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The Association Between Telehealth Use During Buprenorphine Treatment for Opioid Use Disorder and Clinical Outcomes: A Retrospective Cohort Study. 在丁丙诺啡治疗阿片类药物使用障碍期间使用远程医疗与临床结果之间的关系:回顾性队列研究
IF 2.8 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-25 DOI: 10.1089/tmj.2024.0410
J Priyanka Vakkalanka, Brian C Lund, Stephan Arndt, Knute D Carter, Ryan Carnahan

Background: Patients with opioid use disorder (OUD) represent a high-risk population due to increased rates of adverse health outcomes and death. To evaluate whether telehealth utilization during OUD treatment compared with in-person encounters alone was associated with emergency department (ED) utilization, inpatient admissions, and mortality within three years of initiating buprenorphine. Methods: We conducted a retrospective cohort study within the Veterans Health Administration among Veterans treated for OUD between 2012 and -2022. The primary exposure was modality of care, characterized as telehealth encounters (with or without an in-person visit) compared with in-person visits only. Outcomes included an ED visit, inpatient admission, or mortality within three years of the index buprenorphine prescription. We measured the association between each type of treatment modality and outcomes through Cox proportional hazards regression modeling, adjusting for demographic and clinical covariates and confounders. Findings: Of the 57,021 Veterans diagnosed with OUD and who initiated buprenorphine, 38,072 Veterans met study eligibility criteria. The majority of Veterans were male, non-Hispanic White, 25-44 years of age, and lived in urban areas. Approximately 60% of this entire cohort experienced at least one ED visit, 40% experienced an inpatient admission, and 8% died during follow-up. Telehealth use compared with in-person visits only was associated with reduced ED visits (adjusted hazard ratio [aHR] 0.81; 95% confidence interval [CI] 0.77-0.85), inpatient admissions (aHR: 0.71; 95% CI: 0.67-0.76), and mortality (aHR: 0.80; 95% CI: 0.67-0.94). Conclusions: Telehealth may help overcome barriers to in-person care. During buprenorphine treatment for OUD, telehealth as a point of contact with providers and the health care system may reduce more adverse health outcomes, potentially through improving treatment retention. Qualitative studies may help shed light on the mechanisms through which telehealth directly impacts clinical outcomes.

背景:阿片类药物使用障碍(OUD)患者是一个高风险人群,因为他们的不良健康后果和死亡率都会增加。目的:评估在开始使用丁丙诺啡治疗后三年内,在 OUD 治疗过程中使用远程医疗与单独面对面治疗相比,是否与急诊科(ED)使用、住院和死亡率有关。方法:我们在退伍军人健康管理局内对 2012 年至 2022 年期间接受 OUD 治疗的退伍军人进行了一项回顾性队列研究。主要暴露因素是护理方式,即远程医疗(有或没有亲临现场就诊)与仅亲临现场就诊的比较。结果包括在开出丁丙诺啡处方后三年内的急诊就诊、住院或死亡。我们通过 Cox 比例危险回归模型测量了每种治疗方式与结果之间的关联,并对人口统计学、临床协变量和混杂因素进行了调整。研究结果在确诊患有 OUD 并开始使用丁丙诺啡的 57021 名退伍军人中,有 38072 名符合研究资格标准。大多数退伍军人为男性、非西班牙裔白人、25-44 岁、居住在城市地区。在整个群体中,约有 60% 的退伍军人至少就诊过一次急诊室,40% 的退伍军人住院治疗,8% 的退伍军人在随访期间死亡。使用远程保健与仅亲自就诊相比,可减少急诊室就诊次数(调整后危险比 [aHR] 0.81;95% 置信区间 [CI] 0.77-0.85)、住院次数(aHR:0.71;95% CI:0.67-0.76)和死亡率(aHR:0.80;95% CI:0.67-0.94)。结论远程医疗有助于克服面对面治疗的障碍。在丁丙诺啡治疗 OUD 的过程中,远程保健作为与医疗服务提供者和医疗保健系统的接触点,可能会通过改善治疗的持续性来减少更多的不良健康后果。定性研究可能有助于揭示远程保健直接影响临床结果的机制。
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引用次数: 0
Quality of Life Among Patients with Heart Failure with Reduced Ejection Fraction Receiving Telemedicine Care in Vietnam. 越南接受远程医疗护理的射血分数降低型心力衰竭患者的生活质量。
IF 2.8 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-25 DOI: 10.1089/tmj.2024.0440
Phuong Minh Tran, Hieu Ba Tran, Dung Viet Nguyen, Hung Manh Pham, Loi Doan Do, Ha Quoc Nguyen, James N Kirkpatrick, Rajesh Janardhanan, Christopher M Reid, Hoai Thu Thi Nguyen

