Journal of Telemedicine and Telecare最新文献

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.

IntroductionThe COVID-19 pandemic advanced the use of telehealth-facilitated care. However, little is known about how to measure safety of clinical diagnosis made through telehealth-facilitated primary care.MethodsWe used the seven-step Safer Dx Trigger Tool framework to develop an electronic trigger (e-trigger) tool to identify potential missed opportunities for more timely diagnosis during primary care telehealth visits at a large Department of Veterans Affairs facility. We then applied the e-trigger algorithm to electronic health record data related to primary care visits during a 1-year period (1 April 2020-31 March 2021). The algorithm identified patients with unexpected visits within 10 days of an index telemedicine visit and classified such records as e-trigger positive. We then validated the e-trigger's ability to detect missed opportunities in diagnosis using chart reviews based on a structured data collection instrument (the Revised Safer Dx instrument).ResultsWe identified 128,761 telehealth visits (32,459 unique patients), of which 434 visits led to subsequent unplanned emergency department (ED), hospital, or primary care visits within 10 days of the index visit. Of these, 116 were excluded for clinical reasons (trauma, injury, or childbirth), leaving 318 visits (240 unique patients) needing further evaluation. From these, 100 records were randomly selected for review, of which four were falsely flagged due to invalid data (visits by non-providers or those incorrectly flagged as completed telehealth visits). Eleven patients had a missed opportunity in diagnosis, yielding a positive predictive value of 11%.DiscussionElectronic triggers that identify missed opportunities for additional evaluation could help advance the understanding of safety of clinical diagnosis made in telehealth-enabled care. Better measurement can help determine which patients can safely be cared for via telemedicine versus traditional in-person visits.

BackgroundTelehealth has the potential to increase access to care for medically underserved patients. This qualitative study aimed to identify telecare practices used during the COVID-19 pandemic to meet the needs of patients experiencing homelessness, patients with disabilities, and patients with language preference other than English (LOE).MethodsWe conducted a secondary qualitative data analysis of 47 clinician interviews at Federally Qualified Health Centers (FQHCs) around the country. Using thematic analysis, transcripts were coded by line-by-line by five qualitative researchers. A multidisciplinary team of telehealth experts, researchers and primary care clinicians reviewed memos and excerpts to generate major themes.ResultsWe identified six main areas demonstrating how community providers developed strategies or practices to improve access to care for vulnerable patients: reaching patients experiencing homelessness, serving deaf and hard of hearing patients, improving access for patients with disabilities, serving patients with LOE, improving access for mental and behavioral health services, and educating patients about telehealth. During the pandemic, FQHCs developed innovative solutions to provide access to care for the unhoused, including using telehealth in shelters, vans, and distributing devices like mobile phones and tablets. Telehealth reduced transportation burdens for patients with disabilities and reduced no-show rates for mental health services by adapting group therapy via telehealth features (like break-out rooms) and increasing provider capacity.ConclusionOur study identified strategies adopted by FQHCs to serve underserved populations during the COVID-19 pandemic. Our findings highlight the need for enduring strategies to improve health equity through telehealth..

ObjectiveThis systematic review compared clinical, service and cost effectiveness of telephone consultations (TC) to video consultations (VC).MethodsWe searched Embase, CINAHL and MEDLINE for empirical studies that compared TC to VC using clinical, service or economic outcome measures. Clinician or patient preference and satisfaction studies were excluded. Findings were synthesised descriptively.ResultsA total of 79 articles were included. The most effective modality was found to be VC in 40 studies (50%) and TC in 3 (4%). VC and TC were found to be equivalent in 28 of the included articles (35%). VC were superior or equivalent to TC for all clinical outcomes. When compared to TC, VC were likely to have better patient engagement and retention, to improve transfer decisions, and reduce downstream sub-acute care utilisation. The impact of telehealth modality on consultation time, completion rates, failure-to-attend rates and acute care utilisation was mixed. VC were consistently found to be more cost effective despite having a higher incremental cost than TC.ConclusionsOur systematic review demonstrates equal or better, but not inferior clinical and cost outcomes for consultations delivered by VC when compared to TC. VC appear to be more clinically effective when visual information is required, when verbal communication with the patient is impaired and when patient engagement and retention is linked to clinical outcomes. We have provided conditions where VC should be used in preference to TC. These can be used by clinicians to guide the choice of telehealth modality. Cost effectiveness is also important to consider when choosing modality.

