Telemedicine and e-Health最新文献

Purpose: This is a retrospective chart review examining factors, which may contribute to timing of receipt of prescription for testosterone or estrogen-based interventions for transgender adolescents and young adults who do not receive such a prescription at their first medical appointment. Methods: A total of 176 patient records were available; of this a minority received a prescription for hormone therapy at first medical appointment. Of the remaining 108 unique individuals, 49 received a prescription at a subsequent medical. Results: Participants seen through virtual health care had a significantly longer time in care prior to receipt of estrogen or testosterone prescription (331 days vs. 220 days, p = 0.046). No other significant relationships were found. Conclusion: Patients who utilize telemedicine services for gender-related health care purposes and who did not receive a prescription for estrogen or testosterone at their initial medical encounter have a longer lead time to receipt of hormone therapy.

Introduction: In order to assess patient experiences of telemedicine, researchers and administrators use the net promoter score (NPS), based on a likelihood to recommend (LTR) question. However, there is reason to doubt validity of this metric for this purpose. We assessed the degree to which the LTR question reflects actual patient preferences about telemedicine. Methods: Using data from a patient experience survey collected in Spring 2020, we compared LTR responses to open comments. Through content analysis, we transformed comments into categorical variables and used those variables in a multiple logistic regression model to predict LTR responses. We also thematically analyzed comments to further elucidate our results. Results: Only about half the comments mentioned telemedicine at all. Around 6% of comments were wholly incongruent with LTR responses. In many comments, ideas about telemedicine were semantically entangled with ideas about providers. Our logistic regression found strong associations between sentiments expressed in comments and LTR responses. However, comments about telemedicine were relatively poor predictors for LTR compared to comments about the provider. Discussion: NPS, which is included on many patient experience surveys used by health systems across the United States, has limitations for use as a measure of the acceptability of telemedicine for patients. Patients have more than telemedicine in mind when responding to the LTR question, and ratings conflate attitudes about providers, office policies, and staff with the telemedicine modality. More direct measures are necessary for meaningful research on the acceptability and usability of telemedicine for patients.

Objective: To explore the potential of gatekeeping for specialized consultations and patient care via remote interactions with family physicians. Methods: This cross-sectional study was conducted at a tertiary hospital between November 2020 and December 2021, when specialized consultations were canceled due to the COVID-19 pandemic. Patients who were evaluated for remote consultation with family physicians were included. Remote consultations were done by a family physician team facilitated through the TelessaúdeRS-UFRGS service. The primary outcome was potential patients eligible for discharge from specialty ambulatory to primary care. Data Sources and Analytic Sample: Data were collected from hospital records. Candidates for remote consult included stable health conditions, indicating the absence of acute or decompensated symptoms as reported in the consult request via the online platform, absence of necessity for any medical procedures or scheduled surgeries, and absence of time-sensitive situations. The prevalence of the outcome was estimated at a corresponding 95% confidence interval. The chi-square test compared the outcome according to COVID-19 mortality waves and specialty groups. Results: At the outset, 2,429 consultations were assessed against the study's eligibility criteria. Among these, 2,160 consultations were included, of whom 776 were candidates for family physician team consultation. Subsequently, the remote family physicians team conducted 557 (23% of the original sample) consultations. Overall, 10% (95% CI: 9-11) had the potential to be discharged from specialty care. Patients' age was linked to discharged likelihood. Prevalence rates varied across specialty groups (highest in surgical patients) and COVID-19 waves (highest in the second wave). Conclusions: This study, conducted within a tertiary hospital's specialty outpatient clinic, highlights the potential of remote consultations with a family physician team in identifying cases suitable for management in primary care settings. Our findings demonstrate that 10% of cases assessed through remote consultations exhibited potential for primary care management.

