Journal of Telemedicine and Telecare最新文献

BackgroundTelemedicine has gained traction in surgical subspecialties, particularly since the COVID-19 pandemic. This study aims to identify whether telemedicine can be appropriately integrated within surgical oncology practice.MethodsThis retrospective study evaluated patients who received either telemedicine or office follow-up after undergoing surgical oncology operations between 2016 and 2021. The telemedicine group (TG) and office group (OG) received a 15-question survey regarding their satisfaction with their care. Patient outcomes and responses were analyzed utilizing propensity-score matching in 1:1 fashion.ResultsTelemedicine group and OG each had 21 patients. Length of stay, complication frequency, follow-up frequency, and readmissions frequency within 90-days were comparable between groups. Telemedicine group expressed comparable satisfaction with postoperative care relative to OG (95.2% vs. 85.7%, p = 0.61). All telemedicine patients said they would utilize telemedicine again in the future and would recommend its use to others.ConclusionPatient satisfaction with postoperative telemedicine follow-up is comparable to those with in-person follow-up.

ObjectiveThe aim of this study was to assess the precision of a web-based tool in measuring visual acuity (VA) in ophthalmic patients, comparing it to the traditional in-clinic evaluation using a Snellen chart, considered the gold standard.MethodsWe conducted a prospective and in-clinic validation comparing the Eyecare Visual Acuity Test® to the standard Snellen chart, with patients undergoing both tests sequentially. Patients wore their standard spectacles as needed for both tests. Inclusion criteria involved individuals above 18 years with VA equal to or better than +1 logMar (20/200) in each eye. VA measurements were converted from Snellen to logMAR, and statistical analyses included Bland-Altman and descriptive statistics.ResultsThe study, encompassing 322 patients and 644 eyes, compared Eyecare Visual Acuity Test® to conventional methods, revealing a statistically insignificant mean difference (0.01 logMAR, P = 0.1517). Bland-Altman analysis showed a narrow 95% limit of agreement (0.22 to -0.23 logMAR), indicating concordance, supported by a significant Pearson correlation (r = 0.61, P < 0.001) between the two assessments.ConclusionThe Eyecare Visual Acuity Test® demonstrates accuracy and reliability, with the potential to facilitate home monitoring, triage, and remote consultation. In future research, it is important to validate the Eyecare Visual Acuity Test® accuracy across varied age cohorts, including pediatric and geriatric populations, as well as among individuals presenting with specific comorbidities like cataract, uveitis, keratoconus, age-related macular disease, and amblyopia.

Participatory design (PD) is a methodology that emphasizes user participation in the design of new technologies to leverage change within organizations and services. PD originated in the computer science field in the 1970s and 1980s when new programs and technologies were developed to empower workers, by involving them in decisions that affected them. PD in health research has been proven to change clinical practice. Genuine user involvement that includes all stakeholders, and robust collaborations across sciences, sectors, and disciplines are basic elements of successful research to change clinical practice and to implement novel technical and organizational approaches. This paper summarizes seven case studies involving the use of PD in telehealth research. All cases presented promoted organizational changes supported by health information and communications technology, and have been implemented at either international, national, regional, or local levels. We describe how PD can be applied in health sciences and used to facilitate organizational changes, new perspectives, and new communications methods. The relevance and suitability of PD as a research design in health science is explained, and recommendations for conducting PD studies in telehealth research are presented. In PD, mutual learning and co-creation is facilitated. Consequently, learning from users, rather than studying them, corroborates our understanding and the emergence of new knowledge.

BackgroundThe COVID-19 pandemic has posed unprecedented challenges to healthcare systems globally, necessitating innovative care models like hospital-at-home and virtual care programs. The Influenzer telemedicine program aims to deliver hospital-led monitoring and treatment to patients at home. Integrating telemedicine technology with domestic visits provides an alternative to traditional hospitalization, with the aim of easing the burden on healthcare facilities without compromising patient safety. To evaluate the effectiveness of the Influenzer program, a randomized controlled trial is proposed. This study aimed to assess the feasibility of the proposed clinical trial design.MethodsA non-randomized feasibility study was conducted at the Department of Pulmonary and Infectious Diseases at Nordsjaellands Hospital offering a telemedicine-supported early discharge program to patients with lower respiratory tract infections, including COVID-19. The feasibility of trial procedures, including recruitment, adherence, and retention, was analyzed. Also, participants' characteristics and trajectory during the intervention, including telemedicine and domestic services, were assessed.ResultsNineteen patients were enrolled from June 2022 to April 2023 and treated at home. Forty patients were not enrolled as 15 (25%) were non-eligible according to study protocol, 15 (25%) refused to participate and 10 (17%) had not been approached. Subjects treated at home had comparable clinical outcomes to those treated in the acute hospital, no major safety incidences occurred and patients were highly satisfied. Participants demonstrated 99% adherence to planned daily monitoring activities. In total, 63% completed all survey assessments at least partially including baseline, at discharge, and 3 months post-discharge, while 89% participated in a follow-up interview. No participants withdrew their consent.ConclusionsThe feasibility study documented that the Influenzer home-hospital program was feasible and well accepted in a Scandinavian setting in terms of no withdrawals and excellent participant adherence to the planned daily monitoring activities. Challenges in the organizational structures including patient recruitment and data collection required resolution prior to our randomized clinical trial. Insights from this feasibility study have led to the improved design of the final Influenzer program evaluation trial.Trial registrationClinicalTrials.gov, NCT05087082. Registered on 18 August 2021.

