Telemedicine and e-Health最新文献

Introduction: During the COVID-19 pandemic, the University of California, Davis Health (UCDH) system expanded teleophthalmology for diabetic retinopathy (DR) screening through increased sites and personnel, custom workflows, and improved awareness. Here, we report the outcomes of the expansion and investigate disparities during the pandemic lockdown. Methods: We retrospectively reviewed patients who received remote DR screening to compare demographic, socioeconomic, and clinical differences between individuals who underwent screening before, during, and after the COVID-19 lockdown. Results: UCDH increased quarterly teleophthalmology visits from 46.4 ± 13.9 before to 253.8 ± 38.0 visits after the COVID-19 lockdown (p < 0.001), while DR screening rates improved from 51.0 ± 1.5% to 56.9 ± 1.6% over that period (p = 0.03). During the pandemic, we observed greater proportions of unemployed (p < 0.001), higher-income (p < 0.001), geographically nearby (p = 0.001) patients, and fewer individuals with socioeconomic disadvantage as measured by their area deprivation index (p = 0.02). Fewer patients with poorly controlled diabetes (p = 0.014) or hypertension (p = 0.04) also received remote screening during the pandemic, although most of these disparities were no longer detectable after the initial lockdown. Discussion: Teleophthalmology expansion at UCDH during the COVID-19 pandemic led to sustained improvements in DR screening. Although some vulnerable individuals had reduced access to teleophthalmology during the initial lockdown, these disparities were not sustained postpandemic.

Background: The COVID-19 pandemic significantly impacted patients with chronic diseases (CDs), disrupting in-person consultations and health care services. In response, telemedicine was rapidly adopted to maintain continuity of care, especially in tertiary hospitals such as the Clinical Hospital of the Ribeirão Preto Medical School at the University of São Paulo, which became a leader in telemedicine in Brazil. The objective of this study was to describe the hospital's experience with telemedicine for managing CDs during the COVID-19 pandemic and evaluate its impact on hospital admissions and mortality. Methods: We conducted a retrospective cohort study analyzing 614,367 consultations from 2020 to 2021. Consultations were categorized as in-person or telemedicine, and patients with more than four consultations annually were included. Data were retrieved from electronic health records, and outcomes of interest included hospital admissions and mortality within 3 days of consultation. Telemedicine intensity was assessed by the percentage of teleconsultations per patient. Results: Of the 614,367 consultations, 52% met the inclusion criteria, representing 36,033 patients. The percentage of teleconsultations was 36.1%, with higher rates in 2020 (48.0%) compared with 2021 (28.8%). Psychiatry had the highest rate of teleconsultations (53.5%), while oncology had the lowest (11.2%). Patients with teleconsultations had lower hospital admission rates (0.15% for the Charlson Comorbidity Index [CCI] of 0) compared with in-person consultations. Mortality was inversely related to the intensity of telemedicine use, with teleconsultation rates above 16.7% associated with a significant reduction in mortality across all CCI levels. Conclusion: Telemedicine proved to be a crucial tool during the pandemic, restoring access to care and reducing hospital admissions and mortality for patients with CDs. Future studies using artificial intelligence techniques will further explore the impact of telemedicine on chronic disease management across specialties.

Background: The impact of telemedicine on health care costs and utilization has not been comprehensively assessed across diverse health care settings. This scoping review aimed to explore these impacts, focusing on the variations in intervention types. Methods: A literature search followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, covering the last 10 years in PubMed/Medline, Web of Science, and Scopus. The Population, Intervention, Comparison, Outcome framework was employed to define the population (patients), intervention (telemedicine/telehealth), comparator (standard care or pre-telemedicine), and outcomes (health care costs and utilization). Both randomized controlled trials and observational studies were included in the search. The search focused specifically on health care institutions or hospitals as the level of inquiry. Telemedicine interventions were characterized using the TOAST framework's six layers, while the four phases of the health care process (prevention, diagnosis, treatment, and recovery) were incorporated to further contextualize the interventions. Studies were synthesized and presented in tables and figures to provide an organized summary of the findings. Results: From 4,454 articles, 14 met inclusion criteria, with 12 examining costs and seven utilization. Six studies reported significant cost reductions with telemedicine compared with standard care. In utilization, four out of seven studies showed significant improvements. Conclusion: This review indicates that telemedicine may reduce health care costs and enhance resource utilization during the treatment phase compared to traditional in-person visits.

Background: Arthritis, characterized by joint inflammation, pain, and impaired daily activities, has seen a rapid increase globally. Telehealth has emerged as a transformative approach in managing chronic diseases, including arthritis, by overcoming barriers such as geographic limitations and high costs. Objectives: The primary objectives of this study were to conduct a comprehensive bibliometric analysis of telehealth in arthritis pain management over the past two decades, examine publication trends, citation patterns, and keyword co-occurrences related to telehealth strategies in arthritis management, identify key research areas, influential works, and emerging themes within the field. Methods: A comprehensive search was conducted in the Scopus database for articles related to telehealth in arthritis. A systematic screening process, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was adopted. Bibliometric analysis was used for keyword analysis, citation analysis, and research trends. Results: The bibliometric analysis revealed significant trends in telehealth research for arthritis pain management. A sharp increase in publications was observed from 2020 onwards, coinciding with advancements in digital health technologies and the COVID-19 pandemic. Frequently occurring keywords included "telemedicine," "telehealth," "digital health," "m-health," and "telerehabilitation." The top cited articles primarily explored the efficacy of telerehabilitation in managing postsurgical recovery and chronic knee pain. Emerging themes indicated an increased focus on mobile applications, digital health solutions, and patient-centered care. Conclusion: Telehealth has evolved from a novel concept to a mainstream solution in managing arthritis, driven by technological advancements and the necessity for accessible and cost-effective care.