Background: Telemedicine is an effective method to monitor patients at home and improve outcomes of heart failure (HF), especially HF with reduced ejection fraction (HFrEF). However, little is known about the impact of telemedicine on the quality of life (QoL) among outpatients with HFrEF in lower-middle-income countries (LMICs). Methods: In this single-center, prospective, randomized, controlled, open, and parallel-group clinical trial in northern Vietnam, patients with HFrEF were allocated to either telemedicine or control groups. Participants in the experimental arm underwent a home-based telemedicine program with regular telephone follow-ups and consultations. Participants in the control group received usual care. Both groups were followed for 6 months. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score from baseline. The analysis was conducted on an intention-to-treat basis. Results: A total of 223 participants were randomized into two groups-the telemedicine group and the usual care group. Of the 223, 170 patients [mean age: 61.5 ± 15.0 years; female: 122 (71.8%)] completed follow-up and were included in the final analysis (87 in the telemedicine group and 83 in the usual care group). At baseline, the MLHFQ scores were equivalent between the two groups (median [interquartile range]: 81 [73-92] vs. 81 [74-92]; p = 0.992). After 6-month follow-up, the telemedicine group showed greater improvement in MLHFQ total scores than the usual care group (mean change in MLHFQ score: -15.5 ± 14.0 vs. -1.3 ± 6.2; difference in change: -14.2 [95% confidence interval, CI: -17.5, -11.0]; p < 0.0001). Similar results were found for the MLHFQ physical dimension score (difference in change: -5.8 [95% CI: -7.4, -4.1]; p < 0.0001) and the MLHFQ emotional dimension score (difference in change: -3.2 [95% CI: -4.2, -2.2]; p < 0.0001). Conclusions: In this study, a telemedicine intervention significantly improved QoL compared with usual care among patients with HFrEF in an LMIC.

背景:远程医疗是在家监测患者和改善心力衰竭(HF)预后的有效方法,尤其是射血分数降低的心力衰竭(HFrEF)。然而,人们对远程医疗对中低收入国家(LMICs)门诊心衰患者生活质量(QoL)的影响知之甚少。方法:在越南北部进行的这项单中心、前瞻性、随机对照、开放式和平行组临床试验中,HFrEF 患者被分配到远程医疗组或对照组。实验组的参与者接受基于家庭的远程医疗项目,并定期接受电话随访和咨询。对照组的参与者接受常规护理。两组患者均接受了 6 个月的随访。主要结果是明尼苏达心衰患者生活问卷(MLHFQ)得分与基线相比的变化。分析以意向治疗为基础进行。结果共有 223 名参与者被随机分为两组--远程医疗组和常规护理组。在这 223 名患者中,有 170 名患者[平均年龄:61.5 ± 15.0 岁;女性:122 名(71.8%)]完成了随访并被纳入最终分析(远程医疗组 87 名,常规护理组 83 名)。基线时,两组的 MLHFQ 分数相当(中位数[四分位数间距]:81 [73-92] vs. 81 [74-92]; p = 0.992)。随访 6 个月后,远程医疗组的 MLHFQ 总分改善幅度大于常规护理组(MLHFQ 平均得分变化:-15.5 ± 14.0 vs. -1.3 ± 6.2;变化差异:-14.2 [95% 置信区间,CI:-17.5, -11.0];p < 0.0001)。MLHFQ身体维度评分(变化差异:-5.8 [95% 置信区间:-7.4,-4.1];p < 0.0001)和MLHFQ情绪维度评分(变化差异:-3.2 [95% 置信区间:-4.2,-2.2];p < 0.0001)也有类似结果。结论在这项研究中,与常规护理相比,远程医疗干预极大地改善了低收入国家高频心衰患者的 QoL。
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引用次数: 0
Acceptability of Forensic Sexual Assault Telehealth Consultation. 法医性侵犯远程医疗咨询的可接受性。
IF 2.8 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-22 DOI: 10.1089/tmj.2024.0461
Sheridan Miyamoto, Jennifer Delwiche, Manvita Mareboina, Yoon S Hur, Elizabeth Greninger