ObjectiveThis study aimed to assess the effects of telerehabilitation with multimodal exercise on cardiac remodeling and blood pressure in hypertensive older adults.MethodsThirty-two hypertensive older adults (66.7 ± 5.33 years; 29.5 ± 4.22 Kg/m²; 24 female) were randomized into either a telerehabilitation or a control group. Echocardiographic parameters and blood pressure were assessed before and after the 16-week intervention. The exercise program was supervised, individualized, and offered 3×/week via videoconference.ResultsBlood pressure significantly decreased after telerehabilitation when compared to the control group, presenting a large effect size. The moderate effect size in relative and posterior wall thickness (g = 0.63; g = 0.61), shortening fraction (g = 0.54), and ejection fraction (g = 0.68).ConclusionAs a preliminary study, telerehabilitation is favorable to promote a moderate clinical improvement of some cardiac morphofunctional parameters and reduce blood pressure in hypertensive older adults.

BackgroundAdherence to continuous positive air pressure (CPAP) in patients with obstructive sleep apnoea (OSA) has remained invariably low over the last decades. Remote monitoring of the nocturnal CPAP treatment, within telemedicine (TM)-based follow-up programs, in these patients has been suggested as a potential tool to improve adherence and release the workload of sleep units. The aim of this study was therefore to assess whether a follow-up program carried out by a Remote Medical Care Centre (RMCC), outside the sleep unit, improves adherence to CPAP in the short and long term in patients with OSA.MethodsIn this pilot protocol, we enrolled 37 patients starting CPAP in our Sleep Centre (SC). After three months of standard care in our SC, patients initiated a six-month remote follow-up carried out by the RMCC, functioning as an intermediary between patients and SC. Monthly reports and indication for face-to-face visits were sent to the SC for six months. After this period patients returned to usual care for one year. Results were compared with those obtained in 38 patients (controls) followed with usual care over the same time range.ResultsMean nightly use of CPAP increased from 3.2 ± 2.4 h pre-RMCC to 5.2 ± 1.9 h post-RMCC (p < 0.0001). Nights/month of CPAP use improved from 19.8 ± 9.2 to 25.2 ± 2.5 (p < 0.05) and nights/month with CPAP use >4 h from 12.5 ± 10 to 21.03 ± 8.9 (p < 0.05). This improvement remained stable after 12 months from the return of patients to usual care. No significant changes in CPAP use were observed in controls over the time.ConclusionA six-month follow-up through a remote facility can significantly improve adherence to CPAP in the short and long term. This pilot study provides a solid base for the design of multicentre randomized trials focusing on new models which are able to increase the long-term efficacy of TM programs.

IntroductionUniversal digital mental health interventions (DMHIs) are emerging as a viable approach to promoting mental health among children and adolescents in general population. However, there is a scarcity of meta-analyses that examined their short- and long-term effects or potential moderators in individuals aged 19 or younger.MethodsA systematic search was conducted to identify randomised controlled trials that delivered universal DMHIs for promoting mental health, targeting children and adolescents aged 19 or younger in general population. Meta-analysis was performed to identify studies using Comprehensive Meta-Analysis.ResultsThe meta-analysis of 29 included studies identified significant overall effects (g = 0.16) as well as significant effects for anxiety (g = 0.09), depression (g = 0.06), psychological distress (g = 0.28), externalising problem (g = 0.21), psychological well-being (g = 0.19), interpersonal functioning (g = 0.21) and social-emotional skills (g = 0.19) at post-intervention. The analysis of 7 studies that followed up 6 months or longer revealed a significant overall effect (g = 0.09) as well as significant effects for anxiety (g = 0.11) and depression (g = 0.05) at follow-up. Age and intervention duration moderated the overall effects. Gamification moderated the effect on depression. Attrition rate moderated the effect on social-emotional skills.ConclusionsProviding universal DMHIs with longer durations to younger children may be critical for effectively improving a range of mental health outcomes among children and adolescents. To promote engagement and effectiveness, future studies may explore how gamification and other features for reducing attrition could be effectively incorporated into DMHIs.

