Telemedicine and e-Health最新文献

Introduction: Telehealth has the potential to improve health care access and reduce disparities. We examined whether the density of medical cannabis (MC) patients, stratified by those who were seen by a telemedicine provider or not, is associated with a concentrated disadvantage within Pennsylvania in 2022. Methods: This zip code-level analysis assessed associations between the concentrated disadvantage index (CDI) and counts of telemedicine-approved and all other MC patients. Total MC patient counts were obtained from Pennsylvania's Department of Health, counts of telemedicine-approved MC patients were obtained from a telehealth provider (Leafwell), and CDI data were obtained from the 2022 American Community Survey. Multivariable negative binomial regression models with population offsets and robust standard errors were used, accounting for spatial autocorrelation through spatial lag adjustments. Results: The CDI was not associated with the number of telemedicine-approved MC patients (incidence rate ratios [IRR] = 0.962; p = 0.355) but was significantly negatively associated with all other MC patients (IRR = 0.904; p = <0.001). The number of in-office MC providers was significantly associated with the count of all other MC patients but not with telemedicine-approved patients. Spatial factors significantly influenced the distribution of both patient groups. Discussion: These findings suggest that telemedicine may play a crucial role in reducing access disparities for MC in socioeconomically disadvantaged areas. The lack of a significant association between CDI and telemedicine-approved MC patients indicates that telehealth services can overcome barriers such as provider scarcity and transportation issues. By facilitating remote consultations and approvals, telemedicine expands access for patients who might otherwise be unable to obtain MC.

Introduction/Methods: Patient Monitoring at Home is a Remote Patient Monitoring (RPM) program through Michigan Medicine, which provides symptoms and vital sign monitoring via a provided cellular tablet and Bluetooth-connected devices. A team of registered nurses monitors patients 7 days per week. Results: The team examined 6-month outcomes for 1,139 encounters from November 2020 to August 2022, which showed a 59% reduction in the average number of hospital admissions 6 months after the start of enrollment (1.38 vs. 0.57, p < 0.0001) across multiple enrollment diagnoses including COVID-19, congestive heart failure, and hypertension. The duration of enrollment varied, ranging from 7 to 386 days, with a median of 38 days. A shorter duration of monitoring was associated with a more favorable outcome (hospitalization reduction). Discussion: Our findings show that RPM is effective in reducing hospital admissions for a wide variety of conditions. More research is needed to optimize patient selection, ideal method, and duration of monitoring.

Background: Implementation of telemental health care in emergency departments (EDs) in the United States (U.S.) has been increasing. Artificial intelligence (AI) can augment traditional qualitative research methods; little is known about its efficiency and accuracy. This study sought to understand ED directors' qualitative recommendations for improving telemental health care implementation and to understand how AI could facilitate analysis of qualitative survey responses. Methods: Directors at a nationally representative sample of 279 U.S. EDs that used telemental health care completed an open-ended survey question about improving telemental health care implementation between June 2022 and October 2023. Two groups of researchers completed independent qualitative coding of responses: one group used traditional qualitative methods, and one group used AI (ChatGPT 4.0) to facilitate analysis. Both groups independently developed a codebook, came to consensus on a combined codebook, and each group independently used it to code the survey responses. The two groups identified themes in ED directors' recommendations and compared codebooks and code application across traditional and AI approaches. Results: Themes included (1) recommendations for improving telemental health care directly and (2) recommendations for improving mental health care systems broadly to make telehealth more effective. ED directors' most common recommendation was enabling faster and more streamlined access to telemental health care. AI augmented human coding by identifying two valid codes not initially identified by human analysts. In codebook application, 75% of responses were coded consistently across AI and human coders. Conclusions and Relevance: For US EDs using telemental health care, there is a need to improve timeliness and efficiency of access to telemental health care.

Purpose: To examine the short- and medium-term effects of pelvic floor muscle training (PFMT) applied via telerehabilitation (TR) on pelvic floor muscle function, pelvic floor symptoms, and quality of life. Methods: Fifty-eight women between the ages of 18 and 35 who were between 6 and 8 weeks postpartum were included. The participants were randomized into the PFMT applied via TR (TR-PFMT) group or the supervised PFMT (S-PFMT) group. The PFMT was performed for 8 weeks, 2 days a week, and 45-50 min a day. The participants' pelvic floor muscle function, pelvic floor symptoms, and quality of life were evaluated with the superficial electromyography, the Pelvic Floor Distress Inventory-20 (PFDI-20), and the Pelvic Floor Impact Questionnaire-7, respectively. Results: Phasic, tonic, and endurance activities of the pelvic floor muscles were significantly higher in both groups immediately after and 8 weeks after the exercise program (all p < 0.05). In addition, total PFDI-20 and all subscales' scores decreased significantly in the TR-PFMT group (all p < 0.05). In the S-PFMT group, total PFDI-20 (p = 0.012) and Urinary Distress Inventory-6 (p = 0.012) scores improved significantly. A significant difference was found between the groups in favor of the TR-PFMT group in terms of total PFDI-20 (p = 0.024; p = 0.024) and Urinary Distress Inventory-6 (p = 0.033; p = 0.040) scores immediately after and 8 weeks after the exercise program. Conclusions: TR-PFMT and S-PFMT improved women's pelvic floor muscle function, pelvic floor symptoms, and quality of life in the short and medium term. Improvement in urinary symptoms was greater after TR-PFMT. TR-PFMT should be considered for postpartum women.