Introduction: Telehealth shows promise in increasing access to specialty care for individuals who experience sexual assault. Methods: This study analyzed 466 cases from rural and urban hospitals between September 2018 and March 2024, examining telehealth acceptability rates and reasons for declination. Of 362 eligible cases, 89.5% accepted telehealth consultation. Among those who declined, 65.8% were not given the opportunity to interact with a telehealth sexual assault nurse examiner (teleSANE) during decision-making. Results: These findings indicate high acceptability of forensic sexual assault telehealth and suggest that providing patients the opportunity to interact with teleSANEs before deciding may further increase acceptance. Conclusion: The study contributes to understanding telehealth's viability for sexual assault care across diverse settings and demographics, supporting the potential of teleSANE programs to enhance equitable access to specialty care, particularly in underserved areas. This research addresses gaps in existing literature by exploring acceptability in a wide range of settings, demographics, and circumstances.

导言:远程医疗有望增加性侵犯患者获得专科护理的机会。方法:本研究分析了 2018 年 9 月至 2024 年 3 月期间来自农村和城市医院的 466 个病例,研究了远程医疗的接受率和拒绝原因。在 362 个符合条件的病例中,89.5% 接受了远程医疗咨询。在拒绝者中,65.8%的人在决策过程中没有机会与远程医疗性侵犯护士检查员(teleSANE)互动。结果:这些结果表明法医性侵犯远程医疗的可接受性很高,并表明在做出决定前为患者提供与远程 SANE 互动的机会可能会进一步提高可接受性。结论:这项研究有助于了解远程医疗在不同环境和人口统计中对性侵犯护理的可行性,支持远程 SANE 计划在促进公平获得专科护理方面的潜力,尤其是在服务不足的地区。这项研究通过探讨不同环境、人口和环境下的可接受性,填补了现有文献的空白。
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引用次数: 0
Taking a Step Back or a Step Forward. 退一步还是进一步?
IF 2.8 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-19 DOI: 10.1089/tmj.2024.0560
Charles R Doarn
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引用次数: 0
Tele-Critical Care, Severity of Illness, and 30-Day Mortality Risk: A Retrospective, Cohort Analysis. 远程重症监护、病情严重程度和 30 天死亡风险:一项回顾性队列分析。
IF 2.8 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-19 DOI: 10.1089/tmj.2024.0436
Chiedozie Udeh, Christina M Canfield, Abigail Brown, Jonathan Castro, J Steven Hata