Introduction: Many perinatal services to manage chronic diseases transitioned to telehealth following the onset of the coronavirus disease 2019 (COVID-19) pandemic. This study was conducted to review the literature and summarize the effectiveness of telehealth for diabetes, hypertensive disorders of pregnancy (HDP), mental health (anxiety and depression), and opioid use disorder (OUD) management during the perinatal period postonset of COVID-19. Methods: PubMed, CINAHL, Web of Science, and IEEE Xplore databases were searched for articles published between 2020 and 2023 using keywords (COVID-19) and (maternal, maternity, obstetrics, perinatal, pregnancy) and (telemedicine, telehealth). Inclusion criteria were: intervention or change in practice with clinical results, postonset of COVID-19, English language, and addressed disease management (i.e., diabetes, hypertension, mental health, OUD) during pregnancy or postpartum. Exclusion criteria were: commentary, guideline, protocol, or review articles and perspectives. Results: The review included 24 articles, including 7 randomized controlled trials. Articles evaluated diabetes (N = 9), HDP (N = 4), mental health (N = 10), and OUD (N = 1). One-half (N = 12) were conducted in the United States and telehealth interventions (e.g., app, videoconferencing, audio visits) and clinical effectiveness varied by disease state. Most studies reported at least one positive outcome of telehealth (N = 19, 79.2%); however, some also reported negative outcomes (N = 8, 33.3%). Glycemic control was adequately achieved in most studies (N = 8, 88.9%), and the majority of studies (N = 3, 75%) reported positive or neutral results for the management of HDP. Various telehealth interventions resulted in lower anxiety and depression symptoms. Only one study examined OUD and reported negative outcomes. Conclusions: Telehealth offered effective management of diabetes, hypertension, anxiety, and depression in perinatal women and often improved patient outcomes during COVID-19. Therefore, telehealth should continue to be offered to perinatal women with these chronic conditions as appropriate for individual and clinical situations. More research is needed to evaluate the effectiveness of telehealth interventions for OUD management.

Objectives: To compare the health outcomes, specifically hospitalization and mortality rates, of primary care physicians' referrals to the cardiology department for ambulatory assistance in heart failure (HF) over three clearly defined periods: before, during the electronic consultation program implementation (e-consult), and during the COVID-19 pandemic. Methods: Between 2010 and 2021, 6,859 HF patients were referred at least once. Of these, 4,851 received e-consultations, and 2,008 underwent single-act consultations. A time series regression model was used to analyze the impact of e-consult implementation (started in 2013) on all-cause, cardiovascular (CV), and HF-related hospital admissions and mortality rates. Results: e-Consults reduced the waiting time for cardiology care to 9 days. Hospital admissions decreased significantly after the implementation of e-consult (relative risk incidence [RRi] [95% confidence interval {CI95%}]: 0.867 [0.875-0.838] for HF, 0.838 [0.825-0.856] for cardiovascular disease, and 0.639 [0.635-0.651] for all-cause diseases), and mortality decreased (RRi [CI95%]: 0.981 [0.977-0.983] for HF, 0.977 [0.970-0.980] for CV, and 0.985 [0.984-0.985] for all causes). These improvements persisted during the COVID-19 pandemic. Conclusions: The implementation of the e-consult program for managing HF patient referrals resulted in reduced waiting times for cardiology care and decreases in hospitalizations and mortality rates. These benefits were maintained during the COVID-19 pandemic.

Background: Provider-to-provider emergency department telehealth (tele-ED) has been proposed to improve rural sepsis care. The objective of this study was to measure the association between sepsis documentation and tele-ED use, treatment guideline adherence, and mortality. Methods: This analysis was a multicenter (n = 23) cohort study of sepsis patients treated in rural emergency departments (EDs) that participated in a tele-ED network between August 2016 and June 2019. The primary outcome was whether sepsis was documented explicitly in the clinical note impression in the local ED, and the primary exposure was rural tele-ED use, with secondary outcomes of time to tele-ED use, 3-h guideline adherence, and in-hospital mortality. Results: Data from 1,146 rural sepsis patients were included, 315 (27%) had tele-ED used and 415 (36%) had sepsis recognized in the rural ED. Tele-ED use was not independently associated with sepsis recognition (adjusted odds ratio [aOR]: 1.23, 95% confidence interval [CI]: 0.90-1.67). Sepsis recognition was associated with earlier tele-ED activation (adjusted hazard ratio 1.66, 95% CI: 1.28-2.15) and greater 3-h guideline adherence (aOR 1.37, 95% CI 1.03-1.83) Sepsis recognition was not independently associated with mortality (aOR 1.32, 95% CI 0.97-1.80). Conclusions: Although tele-ED care is a promising strategy to improve sepsis outcomes, its use was limited by under-recognition of sepsis in rural EDs.