Introduction: This research examines the characteristics associated with the use of remote consultations in general practice in Ireland during and after the COVID-19 pandemic. Methods: The analysis uses three waves of a nationally representative cross-sectional survey of health in Ireland ("Healthy Ireland" survey), relating to the years 2020/2021, 2021/2022, and 2022/2023. The sample includes people aged 15 and over who reported seeing a general practitioner (GP) in the 4 weeks prior to the survey. The outcome variable ("remote consultation") captures whether a respondent reported that their most recent GP consultation took place via telephone or video ("remote consultation"). Logistic regression analysis was used to assess the relationship between the likelihood of having a remote consultation and a range of potential explanatory variables including age, gender, insurance status, and socioeconomic status. Results: There was a significant decrease in the percentage of respondents reporting remote consultations over the period of analysis, from 39% in 2020/2021 to 10% in 2022/2023. In later periods, being female (odds ratio [OR] = 1.47 [1.04, 2.09]), having private health insurance (OR = 1.76 [1.13, 2.73]), and having a long-term health condition (OR = 1.53 [0.98, 2.39]) were positively associated with the probability of reporting a remote consultation, while being in an older age group (OR = 0.29 [0.13, 0.62]) was negatively associated with the likelihood of a remote consultation. Discussion: The high prevalence of remote consultations during the COVID-19 pandemic was not maintained in the postpandemic period. Policymakers should consider the reasons for this and consider the gendered, age-based, and insurance-based disparities in remote consultation utilization in the development and promotion of digital health care.

Purpose: To evaluate the effectiveness of a patient portal telehealth outreach program to return patients with diabetic retinopathy (DR) lost to follow-up (LTFU) for eye care. Methods: Patients with DR receiving intravitreal injection (IVI) therapy who were >90 days beyond recommended return were deemed LTFU. Outreach messages were sent via a patient portal, when available, or through the U.S. mail. Patients received information on how to schedule a retinal examination and a symptom-screening questionnaire. The adherence rate to scheduled appointments was assessed 90 days postintervention. Labor costs were estimated based on communication time. Results: Among 359 patients with DR receiving IVIs, 22% were LTFU, overdue by a median of 362 days. Receiving fewer IVIs was the factor most strongly associated with becoming LTFU (8.9  ±  9.1 injections vs. 22 ± 20 injections, p < 0.001). The outreach program engaged 39 patients via the patient portal and 28 patients via the U.S. mail. A similar number of patients in each cohort was scheduled (13% vs. 14%, p = 0.862) and completed appointments (10% vs. 14%, p = 0.616). Whereas patient-portal messages took an average of 64 s to send at a labor cost of $0.35/message, each letter sent by mail took approximately 5 min to prepare at a total cost of $2.19. Conclusions: A patient portal-based telehealth outreach program is effective at returning patients with DR to eye care and can be implemented at a lower cost, compared with conventional mailed recall letters. Efforts are needed to increase digital health literacy and access to improve the efficiency of health care delivery.

Introduction: Few studies have explored patient choice of visit modality between in-person, video, and telephone for prenatal care where exams are viewed as core to care and how this choice impacts no-show rate. This study evaluated the association between choice of visit modality and prenatal care visit attendance. Methods: In this observational (July 2020-June 2022) mixed methods study of an urban safety-net obstetrics clinic, we collected sociodemographic traits, telemedicine eligibility (as determined by a clinician), choice of visit modality (in-person, telephone, and video), and visit completion status. Using logistic regression analysis, we evaluated associations between sociodemographic traits, telemedicine eligibility, and visit modality with visit completion among all visits and only telemedicine-eligible visits. We interviewed patients and used thematic analysis to explore reasons for choosing a telemedicine visit and their visit experience. Results: Of 504 participants, there were 1,311 visits and 554 telemedicine-eligible visits. The no-show rate was 11.3% (148/1,311) among all visits and 14.1% (78/554) in telemedicine-eligible visits. Only phone visits were associated with higher odds of no-shows (vs. in-person visits) (adjusted odds ratio [aOR] = 2.34; 95% confidence interval [CI]: 1.10, 4.98) among all visits and telemedicine-eligible visits (aOR = 2.40; 95% CI: 1.09, 5.27). In 20 patient interviews, patients reported choosing telephone visits when the reason for the visit was perceived as less serious or if they had competing obligations. Discussion: Inconsistent with prior literature, we found higher no-show rates for phone visits, potentially because phone visits are chosen by patients who view their visit as lower priority. More research is needed to understand how telemedicine impacts disparities in prenatal care.