Introduction: Studies have shown that tele-critical care (TCC) improves outcomes in intensive care unit (ICU) settings with low baseline performance. Evidence also suggests that TCC outcomes may be modified by heterogenous baseline severity of illness. We examined the association of admission Acute Physiology and Chronic Health Evaluation IV (APACHE IV) score quartiles (APQ1-APQ4) and TCC exposure with 30-day mortality. Methods: Retrospective, cohort study of 151,780 consecutive ICU patients admitted to nine hospitals within Cleveland Clinic Health System from 2010 to 2019. Data were abstracted from an institutional ICU Datamart and APACHE IV registry. Analyses included summary statistics for demographics, unadjusted survival functions, and incidence rates across ascending APACHE quartiles (APQ1-APQ4). Multivariate Poisson regression modeled covariates associated with incidence rate ratio (IRR) for mortality, across quartiles including statistical interaction between TCC exposure and APACHE quartiles. Results: Unadjusted mortality risk ratios of TCC/no TCC were statistically different across APQ1 (0.83; 95% confidence interval [CI] 0.71-0.97), APQ3 (0.63; 95% CI 0.57-0.69), and APQ4 (0.77; 95% CI 0.74-0.82) (all p < 0.05) but not in APQ2 (0.98; 95% CI 0.88-1.10; p = 0.77). Multivariate Poisson modeling found reduced IRR with TCC (IRR 0.82; 95% CI 0.70-0.97). Relative to APQ1, risk was increased across quartiles, APQ2 (IRR 2.15; 95% CI 1.83-2.52), APQ3 (IRR 3.93; 95% CI 3.39-4.56), and APQ4 (IRR 9.30; 95% CI 8.10-10.67). Interaction with TCC significantly reduced risk in APQ3 (IRR 0.80; 95% CI 0.67-0.96). Conclusion: TCC exposure is associated with reduced 30-day mortality, affected by various clinical factors, to provide heterogenous impact. Mortality benefit appears to particularly accrue among patients with higher, but not the highest quartile for severity of illness, based on their APACHE IV scores.

引言:研究表明,远程重症监护(TCC)可改善重症监护室(ICU)中基线绩效较低的患者的治疗效果。也有证据表明,远程重症监护的效果可能会受到不同基线病情严重程度的影响。我们研究了入院时急性生理学和慢性健康评估 IV (APACHE IV) 评分四分位数(APQ1-APQ4)和 TCC 暴露与 30 天死亡率的关系。方法:回顾性队列研究对克利夫兰诊所医疗系统内九家医院 2010 年至 2019 年连续收治的 151780 名 ICU 患者进行回顾性队列研究。数据摘自机构 ICU Datamart 和 APACHE IV 注册表。分析包括人口统计学、未调整生存函数和APACHE四分位数递增(APQ1-APQ4)发病率的汇总统计。多变量泊松回归模拟了与死亡率发病率比 (IRR) 相关的协变量,包括 TCC 暴露和 APACHE 四分位数之间的统计交互作用。结果未经调整的 TCC/no TCC 死亡率风险比在 APQ1(0.83;95% 置信区间 [CI]0.71-0.97)、APQ3(0.63;95% CI 0.57-0.69)和 APQ4(0.77;95% CI 0.74-0.82)之间存在统计学差异(均 p <0.05),但在 APQ2(0.98;95% CI 0.88-1.10;p = 0.77)之间没有差异。多变量泊松模型发现,TCC 的 IRR 降低(IRR 0.82;95% CI 0.70-0.97)。相对于 APQ1,APQ2(IRR 为 2.15;95% CI 为 1.83-2.52)、APQ3(IRR 为 3.93;95% CI 为 3.39-4.56)和 APQ4(IRR 为 9.30;95% CI 为 8.10-10.67)四分位数的风险均有所增加。与 TCC 的交互作用大大降低了 APQ3 的风险(IRR 0.80;95% CI 0.67-0.96)。结论TCC暴露与30天死亡率的降低有关,受各种临床因素的影响,产生不同的影响。根据 APACHE IV 评分,病情严重程度较高而非最高四分位数的患者似乎更容易从中获益。
{"title":"Tele-Critical Care, Severity of Illness, and 30-Day Mortality Risk: A Retrospective, Cohort Analysis.","authors":"Chiedozie Udeh, Christina M Canfield, Abigail Brown, Jonathan Castro, J Steven Hata","doi":"10.1089/tmj.2024.0436","DOIUrl":"10.1089/tmj.2024.0436","url":null,"abstract":"<p><p><b>Introduction:</b> Studies have shown that tele-critical care (TCC) improves outcomes in intensive care unit (ICU) settings with low baseline performance. Evidence also suggests that TCC outcomes may be modified by heterogenous baseline severity of illness. We examined the association of admission Acute Physiology and Chronic Health Evaluation IV (APACHE IV) score quartiles (APQ1-APQ4) and TCC exposure with 30-day mortality. <b>Methods:</b> Retrospective, cohort study of 151,780 consecutive ICU patients admitted to nine hospitals within Cleveland Clinic Health System from 2010 to 2019. Data were abstracted from an institutional ICU Datamart and APACHE IV registry. Analyses included summary statistics for demographics, unadjusted survival functions, and incidence rates across ascending APACHE quartiles (APQ1-APQ4). Multivariate Poisson regression modeled covariates associated with incidence rate ratio (IRR) for mortality, across quartiles including statistical interaction between TCC exposure and APACHE quartiles. <b>Results:</b> Unadjusted mortality risk ratios of TCC/no TCC were statistically different across APQ1 (0.83; 95% confidence interval [CI] 0.71-0.97), APQ3 (0.63; 95% CI 0.57-0.69), and APQ4 (0.77; 95% CI 0.74-0.82) (all <i>p</i> < 0.05) but not in APQ2 (0.98; 95% CI 0.88-1.10; <i>p =</i> 0.77). Multivariate Poisson modeling found reduced IRR with TCC (IRR 0.82; 95% CI 0.70-0.97). Relative to APQ1, risk was increased across quartiles, APQ2 (IRR 2.15; 95% CI 1.83-2.52), APQ3 (IRR 3.93; 95% CI 3.39-4.56), and APQ4 (IRR 9.30; 95% CI 8.10-10.67). Interaction with TCC significantly reduced risk in APQ3 (IRR 0.80; 95% CI 0.67-0.96). <b>Conclusion:</b> TCC exposure is associated with reduced 30-day mortality, affected by various clinical factors, to provide heterogenous impact. Mortality benefit appears to particularly accrue among patients with higher, but not the highest quartile for severity of illness, based on their APACHE IV scores.</p>","PeriodicalId":54434,"journal":{"name":"Telemedicine and e-Health","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Effect of Telehealth on Cost of Health Care During the COVID-19 Pandemic: A Systematic Review. 远程医疗对 COVID-19 大流行期间医疗成本的影响:系统回顾。
IF 2.8 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-18 DOI: 10.1089/tmj.2024.0369
Lauren Lavin, Heath Gibbs, J Priyanka Vakkalanka, Sara Ternes, Heather S Healy, Kimberly A S Merchant, Marcia M Ward, Nicholas M Mohr