Background: Since the COVID-19 pandemic, telehealth has been widely adopted, and several studies have highlighted the benefits of telehealth. However, there are limited studies in pediatric neurology with a focus on epilepsy. The objective of this single-site retrospective cohort study was to examine patient experience scores of telehealth versus in-person established encounters in an outpatient pediatric neurology clinic. Methods: Data were abstracted from April 1, 2020 through March 31, 2024. Variables included demographics, appointment type (telehealth vs in-person), appointment date, primary diagnosis and net promoter score (NPS) number and category. A subanalysis of epilepsy diagnosed patients, and a matched patient analysis were conducted. Results: There were 2,863 in-person visit encounters and 635 telehealth visit encounters. Telehealth encounters had a statistically greater mean NPS of 9.7, compared with in-person visits (9.5). Both telehealth and in-person encounters had more than 90% of promoter scores, indicating a high score of 9-10. During the COVID-19 time period (defined as April 1, 2020 to May 4, 2023), NPS were higher with a mean of 9.7 for telehealth encounters, compared with in-person encounters (9.5). There were no differences in NPS post-COVID-19. Primary encounter diagnoses of Epilepsy/Seizure had a slightly greater mean NPS for telehealth visits (9.7) compared with in-person encounters (9.5). The matched patient analysis revealed no difference between telehealth and in-person encounter NPSs with means of 9.7 and 9.6, respectively. Conclusion: NPS, which are a measure of patient experience, were superior or equal to in-person visits for pediatric neurology telehealth encounters both during the COVID-19 pandemic and in the postpandemic period.

Objective: The Health Resources and Services Administration (HRSA)-funded health centers provide critical behavioral health services to historically and medically underserved individuals with complex health and social needs. As health centers rapidly expanded telehealth in response to COVID-19, the objective of the study was to assess whether telehealth use was associated with utilization and continuity within mental health care received by patients of HRSA-funded health centers. Methods: Cross-sectional analyses, using a nationally representative sample of adult patients with mental health needs from the 2022 Health Center Patient Survey (n = 1,044), explored associations between telehealth use and utilization of mental health services from primary care providers (PCP) and continuity of counseling services. Multivariate logistic regression models accounted for predisposing, enabling, and need factors to assess the influence of telehealth use on utilization and continuity outcomes. Results: After adjusting for patient-level factors, telehealth users with mental health needs had statistically significant and higher odds of receiving mental health services from a PCP at a health center compared with nontelehealth users (adjusted odds ratios [aOR] = 2.60, p < 0.001; 95% confidence interval [CI] [1.50, 4.52]). Telehealth-using patients receiving counseling services had statistically significant and higher odds of receiving all counseling services at a health center compared with nontelehealth users (aOR = 3.65, p < 0.001, 95% CI [2.04, 6.53]). Conclusions: Telehealth facilitates mental health care utilization and continuity for historically and medically underserved patients at health centers and can be an important tool for care management and coordination for patients with mental health needs, particularly during and following public health emergencies.

Background: Maintaining primary care during disasters is crucial for mitigating health impacts. Telehealth can facilitate continuity but is often underutilized. The Veteran's Health Administration (VA) rapidly increased telehealth capacity in 2020, but the impact on disaster telehealth utilization remains unknown. We analyzed the impact of two hurricanes (Hurricane Michael in 2018 and Hurricane Ian in 2022) on telehealth utilization by VA primary care facilities. Design: Interrupted time series analysis of primary care visits to VA facilities in hurricane-affected states for 7 days before and 14 days following each event. Primary care visits were identified from the VA Corporate Data Warehouse. The primary outcome was the proportion of visits conducted virtually after each hurricane. Models included patient demographics, facility rurality, storm severity, and baseline facility telehealth capacity. Results: Seventy-eight VA facilities were evaluated for Hurricane Michael and 126 for Hurricane Ian. After covariate adjustment, Michael was associated with an immediate increase in the proportion of telehealth visits by 8.5 percentage points (95% confidence interval [CI]: 4.3%-12.7%, p < 0.001) and Ian by 12.3 percentage points (95% CI: 8.4%-16.1%, p < 0.001). Analyses by facility rurality demonstrated significant increases in telehealth for urban and rural facilities following Michael in 2018 (urban: 7.1%, 95% CI: 2.7%-11.5%, p < 0.001; rural: 15.1%, 95% CI: 4.5%-25.7%, p < 0.001) but only for urban facilities following Ian in 2022 (13.8%, 95% CI: 9.7%-18.0%, p < 0.001). Increases in telehealth utilization were larger for facilities in severely damaged areas. Conclusions: Telehealth was critical to VA primary care delivery during both hurricanes, with higher utilization seen in 2022 likely from the intervening scale-up of telehealth capacity. Rural facilities may be lagging in disaster telehealth utilization, exacerbating disparities in care delivery.