Journal of Telemedicine and Telecare最新文献

Introduction: COVID-19 necessitated a shift from in-person to virtual care for all patients, particularly older adults. It is unknown how older individuals' views of telehealth changed during this time and how this may affect their future use of telehealth services.

Methods: We used data from a cross-sectional online survey of a nationally representative sample of 2074 U.S. adults ages 50-80 who were participants in the National Poll on Healthy Aging. We performed a descriptive and multivariable analysis of individuals' perspectives on past and future telehealth visits, sociodemographics, and health status.

Results: Before March 2020, 5.8% of respondents had used telehealth, compared to 32.0% by June 2020. Of telehealth users, 36.1% indicated their most recent telehealth visit used audio-only (i.e., without video) technology. In multivariable analysis, those who never used video technology compared to those who were "very comfortable" (average marginal effect (AME) 49%, 95% CI: 36-63), identified as Hispanic (AME 19% vs White, non-Hispanic, 95% CI: 5-32), or were female (AME 9%, 95% CI: 1-17) were more likely to report audio-only use. Concerns remained about the inability to conduct physical exams (75%) and telehealth quality of care (67%), though most (64%) older adults indicated an interest in future telehealth visits.

Discussion: Telehealth use increased substantially among older U.S. adults during the early months of the COVID-19 pandemic; however, many reported using audio-only telehealth, an important consideration for policymakers and providers. Addressing older adults' concerns about and barriers to telehealth visits is needed to ensure telehealth does not exacerbate disparities in their care.

Behavioral medicine researchers have rapidly adapted study procedures and interventions to telehealth modalities during the pandemic. We rely heavily on telehealth research methods to avoid study delays and mitigate risk to chronically ill patients our studies aim to support. We implemented methods to virtually recruit, enroll, and retain patients and their families on clinical trials, and virtually deliver study interventions. These adaptations are likely to become permanent amid ongoing virus variants and surges in cases. However, little has been written about how remote methods apply in practice. This paper documents these processes to maximize efficiency across our research studies and systems and highlights the strengths and challenges of transitioning our research protocols to telehealth. We outline solutions to using remote methods across the entire span of the research process, including study recruitment, data collection, and intervention delivery. We offer insight into the implications of these transitions on research staff and interventionists. In providing a transparent review of the advantages and challenges of implementing remote methods, we encourage discourse around remote methods implementation, share the lessons we learned, and inform the design of future trials. Further research is needed to review the clinical feasibility and acceptability of these procedures.

Introduction: We aimed to evaluate the implementation of the Good Life with osteoArthritis in Denmark (GLA:D^®) program via telehealth in Australia using Reach, Effectiveness, Adoption, Implementation, and Maintenance Qualitative Evaluation for Systematic Translation framework.

Methods: Using a convergent mixed-methods design, semi-structured one-on-one interviews with physiotherapist adopters and nonadopters of GLA:D^® via telehealth were analyzed thematically alongside the examination of registry data (1 March 2020-10 February 2022) from patients with hip or knee osteoarthritis completing GLA:D^® via telehealth (telehealth-only) or combined with in-person care (hybrid). Effectiveness was determined as changes from baseline to 3-month follow-up (mean differences, 95% confidence intervals, effect size) for Knee injury and Osteoarthritis Outcome Score (KOOS-12)/Hip disability and Osteoarthritis Outcome Score-12 (HOOS-12), and chair stand test. Group- and individual-level changes were compared to published minimally clinically important change scores.

Results: Twenty-three interviews (12 adopters, 11 nonadopters) found key barriers/facilitators to reach and adoption, high perceived effectiveness, and strategies to support sustainability. Of 2612 registered patients, 85 (3%) and 115 (4%) completed GLA:D^® via telehealth-only or hybrid model, respectively. Most effectiveness outcomes were associated with moderate-large improvements. Group-level changes exceeded minimally clinically important change values for KOOS/HOOS-quality of life and chair stand test. Nearly two out of three patients reached a minimally clinically important change for KOOS/HOOS-quality of life. With telehealth-only and hybrid delivery, 99% (n = 82) and 85% (n = 97) were satisfied/very satisfied. Physiotherapist adoption was limited (n = 128, 6%).

Discussion: GLA:D^® delivered via telehealth is effective, had high patient satisfaction, and was perceived positively by physiotherapist adopters. Addressing low reach and adoption requires further implementation strategies to facilitate greater telehealth opportunities for patients and physiotherapists.