Objective: To compare patient attitudes toward and ability to complete telehealth visits between Spanish- and English-speaking patients in a gynecologic oncology clinic at an urban safety-net hospital. Methods: The data for this study comes from a series of interviews conducted among patients who received gynecologic oncology care at a safety-net hospital in California from August through September 2020 and January through February 2021. Questions were based on the California Consumer Assessment Survey Instrument by the California Health Care Foundation. These were supplemented by categorical questions addressing telehealth access variables and overall patient experience. Results: A total of 117 patients completed the survey in Spanish and 94 in English, most of whom were seen for face-to-face visits. Patient satisfaction was high regardless of visit modality or language. Patients who completed the survey in Spanish were more likely to believe that an in-person visit was better than a phone visit and to think that the provider at an in-person visit listened carefully. Spanish-speaking patients were less likely to be scheduled for a telehealth visit at their next appointment. Access to the tools needed to complete a telehealth visit was generally good among both groups, though Spanish-speaking patients were less likely to be able to install a telehealth app. Conclusions: While surveyed patients reported a high degree of satisfaction as well as the ability and willingness to complete telehealth visits, Spanish-speaking patients may prefer in-person care.

Introduction: This study aims to assess how the adoption of telemedicine by primary care providers influenced new patient referrals to pediatric ophthalmology. Methods: Retrospective chart review of new pediatric ophthalmology referrals from primary care providers within the same 3 months (April, August, and December) each year between 2019 and 2021. Patient demographics, reason for referral, and recommended continued ophthalmical care (as a proxy for referral quality) were evaluated. Logistic regression models, chi-square tests, and Mann-Whitney tests were performed to assess the impact of telemedicine referrals. Results: Of the 1,181 referrals reviewed, 551 were included in the final analysis. Telemedicine use increased over time (p < 0.005). Comparing telemedicine and in-person referrals, there was no difference in patient age, sex, race, language, or insurance type (all p > 0.05). A significant difference was observed between the reasons for referrals by referral type (p < 0.005). The most common reason for telemedicine referrals was ophthalmic manifestations of systemic diseases, while the most common reason for in-person referrals was failed vision screening. Patients with public insurance and those referred after 2020 had higher odds of recommended continued care (adjusted odds ratio [OR]: 1.67, p = 0.01 and 1.98, p = 0.002), though referrals based on telemedicine visits were less likely to require continued ophthalmic care (adjusted OR: 0.33, p = 0.001). Conclusion: Pediatric ophthalmology referrals were influenced by the adoption of telemedicine by primary care providers. Referrals based on telemedicine visits were less likely to warrant continued ophthalmic care, suggesting that the impact of telemedicine on facilitating referrals and improving access to pediatric ophthalmology subspecialty care remains uncertain.

Background: We aimed to assess differences in the impact of the COVID-19 public health emergency (PHE) on urban and rural health care facility (HCF) management of intentional overdoses and self-harm using telemedicine consultation from poison control centers (PCCs). Methods: We utilized a mixed-methods, explanatory study design of poison centers in the United States. The primary exposures were geography (urban vs. rural HCFs) and time (the pre-COVID-19 PHE [January 1, 2018-March 10, 2020] vs. COVID-19 PHE [March 11, 2020-December 31, 2022]). The primary outcomes were patient disposition: admission to critical care unit (CCU); non-CCU; or psychiatric facility. We measured these associations using a multinomial regression, adjusting for demographic and clinical factors. We interviewed PCC staff to gain insight about perspectives of PCC staff in managing intentional overdoses. Results: Of the 1,416,809 intentional overdoses identified, 1,313,704 (93%) were included in our analysis. Compared with urban HCFs in the pre-COVID-19 era, CCU admissions were greater among rural HCFs (adjusted odds ratio [aOR]: 1.12; 95% confidence interval [CI]: 1.10-1.14); however, they were lower in the COVID-19 PHE era within rural (aOR: 0.72; 95% CI: 0.71-0.73) and urban HCFs (aOR: 0.74; 95% CI: 0.73-0.75). Trends were similar in non-CCU and psychiatric admissions. We identified four themes: challenges of admitting overdose cases; changes in calls related to COVID-19 and intentional overdoses; changes in technology, staffing, and operations to adapt to the COVID-19 PHE; and changes in communications for telemedicine. Conclusions: The COVID-19 PHE introduced challenges for urban and rural HCFs in treating mental health and overdoses. PCCs are a vital source of telemedicine support available to both urban and rural clinical providers to ease the existing health care burden.

