Telemedicine and e-Health最新文献

Introduction: Elite athletes experience sport-specific stressors and are at risk of developing mental health symptoms during and after their careers. E-Mental health interventions may pioneer a new approach to health care, which could help overcome barriers regarding its accessibility for elite athletes. This study aims to examine the needs and demands regarding the design and content of e-mental health interventions for elite athletes. Methods: A cross-sectional study was conducted via a web-based survey with N = 275 elite athletes, of which 167 were female and who participated in a variety of individual and/or team sports. Previous experience using e-mental health interventions was assessed. Needs and demands regarding format, frequency, content, and topics of an e-mental health intervention were analyzed descriptively and were compared between individual and team athletes using ANOVAs. Results: Elite athletes expressed a preference for an individual program via smartphone app (94.2%) with audio/video material (69.1%) and interactive tasks (60.4%). Regarding the frequency of e-mental health intervention, athletes in individual (62.2%) and team sports (60.0%) both preferred weekly intervention with sessions lasting between 20 and 30 min, whereas athletes engaged in both kinds of sports favored an intervention either on a weekly basis (44.7%) or on request (38.3%). The most relevant topics of e-mental health interventions for elite athletes were "Coping with pressure" (92%) and "Self-worth/self-esteem" (90%). Conclusions: The results of this study highlight the potential relevance of a user-centered design approach and could contribute valuable insights into developing e-mental health interventions for elite athletes.

Background: Atrial fibrillation (AF) burden is strongly associated with an increased risk of stroke, which, in most cases, can be prevented through earlier detection of AF and the timely initiation of anticoagulation therapy. Smartphone devices can provide a simple, non-invasive, cost-effective early AF detection solution. Methods: PubMed, Embase, and Scopus databases were searched for studies comparing smartphone-based photoplethysmography (PPG) with standard electrocardiogram for AF detection. A bivariate random-effects model with a 95% confidence interval (CI) was applied to generate the summary receiver operating characteristic (SROC) curve. Results: Fourteen studies were included, comprising 5,090 patients with an AF prevalence of 31.6%. The pooled sensitivity and specificity were 0.96 (95% CI, 0.93-0.97) and 0.97 (95% CI, 0.95-0.98). The area under the SROC curve was 0.98 (95% CI, 0.94-0.99). The diagnostic odds ratio was 960 (95% CI, 439-2,104), with significant heterogeneity (I² = 51%). The projected positive and negative predictive values were 66.5% and 99.7%, respectively, in the elderly population aged >65 years and 39.2% and 99.9% in the general population. Conclusion: Smartphone-based PPG demonstrated relatively high sensitivity and specificity and appears capable of ruling out AF. Patients aged >65 are more likely to benefit from AF screening.

Background: Unmet social needs may hinder health care providers' ability to deliver suitable care. Telehealth has emerged as a mechanism to broaden care reach; however, limited studies have examined the relationships between telehealth services and social need outcomes. This study explores the impact of telehealth services, encompassing (1) telestroke, (2) telepsychiatry and addiction treatment, (3) teleconsultation and office visits,(4) tele-intensive care units, (5) telemonitoring postdischarge, (6) ongoing chronic care management, and (7) other remote monitoring, on social need performance outcomes. Methods: The 2022 American Hospital Association annual survey and the Area Health Resource Files, which include comprehensive hospital and community indicators, were utilized. A mixed-effects logistic regression was applied, analyzing 1,005 acute care general hospitals. Results: The results revealed that patients who received telemonitoring services after discharge were 1.72 (95% confidence interval [CI]: 1.03-2.88) times more likely to achieve better health outcomes compared with those who did not receive such services. These patients also experienced a significant decrease in the likelihood of requiring additional hospital or system services, with an odds ratio of 2.39 (95% CI: 1.32-4.00). Additionally, patients utilizing telepsychiatry and addiction treatment services had 1.66 times higher odds of reporting improved community health status (95% CI: 1.22-2.27). Lastly, patients who used teleconsultation and office visit services had 38% lower odds of experiencing poor community health status (95% CI: 0.40-0.95). Discussion: The findings highlight the potential of targeted telehealth services to positively impact health outcomes, reduce health care costs, and improve community health status.

