Telemedicine and e-Health最新文献

Background: Studies have reported telehealth benefits, focusing on telehealth performance during the pandemic. However, there is a need to assess the persistence of patients' satisfaction beyond the pandemic. The objective of this work was to evaluate patient satisfaction, acceptance, and utilization of telehealth in the postpandemic years, highlighting significant barriers and potential areas for future studies. Methods: Published studies were identified from PubMed and Scopus databases from January 2022 to January 2024. Predesigned inclusion/exclusion criteria and Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram were applied. Search terms related to "Post-pandemic," "Patient satisfaction," and "Telehealth" were used, and the primary outcomes of interest (patients' perception and satisfaction) were extracted from the articles. Results: A total of 228 articles were obtained from the literature search. After screening, 17 articles were included in the study. Most studies recorded sustained satisfaction and a decrease in utilization early postpandemic. Recurring areas of concern reported by patients were barriers related to patient-physician communication, the ineffectiveness of telehealth due to a lack of physical examination, and the preference for telehealth for less severe conditions. Individuals without prior telehealth experience had the lowest tendency to utilize telehealth. Treatment time, reduced trust in specialist competency, and lack of familiarity with telehealth modality were identified as nonconventional factors influencing telehealth utilization. Conclusion: Telehealth remains an essential form of care delivery in the postpandemic years. This review emphasizes the need for more up-to-date research on patients' telehealth perceptions. The recurring barriers, emerging nonconventional factors, and telehealth optimization for less preferred visit types are areas for future research.

Background: Telemedicine (TM) is a crucial component of modern health care, yet its adoption in nursing remains suboptimal. Effective integration requires structured training, institutional support, and digital infrastructure. Purpose: This study investigates TM utilization among nurses in the United Arab Emirates (UAE), focusing on its integration into practice, the training received, and the resources available to support its implementation. Methods: A cross-sectional survey was conducted among 434 nurses across hospitals and clinics in Dubai Health, UAE. The survey assessed demographic and professional details, TM experience, training availability, infrastructure, and institutional support. Data were analyzed using descriptive statistics and logistic regression. Results: While 70% of nurses reported TM availability, only 27% actively used it. Usage frequency varied, with 18% utilizing TM daily, 8% weekly, and 10% monthly. Adoption was highest in pediatric and geriatric care (50%) and lowest in intensive care units (11%). Remote patient monitoring and health education (47%) were the most common applications, whereas specialty consultations had the lowest use (17%). Logistic regression identified TM availability (OR = 2.1) and prior training (OR = 3.0) as key predictors of utilization (p < 0.001). However, only 14% of participating nurses had received formal TM training, though 90% expressed willingness to participate in future programs. Nurses' demographics, job titles, years of experience, and health sector did not significantly predict TM utilization (p > 0.05). Conclusion: TM has the potential to transform nursing practice, but its integration requires enhanced training programs, infrastructure investment, and institutional support. Addressing these gaps will optimize TM utilization and improve health care delivery.

Background: State professional licensure has been cited as a significant barrier to widespread telehealth adoption, and states have developed strategies to reduce such licensure burdens through policy changes. We aimed to measure the association between state-level medical licensure policies and outpatient telehealth utilization between 2018 and 2022 among Medicare beneficiaries. Methods: We conducted a quasi-experimental study of a 5% sample of age-qualifying Medicare fee-for-service beneficiaries between January 2018 and December 2022. We assessed state-level medical licensure policy for telehealth visits, captured as participation in Interstate Medical Licensure Compact (IMLC) before the COVID-19 public health emergency (PHE) and/or policy relaxation during the COVID-19 PHE. Outcomes included out-of-state telehealth (OOS-TH) and in-state telehealth (IS-TH). We evaluated the association between state-level policies and outcomes through logistic regression, adjusting for patient-level characteristics and month/year of the encounter. Results: We analyzed 141,199,029 outpatient encounters for 1,682,501 Medicare beneficiaries. In the pre-COVID-19 era, IMLC participation was associated with higher OOS-TH (adjusted odds ratio [aOR]: 2.24; 95% confidence interval [CI]: 2.09-2.40) but not IS-TH (aOR: 0.98; 95% CI: 0.96-1.01). In the COVID-19 era, we observed higher IS-TH in IMLC-only states (aOR: 1.09; 95% CI: 1.08-1.10) and states with COVID-19 policy relaxations (aOR: 1.11; 95% CI: 1.10-1.12). We observed lower OOS-TH utilization by IMLC participation (aOR: 0.74; 95% CI: 0.72-0.75) and COVID-19 policy relaxations (aOR: 0.83; 95% CI: 0.81-0.85). Conclusions: Permissive licensure policies were higher telehealth utilization, though we observed mixed effects in telehealth type (IS-TH vs. OOS-TH) and by time (pre-COVID-19 vs. COVID-19). Variability in IS-TH and OOS-TH utilization may indicate that while local policies can improve telehealth access, interstate barriers still exist.