This brief editorial describes an emerging area of machine learning technology called large language models (LLMs). LLMs, such as ChatGPT, are the technological disruptor of this decade. They are going to be integrated into search engines (Bing and Google) and into Microsoft products in the coming months. They will therefore fundamentally change the way patients and clinicians access and receive information. It is essential that telehealth clinicians are aware of LLMs and appreciate their capabilities and limitations.

Background: Telehealth is a rapidly growing modality for expanding healthcare access, especially in the post-COVID-19 era. However, telehealth requires high-quality broadband, thus making broadband a social determinant of health. The objective of this study was to evaluate the association between broadband access and telehealth utilization across the United States during the COVID-19 pandemic.

Methods: Using a cross-sectional, ecological study design, we merged county-level data on broadband capacity (Microsoft's Rural Broadband Initiative), telehealth utilization among Medicare Fee-for-Service beneficiaries from January through September 2020 (CareJourney), and county-level socioeconomic characteristics (Area Health Resources Files). Multivariable linear regression was used to estimate the association between broadband capacity, county-level characteristics, and telehealth utilization.

Results: Among the 3107 counties, those with the greatest broadband availability (quintile 5) had 47% higher telehealth utilization compared to counties with the least broadband availability (quintile 1). In the adjusted model, a 1 standard deviation (SD) increase in broadband access was associated with a 1.54 percentage point (pp) increase in telehealth utilization (P < 0.001). Rural county designation (-1.96 pp; P < 0.001) and 1 SD increases in average Medicare beneficiary age (-1.34 pp; P = 0.001), number of nursing home beds per 1000 individuals (-0.38 pp; P = 0.002), and proportion of Native Americans/Pacific Islanders (-0.59 pp; P < 0.001) were associated with decreased telehealth utilization.

Conclusion: The association between broadband access and telehealth utilization and the decreased telehealth utilization in rural areas highlight the importance of broadband access for healthcare access and the need to continue investing in broadband infrastructure to promote equitable healthcare access across populations.

Introduction: The widespread and rapid implementation of virtual care has introduced evolutionary changes in the context, process, and way primary care is delivered. The objectives of this study were to: (1) understand whether and how virtual care has shifted the therapeutic relationship; (2) describe the core components of compassionate care from the patient perspective and (3) identify how and in what circumstances compassionate care might be amplified.

Methods: Participants living in Ontario, Canada were eligible if they had interacted with their primary care clinician following the rapid implementation of virtual care in March 2020, irrespective of virtual care use. One-on-one semi-structured interviews were conducted with all participants and data were analyzed using inductive thematic analysis.

Results: Four themes emerged across 36 interviews: (1) Virtual care shifts communication patterns but the impact on the therapeutic relationship is unclear; (2) Rapid implementation of virtual care limited perceived quality and access among those who did not have the option to utilize it; (3) Patients perceive five key elements as central to compassion in a virtual context; and (4) Leveraging technology to fill gaps within and beyond the visit is a step towards improving experiences for all.

Discussion: Virtual care has transformed the ways in which patient-clinician communication operates in primary care. Patients with access to virtual care described largely positive experiences, while those whose interactions were limited to phone visits experienced decreased quality and access to care. Attention must shift to identifying effective strategies to support the health workforce in building virtual compassion competencies.

Background: SATISPART-Stroke (SATIS-Stroke) is the most complete instrument for the assessment of activity and participation following a stroke. However, its use in a developing country has only been tested through in-person interviews.

Objective: To determine the validity, reproducibility and viability of the SATIS-Stroke scale administered in two tele-assessment modalities: self-assessment of an electronic form versus videoconference.

Methods: Methodological study with Brazilian chronic stroke survivors was conducted. Stage I comprised an in-person interview to apply the SATIS-Stroke and a self-assessment by completing an electronic form to respond to the SATIS-Stroke items. Step II occurred 6 to 8 months after Step I, during which SATIS-Stroke was administered again in-person and via videoconference. The order was randomized.

Results: Ninety-five stroke survivors were recruited, but only 50 answered the electronic form (adherence: 52.6%). Mean scores were higher in the self-administration of electronic form compared to the in-person interview (mean difference = -0.36 ± 0.93; P = 0.009). Adequate reliability was found in the comparison of the in-person and self-assessment of electronic form (ICC_2,1 = 0.66; 95%CI: 0.40-0.81). Fifty stroke survivors participated in Step II, during which adequate reliability was found in the comparison of the in-person administration and videoconference (ICC_2,1 = 0.55; 95%CI: 0.21-0.74) and a moderate correlation was found between the assessment methods (r = 0.43; P = 0.02).