ObjectiveWe compared the impact of accessing healthcare (1) by telehealth (via telephone or video) vs face-to-face; and (2) by telephone vs video telehealth care, on escalation to emergency care.MethodsWe searched Medline, Embase and Cochrane CENTRAL to 24 July 2023; and conducted a citation analysis on 19 September 2023. We included randomised controlled trials. Risk of bias was assessed using Cochrane Tool 2. We calculated risk ratios for dichotomous outcomes and standardised mean difference for continuous outcomes.ResultsTen trials compared telehealth (five telephone, four video, one both) to face-to-face care. Six were overall low, three some concerns and one high risk of bias. There were no differences between telehealth and face-to-face for visits to the emergency department (RR 1.07, 95% CI 0.89 to 1.29), hospitalisations up to 12 months (RR 0.89, 95% CI 0.56 to 1.41), deaths or other adverse events. Costs of care were similar, as were patient satisfaction scores.Six trials compared telephone to video telehealth: three were overall low, two some concerns, and one high risk of bias. There were no differences between telephone and video for visits to the emergency department (RR 0.67, 95% CI 0.41 to 1.12), hospitalisations (RR 1.04, 95% CI 0.73 to 1.48), deaths, other adverse events, costs, or patient satisfaction. Healthcare provider satisfaction was high.ConclusionsTelehealth care - delivered by telephone or by video - may be an appropriate alternative to face-to-face provision of care, as it does not increase the likelihood of escalation of care to the emergency department for patients in primary care, hospital outpatients, post-discharge patients or residents in aged care.

BackgroundTele-assessments are becoming increasingly important to increase access to healthcare services and facilitate patient follow-up. Whether they can provide results with similar accuracy to face-to-face assessments remains relevant.ObjectiveThe aim of this study was to compare the face-to-face and tele-assessment scores of the International Cooperative Ataxia Rating Scale (ICARS) and Assessment and Rating of Ataxia (SARA) in ataxic MS patients and to examine their suitability for tele-assessment.MethodsThe participants were assessed both online and face-to-face. Randomization determined which method would be used first to assess the participants. ICARS and SARA were used in the assessments. Face-to-face assessments were conducted as part of routine clinical practice by one researcher, while teleassessments were performed via real-time video by two different researchers. The video was recorded and reassessed one week later. The agreement and correlation between face-to-face and teleassessments were analyzed using intra-class correlation coefficients (ICC), Bland-Altman Plots, and Pearson's/Spearman's correlation coefficients.ResultsThis study included 20 patients with ataxic MS with an EDSS score of 3.6 ± 0.66. The inter-rater reliability of tele-assessments (ICC_ICARS = 0.97; ICC_SARA = 0.97) achieved excellent reliability. Intra-rater reliability of the tele-assessment was excellent (ICC_ICARS = 0.99; ICC_SARA = 0.99). High correlations were observed in ICARS and SARA scores between face-to-face and tele-assessment methods according to assessors (r > .80 for all).ConclusionICARS and SARA are reliable and agreed-upon tests that can be used with tele-assessments, offering similar data to face-to-face methods.

IntroductionBehavioural changes targeting diet and physical activity to achieve weight loss are considered the cornerstones of metabolic dysfunction-associated steatotic liver disease (MASLD) management. Digital health interventions effectively address barriers in accessing such lifestyle interventions particularly for persons in remote and regional communities that have high rates of MASLD and limited access to healthcare. This research uses co-design methodology to inform the development of a multimodal, digital lifestyle intervention for individuals with MASLD.MethodsOver 20 months (May 2023-January 2025), an iterative co-design process guided by the Double Diamond framework-discover, define, develop, deliver-was implemented. Twenty-seven adults (≥18 years) from Alfred Health, Australia participated in one-on-one interviews to explore insights and perspectives during the discover phase. This included people with MASLD (n = 10; 50% female; mean age: 63.6 years), and healthcare professionals (n = 17; 59% female; mean age: 37.1 years) [dietitians (n = 5), exercise professionals (n = 6) and hepatologists/clinicians (n = 6)], representing a range of ethnic backgrounds. Key themes were synthesised using a reflexive thematic analysis employing a data-driven, inductive approach during the define phase. The develop phase led to actionable suggestions, and final feedback was sought from participants in the deliver phase.ResultsInterviews identified barriers and facilitators that influenced participant engagement and adherence to the digital intervention, highlighting the need for an evidence-based, personalised and holistic approach during the discover and define phases. Five key themes emerged: i) content relevance and adaptability, ii) personalisation, iii) social and community, iv) barriers and facilitators, and v) website interface design. The develop phase focused on refining the intervention based on participant feedback and deliver phase encompassed finalising the digital intervention.ConclusionsThis iterative co-design process identified the needs and preferences of individuals with MASLD for a multimodal, digital lifestyle intervention. This research will guide a holistic, tailored approach with culturally appropriate resources and community engagement, piloted to assess feasibility.

