Journal of Telemedicine and Telecare最新文献

Introduction: In obstetrics, telehealth is widely used in the provision of prenatal and postpartum care. The objective was to compare the utilization of commonly recommended services after delivery among individuals receiving telehealth versus in-person postpartum care.

Study design: We performed a retrospective cohort study of individuals receiving postpartum care at a single institution between 1 July 2020 and 30 June 2023. The primary exposure was the exclusive use of telehealth versus an in-person visit for postpartum care. Two primary outcomes were assessed between 0 and 365 days after the delivery: 1) long-acting reversible contraceptive (LARC) method use and 2) pap smear screening. Secondary outcomes occurring between 0 and 365 days after delivery included: clinic-based weight assessment, clinic-based blood pressure assessment, any prescription contraception use, primary care visit, and pregnancy within 1 year.

Results: Among the 9953 individuals, 9058 (91.0%) had a postpartum visit. 1811 (19.9%) utilized telehealth exclusively, which peaked during the COVID-19 pandemic. Exclusive telehealth users were less likely to have a pap smear (21.6 vs. 40.1%, p < 0.001) or use LARCs (8.6 vs. 19.4%, p < 0.001) than those receiving in-person care. In the adjusted analysis, the odds ratio for receiving a pap smear was 0.38 (95% confidence interval [CI] 0.32-0.47) and for using a LARC was 0.38 (95% CI 0.31-0.47) when comparing telehealth to in-person care. Reduced odds of all secondary outcomes were seen in the exclusive telehealth use compared to the in-person cohort, with the exception of subsequent pregnancy within 1 year, which was not significantly different.

Discussion: Acknowledging that telehealth now has become an important means for patients to access medical care, these findings should prompt clinicians to consider when an in-person postpartum visit should be offered or recommended over telehealth, especially when a patient may not have a preference or reported barriers to accessing an in-person visit.

Telemedicine is comparable in quality to in-person care, adequate for many primary care concerns, acceptable to patients, and can overcome barriers to care. However, patients are reluctant to pay the same for telemedicine as in-person care and uncertainty about future payor reimbursement makes it risky to base a clinical practice primarily on telemedicine. Physical exam-supported information collection and relationship-building are limited in telemedicine, but can be mitigated through remote patient monitoring and ample access to a provider and clinical team. Subscription-based direct primary care models disconnect payment from episodes of care, which can support enhanced communication between the patient and care team and support time for asynchronous tasks such as remote patient monitoring data review. A "telemedicine first, direct primary care" model in which most care is provided through telemedicine and financed via subscription would retain the convenience of telemedicine, mitigate relationship-limiting deficiencies due to the lack of physical contact, and provide a stable revenue stream to support a telemedicine-based approach to care. Paired with specialist access via eConsults and options to refer to in-person care when necessary, this model would support telemedicine as the foundation for practice and connect underserved populations to primary and specialty care.

Introduction: The COVID-19 pandemic dramatically affected the financial performance of hospitals across the U.S. The prompt availability of telehealth options likely impacted both a hospital's healthcare options and opportunities for revenue in the short-term. The aim of this study was to explore the association between early adoption of telehealth and changes in revenue during the early phase of the pandemic, and to compare whether the results differed between rural and urban hospitals.

Methods: We performed first-difference regressions on a cross-sectional dataset of 1,742 U.S. hospitals. Our dependent variables were percent changes in four categories of revenue between 2019 and 2020: inpatient, outpatient, gross, and net. The adoption of telehealth and remote patient monitoring as of 2019 served as the primary independent variables of interest. We controlled for changes in hospital characteristics from 2019 to 2020, including case mix index and number of employees.

Results: Our results suggest that telehealth adoption prior to the COVID-19 pandemic was associated with significant increases in all four revenue categories from 2019 to 2020, ranging from 1.79% (net patient revenue) to 2.92% (outpatient revenue). However, RPM implementation in 2019 was associated with significant declines in gross patient (0.08%) and outpatient revenue (1.50%). The results were largely similar across rural and urban locations.

Discussion: Adopting telehealth before the onset of COVID-19 helped hospitals increase revenue during the initial phase of the pandemic. Alternatively, implementation of remote patient monitoring was associated with revenue declines, likely due to limited ability for monetization. Whether these relationships have persisted needs further investigation.

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.

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).

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.

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.

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.

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.