Background: In the era of value-based health care, maximizing health outcomes and minimizing costs require different value optimization strategies. To maximize value and ensure control of expenditure, time-driven activity-based costing (TDABC) is widely used in health care organizations. In our study, we examined the impact of telehealth technologies on value creation by using the TDABC approach. Methods: We mapped four pairs of (traditional and telemedicine supported) health care delivery processes in terms of time, resource use, and information flow. Data were collected from four sources: approved protocol descriptions, in-depth interviews with senior clinicians, a financial controlling database of unit costs, and additional comments from controlling experts. Results: We found that technological improvements do not necessarily increase the value of protocols. Of the protocols studied, two telemedicine protocols proved to be more cost-effective (80.37% and 45.29% compared with the originals). However, significant cost overruns were detected in two other telemedicine protocols (902.90% and 161.01%, respectively). An increased value could be detected only when the use of telemedicine technology resulted in greater savings in net human capacity compared with the additional expenditure related to telemedicine technology. Conclusions: We concluded that the use of telemedicine technology leads to modifications in protocols at numerous points, which have a significant impact on cost levels. It is not sufficient to examine only the costs of modified steps, as proposed in the TDABC methodology. Our study also suggests that a refined TDABC method is a potential tool for assessing the complex effects of technological change.

Introduction: The COVID-19 pandemic necessitated swift, dramatic changes to the delivery of essential health care services. Numerous professional societies recommend telehealth care for contraceptive counseling and provision. We conducted a retrospective analysis of service delivery data from Planned Parenthood of Illinois (PPIL), a large reproductive health care provider with 17 health centers in Illinois, to understand if this model preserved access to contraceptive services during the COVID-19 emergency. Methodology: This retrospective analysis compared contraceptive service delivery data 12 months pre-pandemic (March 2019-February 2020) with eight months post-pandemic onset (March 2020-October 2020). PPIL consolidated services to six health centers in late March 2020 and rapidly launched telehealth services in April 2020. Our primary outcome was time to appointment compared with pre- and post-pandemic onset. We also compared access by race/ethnicity, age, and geography. Results: Although visit volume decreased (76% decline) and time to appointment increased post-pandemic onset (2.5-4 days higher), telehealth mitigated these changes and was used by patients across the entire catchment area. We observed no disparities among Black and Hispanic patients relative to White patients in the likelihood of using telehealth relative to in-person visits (odds ratio 0.7, 95% confidence interval 0.6-0.9 for both comparisons). Discussion: Telehealth can play an important role in preserving access to contraceptive services when the health care system is under strain and in increasing accessibility in underserved communities.

Background: Telehealth can provide innovative models of care for people living in congregate care communities (CCC), but lack of consistent workflow is a barrier for administrators and staff. We propose a framework for CCC to implement workflows for age-inclusive telehealth. Methods: As part of an infection control initiative with a focus on telehealth optimization, Virginia Infection Mitigation, Prevention and Control Through Technology developed relationships with administrators and staff of CCC across the Commonwealth of Virginia. Partners in this community of practice completed a statewide survey that we conducted on anticipated and experienced barriers to telehealth implementation. Through survey responses, virtual meetings with organizational leadership, and on-site facility visits, our team assessed the strengths, needs, and goals for telehealth capability. Working with administrative and clinical teams, we developed a consultation report to define short- and long-term implementation steps. Results: We collaborated with a nonprofit organization supporting a community of people with neurodevelopmental disabilities and a rural Program of All-Inclusive Care for the Elderly. We developed a framework for telehealth optimization with four tiers: Initiate, Integrate, Incentivize, and Inspire. Each stage included an overall goal with corresponding interventions to guide program implementation. Discussion: The "Four I" Framework can be used to outline telehealth readiness and implement workflows for CCC. We aim to further develop an iterative process and to collaborate with additional organizations to optimize telehealth programs.