ObjectiveThe aim of this study was to identify the factors that might influence patients' adoption of telerehabilitation post-orthopaedic surgery knee and hip.MethodSemi-structured interviews were conducted with 20 total hip arthroplasty (THA; n = 6) and total knee arthroplasty (TKA; n = 14) patients. These interviews were guided by an interview framework inspired by the Unified theory of acceptance and use of technology 2 (UTAUT2). The System Usability Scale (SUS) was used to assess patients' perception of usability.ResultsThe interviews highlighted facilitators perceived by the subjects, such as reinforcement and motivation to practice physical activity, personalised follow-up from clinicians (via gamification), complementarity to conventional therapy and cost (urban travel). The results also revealed perceived barriers, including the risk of injury and lack of relationship with the professional. These factors need to be considered in user-centred design. SUS results were not influenced by the subject gender, or age. The results obtained for the SUS indicate an average score of 54.6 ± 19.6, meaning that potential usability is slightly acceptable.ConclusionUser-centred design is essential for adherence. Individualised and gamified programmes could improve patient care by encouraging participation and autonomy. Setting achievable goals and clinician support help maintain engagement, ensuring the long-term benefits of exercise. These key points could increase mass participation and thus improve telerehabilitation care.

IntroductionSuicide is the second leading cause of death in persons aged 10-34 in the US. Despite the availability of evidence-based suicide screening tools and interventions, there is a gap in suicide prevention knowledge among non-psychiatric healthcare providers. This study examined a novel education program, Project ECHO^®, focused on suicide prevention. Project ECHO^® delivers subspecialized medical knowledge via teleconferencing to primary care providers and behavioral health providers.MethodsThe ECHO-Chicago Suicide Prevention program encompassed three series with 10 (behavioral health providers & primary care providers) or 9 (pediatric primary care providers) one-hour sessions in 2023-2024. Each session was comprised of expert-led didactics and participant-led case discussions. Topics included suicide epidemiology, secondary stress, zero suicide model, screening, cultural competency, safety planning, follow-up, and post-acute care transitions. Pre- and post-series surveys were used to evaluate the education program. Free text responses were analyzed using thematic coding.ResultsIn total, 106 participants participated in the program; 79 (75%) completed both the pre- and post-series surveys. Overall mean self-efficacy scores increased from 4.1 to 5.4 (p < 0.0001) in the behavioral health providers/primary care providers series and from 3.3 to 5.2 (p < 0.0001) in the pediatric primary care providers series. Participants reported an improved ability to manage complex cases and an increased quality of care. Qualitative analysis suggested clinicians benefited from learning specific screening tools and soft skills, including patient communication.DiscussionAs an affordable, scalable model, our novel curriculum has the potential to improve suicide prevention knowledge and practices amongst pediatric, adult, behavioral health, and interdisciplinary providers.

IntroductionTelehealth may offer a valuable resource for family caregivers' physical and psychological well-being; however, understanding its effectiveness is crucial to determining its true potential. Thus, this systematic review and meta-analysis aims to examine the effectiveness of telehealth interventions focused on family caregivers' physical and psychological well-being, along with other factors during the care of older adults with various diseases (such as neurocognitive disorders, chronic conditions, and musculoskeletal diseases).MethodsPubMed, Web of Science, Scopus, and Cochrane Library databases were searched. Studies that investigated the effects of telehealth on family caregivers of older adults with any disease and a comparison group receiving any type of intervention were selected. Two independent reviewers carried out the study selection and data extraction. We conducted a meta-analysis using standardized mean differences (SMDs) to pool the continuous outcomes included. Heterogeneity (I² and Tau²), publication bias (Egger's test and funnel plots), risk of bias (Joanna Briggs Institute tool), potential mediators (meta-regressions), and robustness (leave-one-out method) were also assessed.ResultsTwenty-six studies were selected (23 randomized controlled trial and 3 quasi-experimental studies), including a total of 2932 family caregivers. Telehealth was more effective than usual care in improving psychological well-being (SMD = 0.21; p = 0.006), caregiving competence (SMD, 0.73; p = 0.007), and reducing caregiver burden (SMD = -0.26; p = 0.01) in a follow-up shorter than 4 months. It was not effective in reducing anxiety or depression (SMD = -0.18 and -0.40; p = 0.08 and 0.20, respectively), nor in improving physical fitness (SMD = -0.16; p = 0.460). Considering a follow-up period of 4-12 months, the only outcome in favor of telehealth was the improvement in managing patients' problematic behaviors (SMD = -1.27; p < 0.0001). It was not effective for psychological well-being, anxiety, depression, or caregiver burden (SMD = 0.15, 0.22, 0.08, and -0.33; p = 0.290, 0.260, 0.550, and 0.550, respectively).ConclusionTelehealth may be a valuable option for supporting family caregivers of older adults in improving psychological well-being, caregiving competence, and reducing burden, but the benefits may not last long term.