Discussion: Adequate validity and reliability were found in the tele-assessment. Thus, this method is appropriate and viable for use in developing countries. Although reliable, the self-assessment did not have good adherence in the Brazilian population due to internet access problems, lack of familiarity with the digital form and lack of autonomy to answer the questions alone.

Today, social and healthcare systems at a global level are facing constant challenges dictated by an increasing mismatch between the demand for care services and the supply of human and economic resources. Such a situation has been exacerbated in the past two years by the Covid-19 pandemic. This has led to an increase in the leverage of digitalisation, which has proved to be a crucial tool for the development and application of new organisational models at both hospital and territorial levels, thus addressing the various criticalities already present in the system. In this sense, the Virtual Hospital has emerged as a potential model for increasing effectiveness and efficiency in delivering sociomedical services. Starting from these premises, an EFTE (estimate, feedback, talk, estimate) approach was used to acquire an expert consensus within a multidisciplinary panel of academics and healthcare managers of the Veneto Region in Italy. This article reports the expert opinion on the possible application of the Virtual Hospital model in the national context, starting from the existing international evidence and good practices, highlighting the potential advantages and barriers to its implementation. Furthermore, the article analyses the most relevant areas of investment for the development of intangible assets and the acquisition of tangible assets necessary for its implementation.

Background: Due to the COVID-19 pandemic, telehealth resurfaced as a convenient efficient healthcare delivery method. Researchers indicate that Artificial Intelligence (AI) could further facilitate delivering quality care in telehealth. It is essential to find supporting evidence to use AI-assisted telehealth interventions in nursing.

Objectives: This scoping review focuses on finding users' satisfaction and perception of AI-assisted telehealth intervention, performances of AI algorithms, and the types of AI technology used.

Methods: A structured search was performed in six databases, PubMed, CINAHL, Web of Science, OVID, PsycINFO, and ProQuest, following the guidance of the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews. The quality of the final reviewed studies was assessed using the Medical Education Research Study Quality Instrument.

Results: Eight of the 41 studies published between 2017 and 2022 were included in the final review. Six studies were conducted in the United States, one in Japan, and one in South Korea. Four studies collected data from participants (n = 3014). Two studies used image data (n = 1986), and two used sensor data from smart homes to detect patients' health events for nurses (n = 35). The quality of studies implied moderate to high-quality study (mean = 10.1, range = 7.7-13.7). Two studies reported high user satisfaction, three assessed user perception of AI in telehealth, and only one showed high AI acceptability. Two studies revealed the high performance of AI algorithms. Five studies used machine learning algorithms.

Conclusions: AI-assisted telehealth interventions were efficient and promising and could be an effective care delivery method in nursing.

The American College of Sports Medicine determined the energy consumption of daily activities and sports. Cardiac telerehabilitation (CTR) requires knowing how much energy people consume in daily life outside of cardiac rehabilitation activities. Therefore, we have investigated if the estimated values are valid in CTR. Data from two studies were incorporated. The first study measured ventilatory threshold (VT)1, VT2, and peak exercise on cardiopulmonary exercise testing (CPET) collected from 272 cardiac (risk) patients and compared them to the estimated oxygen consumption (VO₂) at low-to-moderate-intense exercise (3-6 metabolic equivalents [METs]). Next, a patient-tailored application was developed to support CTR using these estimated values, and the intervention (the second study) was conducted with 24 coronary artery disease patients using this application during a CTR intervention. In the first study, VO₂ at VT1, VT2 and peak exercise corresponded to 3.2 [2.8, 3.8], 4.3 [3.8, 5.3], and 5.4 [4.5, 6.2] METs, which are significantly different from the estimated VO₂ at low-to-moderate-intense exercise, especially lower in older, obese, female, and post-myocardial infarction/heart failure patients. These VO₂ varied considerably between patients. The telerehabilitation study did not show significant progress in peak VO₂, but using the application's estimated target, 97.2% of the patients achieved their weekly target, which is a significant overestimate. The estimated and observed exercise-related energy expenditures by CPET were significantly different, resulting in an overestimation of the exercise done by the patients at home. The results can have a significant impact on the quantification of exercise dose during (tele)rehabilitation programs.