Telemedicine and e-Health最新文献

During the COVID-19 pandemic, telemedicine and telehealth saw a groundswell of growth, only to be shackled in the aftermath of the Public Health Emergency. A Think Tank, funded by Agency for Healthcare Research and Quality, was held at Michigan State University in August 2024. This paper serves as an introduction to a series of articles focusing on the evolution and future of telehealth in a postpandemic world. It highlights key themes including patient equity, technology, clinical opportunities, research, and education, using Michigan as a model for national adaptation. The paper aims to ignite further discussion and innovation within the telehealth community.

Objective: e-Health or web-based systems in the field of tinnitus have gained increasing interest. Cognitive behavioral therapy (CBT) delivered via the internet is currently witnessing a surge in both attention and offerings. This systematic review analyzed the efficacy and sustainability of internet-based therapies aimed at reducing tinnitus distress and comorbidities such as anxiety, depression, and sleep disorders. The review exclusively considered randomized controlled trials (RCTs) in which trained personnel were actively involved during intervention. Methods: Utilizing search terms such as tinnitus, internet-based therapy, and e-Health therapy, we identified 155 studies, from which 37 RCTs were carefully examined for data availability. Primary outcome measures included treatment effects for tinnitus distress (Tinnitus Questionnaire and other questionnaires) and handicap (Tinnitus Handicap Inventory), while secondary outcomes encompassed depression, anxiety, and sleep problems. Meta-analyses were conducted employing random-effect models. A study effect model was applied, yielding a singular effect size for each sample. The effect sizes were examined for influences of various moderators. Results: We found a statistically significant large effect size for improvement in tinnitus distress (d = 0.83; [confidence interval 0.61-1.06] with total n = 450 for the experimental group and total n = 504 or the controls), while the reduction of tinnitus handicap was smaller (moderate effect size d = 0.59; [0.44-0.73]). Less strong but still significant effects resulted for depression, anxiety, and insomnia. Most of the long-term outcomes remained stable. As moderators, the risk of bias (RoB) and the severity of tinnitus manifestations were identified. Conclusions: Internet-based therapy provides a valuable avenue for initial therapeutic contact, as supporting component in tinnitus treatment if accompanied by therapists. The heterogeneous quality with high drop-out rates or partly high RoB and the wide range of interventions (counseling, eCBT, mindfulness) might be considered as a limiting factor for a first-line management in tinnitus. So far, the use of e-Health is dependent on availability or user preferences.

Background: Cognitive behavioral therapy (CBT)-based mobile apps have been shown to improve CBT-based interventions effectiveness. Despite the proliferation of these apps, user-centered guidelines pertaining to their design remain limited. The study aims to identify design features of CBT-based apps using online app reviews. Methods: We used 4- and 5-star reviews, preprocessed the reviews, and represented the reviews using word-level bigrams. Then, we leveraged latent Dirichlet allocation (LDA) and visualization techniques using python library for interactive topic model visualization to analyze the review and identify design features that contribute to the success and effectiveness of the app. Results: A total of 24,902 reviews were analyzed. LDA optimization resulted in 86 topics that were labeled by two independent researchers, with an interrater Cohen's kappa value of 0.86. The labeling and grouping process resulted in a total of six main design features for effective CBT-based mobile apps, namely, mental health management and support, credibility support, self-understanding and personality insights, therapeutic approaches and tools, beneficial rescue sessions, and personal growth and development. Conclusions: The high-level design features identified in this study could evidently serve as the backbone of successful CBT-based mobile apps for mental health.

Telehealth modalities have given patients options for delivery of care, and in some cases increased access to care. However, great effort needs to be made by providers and clinic staff to ensure patients are given choice in their delivery of care methods and technological support to work toward equity in care. We propose applying the BEACH model for shared decision-making to help providers support patients in choosing the best care delivery method, while also encouraging providers to seek further education on telehealth competencies. Lastly, we stress the importance of the clinical staff in ensuring patient autonomy, education, and support when choosing telehealth modalities of care.

Before the Covid-19 pandemic, human-centered design work in San Francisco found video visits promising for Medicaid-insured pregnant individuals. They were deemed likely better than phone at addressing concerns about remoteness. We describe our experience with introducing video visits within a safety net clinic that had rapidly adopted phone visits as the standard telemedicine option early in the pandemic. By utilizing Kotter's change framework, providing an equity-focused vision, and supporting the implementation with a skilled, on-the-ground project manager, temporary uptake of offering video visits was achieved. However, competing priorities, staffing structure, and institutional culture were barriers to creating sustained change once grant funding ended, even after improvement of digital infrastructure. Efforts to increase video visit uptake in systems where telephone visits are the norm-as is in many safety net systems-may have limited success without leadership-driven prioritization and culture change at all levels.

Objectives: Telemental health via videoconferencing (TMH-V) can overcome many of the barriers to accessing quality mental health care. Toward this end, in 2011, the U.S. Department of Veterans Affairs (VA) established the National Bipolar Disorders TeleHealth (BDTH) Program to provide expert mental health consultation and treatment to Veterans with bipolar spectrum disorders. Methods: Initial analyses of BDTH services suggested that participants had positive changes in quality-of-care indices and clinical outcomes; however, that evaluation was based on a limited sample of both participants and VA medical centers. We were able to confirm and expand upon those early results by using nearly eight times the number of participants and more than twice as many medical centers. Results: For the 2,456 Veterans who completed the intake to our program, there were significant improvements in some of the quality metrics (e.g., lithium use) and a 54% reduction in positive suicide screens (p < 0.05). The Veterans who completed the initial and postprogram assessments (n = 815) reported a 16.6% reduction in manic symptoms (p < 0.001), a 29.3% reduction in depressive symptoms (p < 0.001), and a 21.2% reduction in mood episodes (p < 0.001). Additionally, these Veterans demonstrated significant improvements (p < 0.001) in mental health-related quality of life between the two assessments. Conclusions: These analyses provide further support for the general effectiveness and safety of telemental health via videoconferencing. Future research should examine the generalizability of these findings across various subgroups (e.g., minority patients, patients in rural areas), populations, and health care systems.