Objective: To establish partnerships with county public health departments to expand telehealth access for referrals to Georgia Memory Net (GMN), a state-funded program focused on improving the early and accurate diagnosis of Alzheimer's disease and other dementias. Method: Funding from the Coronavirus Aid, Relief, and Economic Security Act, and the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act supported GMN partnership development with Georgia Department of Public Health county health departments. Results: Telehealth infrastructure, including remote video neurological assessments and neuropsychological testing, is now available in 10 Georgia county health departments. Expansion efforts are in progress to bring telehealth services to additional counties, broadening GMN reach. Conclusion: Telehealth evaluations delivered through county health departments provide an effective platform for expanding access to specialized dementia diagnosis and treatment, particularly in rural and underserved areas, enhancing early detection and care for patients throughout the state.

Background: Telehealth has long offered promise for improving health care access, but due to restrictive regulations and technology limitations, historic use has been low. Despite telehealth's unprecedented expansion during the COVID-19 pandemic, economic questions remain, raising uncertainty about telehealth's future. Methods: We used an economics lens to conduct a narrative review of the vast medical literature and nascent economic literature on telehealth. We reviewed evidence on demand-side and supply-side forces influencing telehealth adoption and evidence on telehealth's impact on health care use, costs, effectiveness, and equity. Results: Current evidence is sparsely distributed across care types, telehealth modalities (e.g., phone, video, secure messaging), models of telehealth delivery, and pre- and post-pandemic periods. While the literature provides some signals that patients and clinicians are responsive to monetary costs of telehealth, more robust studies are needed, including studies on patient and provider time costs. Telehealth adoption appears to modestly increase outpatient care use, but evidence of its impact on costlier emergency or inpatient care use is needed. There is a lack of studies on monetary costs of telehealth, particularly the impact of telehealth on production costs. Importantly, there is a lack of high-quality studies on the comparative effectiveness of modalities. While there is a growing literature on disparities, studies that address confounders are needed to assess if telehealth can deliver on its promise to improve access for underserved populations. Conclusion: Our review paves the way for a stronger economics literature on telehealth, highlighting areas of future research.

Background: The rapid expansion of telehealth-delivered medication for opioid use disorder (MOUD) during the COVID-19 pandemic highlighted critical digital divide issues in communities. How community context influences the digital divide remains unclear, creating uncertainty about ameliorating the gaps in access to tele-MOUD. Methods: We qualitatively examined the perspectives of 315 opioid community coalition members who were part of the HEALing Communities Study (HCS) to understand how the digital divide created access barriers in urban and rural communities. Primary coding for all interviews used a deductive approach with codes derived from the Reach, Effectiveness, Adoption, Implementation, Maintenance/Practical Robust Implementation and Sustainability Model overarching HCS framework. Secondary coding used the nine determinants of Lythreatis's 2022 digital divide framework, and inductive thematic analysis was used to identify themes with each of the nine determinants. Results: Shared issues across communities related to the digital divide, including trust, social support, technological infrastructure, digital literacy, policy changes, and pandemic-related disruptions, critically influenced telehealth expansion and effectiveness. Rural communities reported specific barriers around infrastructure and socioeconomics, whereas urban communities reported specific barriers around sociodemographic factors. Conclusions: To address these digital divide issues, policymakers should continue to invest in rural infrastructure and improve internet access for underserved populations. Clear guidelines are also needed for when tele-MOUD is appropriate versus in-person visits and when urine drug screening is necessary. Additionally, emphasizing patient choice and maintaining in-person care is important to support equitable access to these services.

Introduction: Disparities in dermatologic care access exist across sociodemographic factors, with racial minorities and uninsured individuals less likely to receive care. Teledermatology expanded during COVID-19, yet national disparities remain understudied. Methods: We conducted a repeated cross-sectional analysis of the 2020-2022 Medical Expenditure Panel Survey, including individuals with at least one dermatology visit. Multivariate logistic regression assessed associations between sociodemographic factors and teledermatology use, with two-part models examining spending. Results: Among 5,280 respondents (representing 68,315,000 patients), visits in 2021 (adjusted odds ratio [aOR] = 2.725, p = 0.003) had higher odds of teledermatology use, as did Black (aOR = 6.467, p < 0.001), Hispanic (aOR = 5.520, p = 0.012), and non-Black, non-White, non-Hispanic race patients (aOR = 3.416, p = 0.002). Patients with a bachelor's degree (aOR = 5.470, p = 0.019) also had increased odds. Medicaid was associated with lower out-of-pocket costs. Discussion: Teledermatology use grew, benefiting racial minorities, but educational barriers persist. Targeted interventions are needed to enhance access.