Background: As the COVID-19 public health emergency (PHE) altered delivery of health care, alternate forms of health care delivery were adopted. The usage of telehealth expanded during the PHE to reduce exposure to COVID-19, which provides the opportunity to understand how expanded telehealth access affected costs of care. The objective of this work was to evaluate the association between telehealth adoption and health care-related costs during the COVID-19 PHE. Methods: We conducted a systematic review by searching PubMed, Embase, Cochrane Central Register of Controlled Trials, and CINAHL from database inception to May 26, 2023. In June 2023, we also searched Telehealth.HHS.gov and the Rural Health Research Gateway. We sought to identify studies across three main search domains: telehealth, COVID-19, and cost. We analyzed costs based on an economic perspective: patient, health care payer, and health care sector. Results: Out of 8,557 studies screened, 12 studies met the inclusion criteria. Studies had high heterogeneity in telehealth modality and cost perspectives. Included studies had, on average, a moderate risk of bias and lacked standardized outcomes that would have aided in across-study comparisons. We found that the COVID-19 PHE was associated with an increase in spending on telehealth services and decreased patient health care costs, which limited changes in monthly total health care spending. Results were variable, however, based on the telehealth application studied. Conclusions: Telehealth may be associated with cost savings from a patient perspective and from a broader health care sector perspective. Future research should focus on the role of integrated telehealth applications and long-term costs using the societal perspective.