ObjectiveThe rapid shift toward home- and community-based care in the US has intensified the demand for home health care, particularly as the population continues to age. Amid challenges such as workforce shortages and increasing patient needs, telehealth has emerged as a potential strategy to enhance care delivery and patient outcomes in home health settings. This literature review examines empirical studies published between January 2020 and April 2024 to investigate the status of telehealth use within the US in home health care settings.MethodsA systematic search was conducted in PubMed and CINAHL for peer-reviewed studies published in English between January 2020 and April 2024. Quality of reviewed studies was assessed independently by reviewers using quality assessment checklists.ResultsSix quasi-experimental studies were included, examining various telehealth modalities in home health care. Tele-video, tele-calls, and remote monitoring were commonly used for patient education, symptom management, and interdisciplinary collaboration. Telehealth interventions were generally associated with high patient satisfaction, reduced acute care utilization, and improved communication between providers and caregivers. Study quality varied, with limitations in sample size, methodology, and outcome measurement affecting generalizability. Further research is needed to optimize telehealth integration in home health care.ConclusionsThese findings highlight the effectiveness of telehealth in delivering home health care and its potential to address current challenges. These findings also call for policy changes for expanded reimbursement models as well as large-scale pragmatic studies to enhance telehealth integration in home health care to support aging in place.

IntroductioneConsults are asynchronous digital communications for primary care professionals to seek timely specialist advice. Potential benefits include increased primary healthcare capacity and referral efficiency. Santa Catarina Telehealth Centre in Brazil has offered eConsults for an increasing number of specialties since 2008. This study described the characteristics of this service, including referral efficiency, sustainability, and satisfaction.MethodsRetrospective longitudinal analysis of eConsults activity data from 2015 to 2022 with three domains of the Model for Assessment of Telemedicine Applications used to structure the analysis.ResultsCharacteristics of the application: The total number of eConsults performed in 2015 was 4764, reaching 41,178 in 2022. While 30.3% of eConsults were synchronous in 2015, only asynchronous communication remained from 2021. Clinical effectiveness: eConsults requested to refer patients to specialist care resulting in primary care management remaining above 30% of the total for all specialties from 2019 to 2022, with hematology having the highest percentage (>52%). Organizational aspects: Established workflows with local specialists responding to eConsults (cardiology, endocrinology, hematology and orthopaedics) kept a constant or increasing number of eConsults and maintained the proportion of primary care management from 2019 to 2022, once recovered from COVID-19 and funding restrictions-related reductions. Over 90% of primary care professionals are either satisfied or very satisfied with the eConsult service.ConclusionOver 8 years, 223,734 consultations were conducted, with high satisfaction, demonstrating the substantial potential for increased primary care-sensitive conditions management. Hiring local specialists, fostering integrated care, and enabling sustainable workflows are key to eConsults' success.

BackgroundNo-show visits have serious consequences for patients, providers, and healthcare systems as they lead to delays in care, increased costs, and reduced access to services. Telemedicine has emerged as a promising alternative to in-person visits by reducing travel barriers, but risks exacerbating the digital divide. The aim of this study was to assess the impact of telemedicine (video and phone) at a tertiary care academic center on no-show visits compared to in-person visits.MethodsA retrospective cohort analysis of all weekday clinic visits among in-state adult patients at a single tertiary care center in the southeast from January 2020 to April 2023 was performed. Rates of no-show visits for patients who were seen via phone and video were compared with those who were seen in-person. Demographic and clinical characteristics of these groups were also compared, including age, sex, race/ethnicity, socioeconomic status, and visit type. The primary outcome was the rate of no-show visits for each visit type.ResultsOur analysis included 3,105,382 scheduled appointments, of which 81.2% were in-person, 13.4% via video, and 5.4% via phone calls. Compared to in-person visits, phone calls and video visits reduced the odds of no-show visits by 50% (aOR 0.5, CI 0.49-0.51) and 15% (aOR 0.85, CI 0.84-0.86), respectively. Older patients, Black patients, patients furthest from clinic, and patients from counties with the greatest degree of vulnerability and disparities in digital access were more likely to use phone visits. No-shows were more common among non-white, male, and younger patients from counties with lower socioeconomic status.ConclusionTelemedicine effectively reduced no-show visits. However, limiting telemedicine to video-based visits only exacerbated disparities in access. Phone calls allow historically underserved patients from lower socioeconomic backgrounds to access healthcare and should be included within the definition of telemedicine.