Introduction: Digital technologies, such as telemedicine and wearable devices, are transforming health care by enhancing cross-sectoral care and targeted health responses. Despite these advancements, challenges such as data protection, lack of interoperability, reimbursement, and financial costs hinder telemedicine's broader implementation, especially within the German health care system. This study explores the use, acceptance, and barriers of telemedicine among cardiologists, internists, and general practitioners in Germany. Methods: A web-based survey was conducted from October 2023 to January 2024, targeting cardiologists, internists, and general practitioners. The survey assessed current telemedicine usage, acceptance, and barriers. Data analysis included descriptive statistics and exploratory cluster analysis. Results: Of the 172 physicians analyzed, 76.2% were cardiologists. Telemonitoring (45.9%) and wearable devices (26.2%) were the most used telemedicine applications, whereas video consultations (11.0%) and apps (19.2%) were less common. Despite high costs (57.7%), insufficient technical expertise (20.8%), and lack of system interoperability (45.8%), respondents rated telemedicine positively and saw several chances and potentials. Cluster analysis identified four user groups: The pioneers, the focused practitioners, the using skeptics, and the uninformed distanced, each with unique needs and challenges. Discussion: The acceptance of elemedicine among physicians indicates recognition of its benefits for patient care. Only half of the respondents felt reasonably well informed about telemedicine. Overall, our study shows the current use of telemedicine as well as the acceptance, barriers, and challenges perceived in the German ambulatory sector. It underlines the increasing importance of telemedicine for patient care and highlights existing barriers to enable wider implementation in the outpatient sector. The results show that telemedicine in Germany is on a promising path. The biggest obstacles still appear to be reimbursement and the technical infrastructure.

Introduction: Rural hospitals continue to close nationally. High fixed costs, low patient volume, and outmigration remain problematic for surviving rural hospitals. This article presents an innovative telemedicine partnership between a small, not-for-profit rural hospital and a tertiary care medical center in the southeast. The vision was to create a sustainable care delivery model where patients receive care at a rural hospital in their home community with the added benefit of clinical expertise from a tertiary care center. Methods: A single-center descriptive case study involving a 32-bed not-for-profit rural community hospital and South Carolina's only comprehensive medical center. This article details the development and implementation of this innovative care delivery model. The strategy and logic model utilized to analyze the program is described. Results: From fiscal year 2019 to 2022, Hampton Regional Medical Center saw an increased number of yearly admissions from 442 to 965. Associated, there was a 20% reduction in inpatient transfers to another facility and a 35% reduction in 30-day readmission, while seeing a more complex patient population as demonstrated by an increase in case-mix index. There was no increase in outmigration. Conclusions: While rural hospitals continue to close nationally, we describe an innovative telemedicine partnership between a small, not-for-profit rural hospital and a tertiary care medical center to build a sustainable care delivery model that can support rural hospital survivability.

Background: This study evaluates the impact of temporary telemedicine implementation on primary care visits, which surged during the COVID-19 pandemic in South Korea. Methods: This study was conducted using national claims data from February 24, 2020 to February 23, 2021. The study included 1,926,300 patients with acute mild respiratory diseases and 1,031,174 patients with acute mild gastrointestinal diseases. The study compared medication prescriptions, follow-up visit patterns, and safety outcomes, including admissions to emergency departments (EDs), general wards (GWs), and intensive care units (ICUs), between telemedicine and in-person visits. Results: Telemedicine was linked to higher medication prescription rates for both respiratory and gastrointestinal conditions, higher levels of antibiotics use, and longer prescription durations. Patients who had an initial telemedicine consultation were more likely to have an in-person follow-up visit within 1 day. Conversely, those with an initial in-person visit were more inclined to use telemedicine for their early second visit within 1 day. There were no significant differences in ED or ICU admissions, except for a slight increase in GW admissions for gastrointestinal conditions. Conclusion: Telemedicine can effectively complement in-person care for acute mild conditions without compromising patient safety, suggesting its potential for broader integration into primary care. Further studies are recommended to optimize telemedicine use and address any long-term impacts on health care delivery.