Background: Many neonatal intensive care units (NICUs) lack access to subspecialist consultants and may transfer patients requiring subspecialty care to referral facilities or seek informal consultation. The objective of this work was to evaluate the feasibility, acceptability, and impact of extending pediatric subspecialty services from a children's hospital to a level III NICU via teleconsultation and describe processes, facilitators, and challenges. Methods: Monitored consultations for 1 year and surveyed clinicians regarding feasibility, perceived benefits, and challenges. Results: Fifty-nine teleconsultations were conducted. NICU providers indicated improved care quality with subspecialty input. Subspecialists reported advantages of documenting, billing, and providing more complete care, but noted logistical strains. Both parties perceived better interdisciplinary communication. Conclusions: This teleconsultation service was feasible, generally acceptable, improved access to subspecialty services, and improved NICU clinicians' perceived care quality. Challenges included infrastructure development costs, workflow training time, logistics, and subspecialist patient volumes. This is among the first descriptions of a pediatric subspecialty teleconsultation service supporting a NICU.

Objective: This cross-sectional study evaluated whether preferences for attending mental health visits virtually or in-person vary by demographics and identified factors influencing these preferences among federally qualified health center (FQHC) patients. Methods: FQHC patients (N = 350) completed a satisfaction survey of their mental health care experiences in 2022. Demographic data were obtained from the electronic health record. Fisher's Exact tests were used to determine whether modality preferences (phone, video, or in-person) varied across demographic factors. Open-ended comments were qualitatively evaluated using an inductive approach to identify themes related to modality preferences. Results: Modality preferences varied by age and language (p's <0.02) but not race and gender (p's >0.36). Reasons for modality preferences fell within six themes: (1) convenience, (2) connection, (3) transportation/accessibility, (4) health concerns, (5) caretaking responsibilities, and (6) technology. Conclusion: These findings clarify the reasons FQHC patients prefer telemental health care and identify gaps in its usage.

Introduction: Telemedicine can support home-based self-care for liver transplant recipients after discharge from the hospital. This study aimed to (1) provide an overview of the forms of home care for liver transplant patients; (2) identify the content elements of telemedicine in the home care of liver transplant patients; and (3) summarize the effect and outcome indexes of using telemedicine in liver transplantation patients. Methods: A search was performed in the electronic databases of PubMed, CINAHL, Web of Science, Cochrane Library, Embase, Google Scholar, CNKI, Wan Fang data and Wei Pu database through March 1, 2024. Subject heading and keywords were used to reflect the concepts of telemedicine, hepatic transplantation. Studies of tele-home care after transplantation in liver transplant recipients over 18 years of age and the form, content elements, and outcome assessments of telemedicine were included. Results: A total of 16 articles met the inclusion criteria, and from this, the application form of telemedicine in liver transplantation patients, intervention elements and evaluation outcome indexes were identified. The forms of application include internet platform, applications, network communication software, and portable devices; and the elements of intervention include telemonitoring, remote health guidance, telerecordings, teleconsultation, and telerehabilitation; and the outcome indicators include physiological indicators, psychological status, Quality of life, self-management ability, compliance, satisfactory degree, complication rate, readmission rate, and feasibility. Conclusion: Telemedicine is active and feasible in the home-based self-care of patients after liver transplantation, but its application is immature and there are still some problems.

Introduction: Pulmonary rehabilitation (PR) is essential for long-term management of chronic obstructive pulmonary disease (COPD). However, evidence regarding the effectiveness of various PR delivered via telemedicine (tele-pulmonary rehabilitation [tele-PR]) is lacking. This study aims to assess the comparative effects of different tele-PR types on clinical outcomes in patients with COPD. Methods: The following databases were searched: PubMed, EMBASE, CENTRAL, CINAHL, and EBSCO Open Dissertations from inception to May 2023. We included randomized controlled trials, quasi-experimental, and cohort studies investigating the effects of tele-PR on exercise capacity. The Cochrane Effective Practice and Organization of Care Group risk of bias was used to assess the quality of included studies. Data were analyzed using STATA 17.0 with a random-effects model. Tele-PR comparisons were ranked using surface under the cumulative ranking (SUCRA). Results: Seven studies (n = 815) encompassing five tele-PR types were included in the network meta-analysis. Two studies were justified as having a high risk of bias. There were no significant differences among different types of tele-PR and face-to-face PR, in terms of improving the 6-minute walk test. However, the hierarchy estimation suggested that tele-coaching by virtual agents more often than three sessions per week is more likely to be better than other tele-PRs (SUCRA 95.4%). Discussion: While uncertainty persists regarding the optimal tele-PR delivery model, our study suggests that tele-PR was not different from face-to-face PR. However, limited studies and evidence of low-quality underscore the need for well-designed clinical trials to yield more robust comparative evidence.