Objective: This study aims to determine how obstetrician-gynecologists provided telehealth from January 2020 to December 2022 in the United States, using de-identified commercial insurance data from FAIR Health. It also explores the trends in telehealth provision by physicians' age, gender, and by state policies on telehealth payment parity. Methods: Aggregated, de-identified data derived from medical claims containing 450,588 physician-quarter observations during 2020 to 2022 were analyzed using descriptive methods to examine the total number of telehealth services to pregnant individuals provided, the number of obstetrician-gynecologists that provided telehealth, and the mean number of telehealth services provided per quarter. Results: Obstetrician-gynecologists' telehealth provision increased rapidly after the onset of the COVID-19 pandemic, reaching its peak during the winter 2020 wave (fourth quarter) during which 4,663 obstetrician-gynecologists provided 13,846 telehealth visits. This was followed by a drop in subsequent quarters and during the fourth quarter of 2022, about 9,500 visits were provided by 2,800 obstetrician-gynecologists. Mean number of telehealth visits per physician was higher among older obstetrician-gynecologists and among those that practiced in states that adapted telehealth payment parity policies. Conclusions: Physician sex, age, and the state of practice location impacted their telehealth provision during the COVID-19 pandemic. Future policies aimed at ensuring telehealth access for pregnant people should consider these factors.

Introduction: Loss to follow-up and decreased access to timely care have health consequences that often lead to increased emergency service utilization for benign, treatable, and preventable conditions. As such, significant medical intervention is necessary. Specifically in the District of Columbia (DC), the health of Medicaid beneficiaries of Wards 7 and 8, overwhelmingly underserved communities, necessitates alternative means for more accessible, convenient, and consistent care, which can be achieved by integrating telemedicine services into current care modalities. Methods: Utilizing survey responses from the pre-COVID-19 pandemic, we identified a need for a community-based telemedicine service centered at the Pennsylvania Avenue Baptist Church, designing a threefold project to build knowledge, capacity, and to test feasibility. To build knowledge, we assessed demographics, telemedicine knowledge, current and past telemedicine use, health care utilization, access and improvement issues, telemedicine layperson utilization, and opinions and desire for telemedicine services. Results: A total of 223 responses were gathered from residents residing in Wards 7 and 8 as well as in the neighboring DC communities. An array of data results demonstrates that integrating telemedicine services into community care centers ultimately satisfies identifiable needs in DC's low-income communities for mental health resources, better coordination of care, more convenient and culturally attuned care, and greater health literacy. Discussion: Integrating telemedicine services into community care centers satisfies the need to decrease costs of care and improve the access and quality of care. Effective evaluation strategies and outcome measures that indicate benefits beyond cost savings could provide useful information on how to integrate sustainable telehealth systems in health care delivery models.

Introduction: In 2021, we introduced a program to promote the use of teledermatology among pediatricians. In the present study, we created and validated a satisfaction questionnaire to assess pediatricians' perceptions of teledermatology. We used this questionnaire to evaluate the efficacy of the program. Methods: First, a provisional questionnaire, based on questionnaires available in the literature, was drafted. A group of experts evaluated the clarity, coherence, relevance and sufficiency of the questions, and we calculated a content validity index (CVI). Only questions with a CVI above 0.78 were acceptable. Based on these results and on the experts' comments, we revised the questionnaire and then sent it to a population of pediatricians. We used their responses to validate the revised questionnaire using statistical methods. A Cronbach's alpha above 0.7 indicated adequate internal consistency, and an intraclass correlation coefficient above 0.75 indicated adequate reproducibility. We used the Varimax method to measure construct validity. Results: We clarified and reformulated some questions from the provisional questionnaire based on the experts' comments. All questions had a CVI above 0.78, so no other changes were needed. Although the statistical validation showed suboptimal construct validity, the revised questionnaire had good internal consistency and reliability, and high content validity index. Discussion: The validated questionnaire is a robust tool for assessing pediatricians' satisfaction with teledermatology.

Introduction: This pilot study examined access to telemedicine-related opioid use disorder (OUD) treatment in underserved communities in Houston, Texas before July 30, 2023. Methods: Participants, both patients and providers, were recruited in partnership with local substance use treatment clinics. Both groups shared experiences before and after the waiver era. Rapid qualitative analysis was conducted by the research team. Results: Fourteen qualitative interviews were conducted via Zoom with 5 treatment providers and 9 self-identified Black or Hispanic patient participants. Participants generally approved telemedicine for OUD treatment due to its technological accessibility and flexibility. However, concerns about technology, care quality, relationship building, and privacy were common among both patients and providers. Discussion: Our study highlights the underutilization of telemedicine for OUD treatment in underserved Houston communities. Efforts to address current limitations and leverage recent policy changes can help bridge the utilization gap in underserved areas.