背景:COVID-19 公共卫生突发事件(PHE)改变了医疗保健服务的提供方式,因此采用了其他医疗保健服务形式。在公共卫生紧急事件期间,远程医疗的使用范围有所扩大,以减少 COVID-19 的暴露,这为了解远程医疗的扩大使用范围如何影响医疗成本提供了机会。这项工作的目的是评估 COVID-19 PHE 期间远程医疗的采用与医疗相关成本之间的关联。方法:我们通过检索 PubMed、Embase、Cochrane Central Register of Controlled Trials 和 CINAHL 进行了一项系统性综述,检索时间从数据库开始到 2023 年 5 月 26 日。2023 年 6 月,我们还搜索了 Telehealth.HHS.gov 和农村健康研究网关。我们试图确定三个主要搜索领域的研究:远程保健、COVID-19 和成本。我们从经济角度分析了成本:患者、医疗支付方和医疗行业。结果:在筛选出的 8,557 项研究中,有 12 项研究符合纳入标准。研究在远程医疗模式和成本视角方面存在高度异质性。纳入的研究平均存在中度偏倚风险,并且缺乏有助于跨研究比较的标准化结果。我们发现,COVID-19 PHE 与远程医疗服务支出的增加和患者医疗费用的减少有关,这限制了每月医疗总支出的变化。不过,根据所研究的远程医疗应用,结果也不尽相同。结论:从患者角度和更广泛的医疗保健行业角度来看,远程医疗可能与成本节约有关。未来的研究应重点关注综合远程医疗应用的作用以及从社会角度考虑的长期成本。
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引用次数: 0
A Cross-Sectional Survey Exploring the Willingness of Hong Kong People to Use Teleconsultation in Primary Care During the COVID-19 Pandemic. 一项横断面调查,探讨香港市民在 COVID-19 大流行期间在基层医疗中使用远程会诊的意愿。
IF 2.8 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-15 DOI: 10.1089/tmj.2024.0215
Emily Tsui Yee Tse, Carlos King Ho Wong, Diana Dan Wu, Julie Yun Chen, Tai Pong Lam

Objectives: To investigate the willingness of the general Hong Kong population to use teleconsultation in primary care and the factors affecting their decisions and to ascertain the medical problems for which people will consider using teleconsultation in primary care. The study was a cross-sectional territory-wide random population survey on adults recruited through a computer-assisted telephone interview system. Outcome Measures: Outcomes were the proportion of the general Hong Kong population indicating their willingness to use teleconsultation in primary care; the drivers and barriers affecting their willingness; and the medical problems in primary care for which people would consider using teleconsultation. Results: After applying population weighting, 51.6% of the study respondents were found to be willing to use teleconsultation in primary care. The main drivers were possessing the perception that teleconsultation would serve the majority of their health problems (odds ratio [OR] = 3.693, p < 0.001), provision of government subsidy (OR = 3.567, p < 0.001), and ownership of a computer/tablet (OR = 2.116, p < 0.001). A major barrier for people's reluctance to use teleconsultation in primary care was having an education level of primary or below (OR = 0.388, p = 0.002). The majority of people had reasonable expectations on which medical conditions teleconsultation could be helpful but misunderstandings did exist. Conclusion: Our survey estimated that more than half of the general Hong Kong population was willing to use teleconsultation in primary care. Health care service providers and the government should address the drivers and barriers and clarify any misconceptions if teleconsultation is to be further developed in the Hong Kong primary care system.

目的调查香港市民在基层医疗中使用远程会诊的意愿和影响其决定的因素,并确定人们会考虑在基层医疗中使用远程会诊的医疗问题。這項研究是一項全港性的隨機抽樣人口調查,透過電腦輔助電話訪問系統,訪問全港成年人。结果测量:结果为香港一般人口中表示愿意在基层医疗中使用远程会诊的比例;影响其意愿的驱动因素和障碍;以及人们会考虑使用远程会诊的基层医疗中的医疗问题。结果显示经人口加权后,51.6%的受访者愿意在初级保健中使用远程会诊。主要驱动因素包括:认为远程会诊能解决他们的大部分健康问题(几率比[OR] = 3.693,p < 0.001)、政府补贴(OR = 3.567,p < 0.001)和拥有电脑/平板电脑(OR = 2.116,p < 0.001)。小学或以下教育程度是人们不愿在基层医疗中使用远程会诊的主要障碍(OR = 0.388,p = 0.002)。大多数人对远程会诊能帮助治疗哪些病症抱有合理的期望,但也存在误解。结论据我们的调查估计,超过半数的香港市民愿意在基层医疗中使用远程会诊。如果要在香港的基层医疗系统中进一步发展远程会诊,医疗服务提供者和政府应解决驱动因素和障碍,并澄清任何误解。
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引用次数: 0
Telehealth to Address Preventable Maternal Deaths: A Call to Action. 远程保健解决可预防的孕产妇死亡问题:行动呼吁。
IF 2.8 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-14 DOI: 10.1089/tmj.2024.0522
Kelly A Hirko, Ann Heler, Tamara Sampson