Background: The exponential growth in the use of telehealth during the pandemic underscored the need to quantify how telehealth impacts overall health care costs. While the pandemic inhibited access to in-person care for all Americans, access to care will remain challenging for some populations. Objective: We sought to assess the cost-benefit of telehealth by reviewing a data set of 1.4 million telehealth encounters across the United States performed between February and September 2020. Methods: A retrospective analysis used data from six large health systems and one state Medicaid agency. The economic model considered both direct and indirect costs. Results: Building upon a report published in 2021 by the Centers for Telehealth and eHealth Law, this article presents an analysis of the six states with the highest telehealth encounters within the data set. The study revealed significant cost savings. Telehealth was associated with a reduction in costs ranging from $445,000 to $33 million for Medicare and $155,000-$181 million for Medicaid, except for one metropolitan area. Cost savings were based on the most frequent diagnoses: behavioral health, cancer, heart disease, pulmonary conditions, and endocrine disorders. Limitations: The use of encounter data prohibited the analysis of a patient's longitudinal use of telehealth. Each encounter was treated as a unique observation. While the data set represented telehealth use across the nation, some states were over-represented while others were under-represented, based on available data. Finally, for the six health systems, data was restricted to the regions covered by the health system. As such, in some states, most encounters take place in metropolitan areas. Conclusion: Telehealth can generate significant cost savings, particularly within the Medicaid program, by increasing access to health care452244 services, especially for conditions directly impacted by provider shortages within geographic proximity to the patient.

Objective: This article aims to provide a concise overview of the benefits, challenges, and suggestions pertaining to extreme forms of telesurgery, as documented in existing publications. In the future, medical personnel will have to overcome the challenges of providing health services in extreme settings, such as on the sea, humanitarian assistance missions, battlefields, underwater missions, and space missions. The advancement of telesurgery technology over the past 25 years will gradually resolve this problem. Methods: This study conducted a narrative review and a comprehensive literature search to explore the topics of extreme telesurgery. This article only included real attempts or experiments with telesurgery on humanitarian missions, on sea or hospital ships, underwater, on planes, and in space station settings. It has also summarized the benefits, challenges, and recommendations related to the extreme types of telesurgery and how they could be useful to shape the future of extreme health care. Results: Over the course of the past quarter century, telesurgery has undergone remarkable advancements, which have made it possible to receive effective treatment for even the most critical cases. When providing surgical care in difficult environments such as a battlefield, humanitarian mission, underwater, zero gravity planes, or in space, it is important to have comprehensive medical support for telesurgery in case the initial plan fails. Conclusions: The use of robotic systems in health care can augment human surgeons' skills and provide accurate support for a broad range of surgical operations.

Background: While the coronavirus disease 2019 (COVID-19) pandemic led many countries to relax telemedicine regulations resulting in increased usage, limited research exists on telemedicine utilization patterns throughout the entire pandemic period. Methods: We conducted a retrospective study using the claims data with National Health Insurance in Kanagawa Prefecture, Japan, from April 2014 to March 2023. Using seasonal autoregressive integrated moving average modeling, we compared observed telemedicine usage with predicted values based on pre-COVID-19 data (April 2014-March 2020) and analyzed utilization patterns across different infection waves. Results: Telemedicine usage increased during peak infection periods of each wave following the first wave (April 2020). From the sixth wave onward (January 2022), COVID-19-related consultations accounted for over 50% of telemedicine usage. Subgroup analysis by disease showed that while most conditions had high proportions of patients with COVID-19 comorbidities, mental disorders maintained relatively low proportions. The highest utilization was observed during the seventh wave, significantly exceeding predicted values. Conclusions: Telemedicine usage increased in parallel with infection surges throughout the pandemic period, not just during the initial outbreak. The findings suggest the necessity of improving telemedicine service quality and accessibility during nonpandemic periods in preparation for future emerging infectious disease outbreaks. This study reveals both the critical role of telemedicine during infectious disease outbreaks and the varying utilization patterns across different diseases.