adverse events related to exercise delivery via telerehabilitation and strategies implemented to decrease the incidence of these unwanted safety events.
Registration number: INPLASY202290104.
Introduction: Given that chronic, long-term conditions are increasingly common in older patients, the impact of telesurveillance program on clinical outcomes is uncertain. This study aimed to evaluate the feasibility and effectiveness of a 12-month remote monitoring program in preventing rehospitalizations in older patients with two or more chronic diseases returning home after hospitalization.
Methods: We conducted a multicenter randomized controlled trial in two parallel groups to evaluate the remote monitoring system. Elderly patients with chronic diseases (at least two comorbidities) aged 65 years or older and discharged home after acute hospital care for a chronic disease were randomized to receive a home telemonitoring program (intervention group, n = 267) or conventional care (control group, n = 267). The remote home monitoring program was an online biometric home life analysis technology (e-COBAHLT) with tele-homecare/automation and biometric sensors. The eCOBALTH intervention group received the automation sensors containing chronic disease clinical factor trackers to monitor their biometric parameters and detect any abnormal prodromal disease decompensation by remote monitoring and providing geriatric expertise to general practitioners. The usual care group received no eCOBALTH program. In both groups, baseline visits were conducted at baseline and the final visit at 12 months. The primary outcome was the incidence of unplanned hospitalizations for decompensation during the 12-month period.
Results: Among 534 randomized participants (mean [SD] age, 80.3 [8.1] years; 280 [52.4%] women), 492 (92.1%) completed the 12-month follow-up; 182 (34.1) had chronic heart failure, 115 (21.5%) had stroke, and 77 (14.4%) had diabetes. During the 12-month follow-up period, 238 patients had at least one unplanned hospitalization for decompensation of a chronic disease: 108 (40.4%) in the intervention group versus 130 (48.7%) in the control group (P = 0.04). The risk of rehospitalization was significantly reduced in the intervention group (age- and sex-adjusted relative risk: 0.72, 95% 95% confidence intervals 0.51-0.94).
Conclusion: A 12-month home telemonitoring program with online biometric analysis using Home life technology combining telecare and biometric sensors is feasible and effective in preventing unplanned hospitalizations for chronic disease decompensation in elderly patients with chronic diseases at high risk for hospitalizations.
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