Over 80% of maternal deaths are preventable. Telehealth approaches can help address disparities by increasing access to quality maternal health care. In this position statement, we advocate for the utility of telehealth to address maternal mortality disparities, focusing specifically on the postpartum period, where most maternal deaths occur. Specifically, we describe how telehealth visits, mobile health applications, and wearable devices for remote patient monitoring can be used to promote the uptake of postpartum care and adherence to evidence-based treatment for the most common causes of maternal death (i.e., cardiovascular conditions and mental health-related conditions). We discuss challenges that must be overcome to ensure the broad and equitable reach of telehealth and identify specific action steps to address this pressing public health issue.

超过 80% 的孕产妇死亡是可以预防的。远程保健方法可以通过增加获得优质孕产妇保健服务的机会来帮助解决差异问题。在本立场声明中,我们主张利用远程保健来解决孕产妇死亡率差异问题,并特别关注大多数孕产妇死亡发生的产后阶段。具体而言,我们介绍了如何利用远程保健访问、移动健康应用和用于远程患者监测的可穿戴设备来促进产后护理的接受度,以及如何针对最常见的孕产妇死亡原因(即心血管疾病和精神健康相关疾病)坚持循证治疗。我们讨论了必须克服的挑战,以确保远程保健的广泛和公平普及,并确定了解决这一紧迫公共卫生问题的具体行动步骤。
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引用次数: 0
The Promise of Remote Patient Monitoring. 远程病人监护的前景。
IF 2.8 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-13 DOI: 10.1089/tmj.2024.0521
Bree Holtz, Frank A Urban, Jill Oesterle, Roger Blake, Androni Henry

The promise of remote patient monitoring (RPM) lies in its ability to revolutionize health care delivery by enabling continuous, real-time tracking of patient health outside traditional clinical settings. The COVID-19 pandemic accelerated the adoption of RPM, particularly in underserved and rural populations, highlighting both its potential and the persistent barriers that limit its widespread use. This paper explores the critical role of technological advancements-such as wearables, artificial intelligence (AI), and broadband expansion-in sustaining and optimizing RPM in the postpandemic era. We examine Michigan as a microcosm of national health care challenges, focusing on its diverse population and geographic barriers, and propose condition-specific RPM protocols to address these inequities. Key facilitators and barriers to RPM implementation are discussed, with a focus on AI integration, community engagement, and digital infrastructure. We also explore the role of policy reform and public-private partnerships in supporting RPM's scalability and long-term sustainability. Our findings suggest that while RPM offers a powerful tool for improving health care access and outcomes, especially for chronic conditions and rural maternal health, sustained investment in technology and infrastructure is critical. By addressing these challenges, RPM can become a cornerstone of modern health care, reducing disparities and improving care delivery for underserved populations.

远程病人监护(RPM)的前景在于它能够在传统的临床环境之外持续、实时地跟踪病人的健康状况,从而彻底改变医疗服务的提供方式。COVID-19 大流行加速了 RPM 的应用,尤其是在服务不足的人群和农村地区,凸显了 RPM 的潜力以及限制其广泛应用的长期障碍。本文探讨了技术进步(如可穿戴设备、人工智能(AI)和宽带扩展)在后大流行时代维持和优化 RPM 的关键作用。我们将密歇根州作为全国医疗挑战的一个缩影进行研究,重点关注其多样化的人口和地理障碍,并提出了针对特定病症的 RPM 协议,以解决这些不平等问题。我们讨论了实施 RPM 的主要促进因素和障碍,重点关注人工智能整合、社区参与和数字基础设施。我们还探讨了政策改革和公私合作在支持 RPM 的可扩展性和长期可持续性方面的作用。我们的研究结果表明,尽管 RPM 为改善医疗服务的可及性和结果提供了强有力的工具,尤其是在慢性病和农村孕产妇保健方面,但对技术和基础设施的持续投资至关重要。通过应对这些挑战,RPM 可以成为现代医疗保健的基石,缩小差距,改善服务不足人群的医疗服务。
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引用次数: 0
Telehealth Research Strategies in a Post COVID-19 Era: A Roadmap for the Coming Decade. 后 COVID-19 时代的远程医疗研究战略:未来十年路线图》。
IF 2.8 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-11 DOI: 10.1089/tmj.2024.0520
Lorraine R Buis, Christopher McGovern, Charles R Doarn