Objective: Analyze the impact of COVID-19 on outpatient mental health (OP-MH) utilization patterns, particularly telehealth, across eight different MH conditions with a 2-year follow-up. Methods: This population-based cohort study uses a 5% random sample of Medicare beneficiaries aged ≥18 and newly diagnosed with one of the eight MH disorders: psychotic, depressive, bipolar, anxiety, trauma-related, substance-use, other MH disorders, and two or more MH disorders. Monthly OP-MH utilization patterns were compared among patients in 2020-2021 newly diagnosed in 2019 to comparable prepandemic cohorts newly diagnosed in 2017. Multiple logistic regression models were conducted to examine differences in telehealth utilization across MH conditions. Results: Across groups, patients were mostly aged 65-84 (n = 39,749 [72.4%] in 2017 and n = 40,513 [75.5%] in 2019), female (n = 33,387 [60.8%] in 2017 and n = 32,193 [60.0%] in 2019), and White (n = 48,314 [88.0%] in 2017 and n = 47,282 [88.1%] in 2019). Total OP-MH utilization dropped (a 27.5% decrease at its lowest) for all MH conditions at the pandemic's onset compared with the nonexposure group. Although utilization increased postpandemic, slight disruptions remained until the end of 2021. Telehealth visits rose from 0.5% in January 2020 to 55% in April 2020, decreasing to 18% by December 2021. Regression analysis showed that patients with psychotic, bipolar, or trauma-related, and two or more MH disorders had higher odds of telehealth usage compared with those with anxiety, while patients with substance-use disorders had lower odds. Rural residents, older adults (65+), and men had lower odds of using telehealth, with residents of the Northeast and West regions showing higher odds compared with the South. Telehealth disparity profiles were uniquely associated with different MH conditions. Conclusion and Relevance: Findings highlight the need for tailored telehealth strategies among Medicare beneficiaries to address specific demographic and geographical disparities across MH conditions.

Background: The use of virtual care (VC) among individuals with chronic disease is well-documented, yet evidence on quality of care outcomes, such as frequency of subsequent hospitalizations, emergency department (ED) visits, and mortality, is fragmented. This systematic review aimed to synthesize evidence of quality of care outcomes, namely subsequent outpatient encounters, hospital admissions, ED visits, and mortality, associated with VC among outpatients with chronic diseases. Methods: A search strategy was developed and applied to six electronic databases (Embase, MEDLINE, the Cochrane Library, PsycINFO, Web of Science, and CINAHL) for articles published between January 1, 2013 and July 6, 2024. Eligible studies included synchronous VC (e.g., live, video, or audio based) between a patient and health care provider. A narrative synthesis compared VC with in-person care, considering types of outpatient care, specialty, VC components, follow-up duration, and outcomes. Results: After reviewing 5,679 abstracts, 24 articles were included. Studies were predominantly from the United States (n = 11), followed by Australia (n = 3) and Canada (n = 2). The follow-up durations ranged from 2 weeks to 2 years, with 14 studies having follow-up durations of 6 months or less. Studies predominantly reported no difference or lower rates of hospital admissions (n = 18/20), ED visits (n = 11/12), and mortality (n = 12/14) among outpatients who used VC compared with those who had in-person visits. Half of the studies (n = 3/6) reported more subsequent outpatient encounters for patients using VC for the initial outpatient encounter compared with those who had in-person visits. Conclusion: The review indicated that outpatient VC is associated with fewer or no different volume of hospital admissions or ED visits among people with chronic conditions but may be associated with an increased number of outpatient follow-up visits. Robust research at scale that considers the volume of VC consumed and associations with outcomes over longer follow-up periods is required.

Background: Depression represents a major public health burden, especially in low- and middle-income countries (LMICs). Telepsychiatry provides a promising solution by offering remote mental health services, overcoming barriers such as limited resources, isolation, and cost. This study aimed to evaluate the comparative efficacy of different telepsychiatry interventions in LMICs by network meta-analysis of randomized controlled trials (RCTs). Methods: We searched PubMed, EMBASE, CENTRAL, CINAHL, PsycINFO, and ProQuest Dissertations & Theses from inception to May 2024 to identify all relevant studies. Telepsychiatry interventions were categorized as: (1) CBTAppGuided, a cognitive behavioral therapy (CBT) app with professional guidance; (2) CBTChatBot, a CBT app that uses a chatbot for guidance; (3) CBTApp, a CBT app without professional guidance; (4) Reminder; and (5) Consultation. Study quality was assessed according to the Effective Practice and Organization of Care guideline. Depression severity was calculated using summary standardized mean differences with 95% confidence intervals (CIs). Results: Seven RCTs were included with a total of 1,469 adults (mean age range: 16.0-35.64 years). Compared with face-to-face usual care, the most effective telepsychiatry intervention was CBTAppGuided [-23.04, 95% CI: -26.12 to -19.96], followed by CBTChatBot [-5.27, 95% CI: -6.25 to -4.29]. Other interventions, including CBTApp [-0.83, 95% CI: -1.32 to -0.34], Reminder [-0.44, 95% CI: -0.72 to -0.16], and Consultation [-0.27, 95% CI: -0.78 to 0.26], demonstrated smaller effects. CBTAppGuided, CBTChatBot, CBTApp, and Reminder achieved statistically significant improvement, whereas Consultation did not show statistically significant improvement and was not different from face-to-face treatment. Conclusion: Telepsychiatry interventions, particularly CBTAppGuided, show potential for reducing depression severity in LMICs, with promising outcomes for both guided and unguided app-based formats. Further research is needed to confirm their effectiveness in resource-limited settings.