An Agency for Healthcare Research and Quality-funded Think Tank, held at Michigan State University, brought together a wide range of subject matter experts in telemedicine, telehealth, digital health, digital access, and health care. The authors of this article represented a group focused on the research needs, constructs, and strategies in the post-COVID era. While telemedicine and telehealth grew exponentially during the pandemic, the challenges that have been with us for decades, while ameliorated to some extent, remain. To showcase the State of Michigan as a model, the authors reviewed challenges and opportunities related to telehealth and telemedicine usage and categorized them into seven areas of highest priority. Based on a review of the literature and consultation in the fields of telehealth, telemedicine, and digital access, we identified seven key categories where research would be most effective going forward. These categories include research into the impact of telehealth on clinical services, telehealth's use in administrative activities, education and training for health care providers and patients, telehealth policy implications at state and federal levels, the impact of future technology and innovation on telehealth services, patient characteristics and their experiences, and the ethical aspects of telehealth in the future. We have formulated this overview of our findings to act as a roadmap for future telehealth research. We recommend that ongoing studies should explore each of the seven categories identified above. The search for solutions to overcome the challenges within these topics must not be constrained to research that has been conducted recently; many of these challenges have faced telehealth researchers for decades, and numerous solutions have been proposed over the years. Some of these proposals should be explored once again in light of technological and societal advances. The findings from these studies should be shared in ways and through venues that can make them accessible outside the spheres of academic research, but also by practitioners, policymakers, and patients. Third, research into telehealth in all its incarnations must be prioritized, and leadership is needed to ensure these areas of study are continued to be spotlighted after the noise of the COVID-19 pandemic grows quiet.

由美国医疗保健研究与质量机构资助的智囊团在密歇根州立大学举行,汇聚了远程医疗、远程保健、数字健康、数字访问和医疗保健领域的众多专家。本文作者所代表的团队重点关注后 COVID 时代的研究需求、构建和策略。虽然远程医疗和远程保健在大流行期间得到了飞速发展,但几十年来一直存在的挑战虽然在一定程度上得到了改善,但依然存在。为了将密歇根州作为典范进行展示,作者回顾了与远程医疗和远程医学应用相关的挑战和机遇,并将其归类为七个最优先领域。根据文献综述以及远程医疗、远程医疗和数字访问领域的咨询,我们确定了七个关键类别,在这些类别中,研究将是未来最有效的方法。这些类别包括远程医疗对临床服务的影响、远程医疗在行政活动中的应用、医疗服务提供者和患者的教育和培训、州和联邦层面的远程医疗政策影响、未来技术和创新对远程医疗服务的影响、患者特征及其体验以及未来远程医疗的伦理方面的研究。我们制定了这份研究结果概述,作为未来远程保健研究的路线图。我们建议,正在进行的研究应逐一探讨上述七个类别。为克服这些课题中的挑战而寻找解决方案时,绝不能局限于最近开展的研究;其中许多挑战是远程保健研究人员几十年来一直面临的,多年来已经提出了许多解决方案。其中一些建议应根据技术和社会的进步再次进行探讨。应通过各种方式和途径分享这些研究成果,使学术研究领域之外的从业人员、政策制定者和患者也能获得这些成果。第三,必须优先考虑对各种形式的远程医疗进行研究,并且需要领导力来确保这些研究领域在 COVID-19 大流行平息之后继续受到关注。
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Telemedicine and e-Health
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