Telemedicine and e-Health最新文献

Objective: Electronic consultations (e-consults) provide a strategic solution to address challenges in health care systems related to cost management and access to care. This study aims to investigate the multilevel patient characteristics associated with higher frequency of receiving e-consults and increased likelihood of completion. Materials and Methods: University of Colorado's electronic medical record were analyzed to study factors influencing referral types (e-consult vs. standard) and their completion rates from April 2018 to September 2023. Multivariate probit regression assessed the impact of patient-level and community-level factors (urban-rural classification, Social Vulnerability Index, and technology accessibility) on e-consult referrals and completion. Results: In 263,882 records, 92.5% were standard referrals, and 7.4% were e-consult referrals. Analysis showed that females were less likely than males (OR = 0.95, 95%CI[0.93, 0.96]), and Blacks were more likely than Whites (OR = 1.03, 95%CI[1.01,1.06]) to receive e-consult referrals. Medicaid patients had lower odds compared to those with Medicare only (OR = 1.04, 95%CI[1.00,1.07]), and rural residency was associated with lower odds (OR = 0.80, 95%CI[0.73,0.88]) of e-consult referral. Factors such as areas with higher population without internet subscription (OR = 1.03, 95%CI[1.01,1.04]) and higher social vulnerabilities (OR = 1.26, 95%CI[1.16,1.37]) increased e-consult odds. Black patients were less likely to have their referrals completed compared to Whites. Patients who resided in regions with limited computer and smartphone access, as well as higher social vulnerabilities, showed decreased odds of referral completion. Discussions and Conclusion: This study highlights the need for partnering with a variety of health care organizations, especially those serving low-income and disadvantaged populations, to enhance health care access equity through the use of e-consults.

Background: Telemedicine offers potential benefits for health care delivery. However, evidence of cross-border telemedicine data exchange within the European Union (EU) remains limited. The objective of this communication provides a brief outline of the regulatory framework, initiatives, and challenges associated with cross-border telemedicine data exchange in the EU, setting the stage for a comprehensive evidence assessment. Methods: We explore the current regulatory landscape (European Health Data Space), existing initiatives (the European Electronic Health Record Exchange Format), and interoperability challenges (e.g., legal, technical, semantic) facing EU cross-border telemedicine data exchange. Results: There is a need for thorough evidence assessment of cross-border telemedicine and related data movements. Conclusion: Understanding the current landscape of cross-border telemedicine is crucial. This article highlights the need for evidence assessment through a formal review to inform future research and policy initiatives in this domain.

Background: Lack of credible sexual partner dialog and support regarding family planning (FP) and other sexual reproductive health issues is a major impediment to contraception service uptake and utilization. This study examined the feasibility and acceptability of attitudes toward using telehealth for remote education of couples through behavioral, motivational, and informational messaging on FP methods and its eventual impact on partner conversations around FP. Methods: The study was conducted in Kampala, Uganda, and involved recruiting 450 men from diverse settings. These men received regular SMS content on FP and sexual and reproductive health for a duration of 6 months. The content aimed to provide information and motivation while serving as a resource for discussions with their spouses. Following the main quantitative study, a qualitative follow-up study was conducted with a subset of 15 randomly selected men. In-depth interviews were conducted with these men to gain deeper insights into their experiences and perspectives. Results: The study revealed positive outcomes where men reported improved knowledge of FP methods such as child spacing, and types of contraception. The messaging prompted discussions with spouses on family size and spousal support. Couples reported a shift toward viewing FP as a joint responsibility, with some couples even taking concrete actions. The findings suggested that telehealth interventions can promote social and behavioral change and can improve couple communication and male involvement in FP decisions in Uganda. Conclusion: The study found that using telehealth messaging to educate men about FP in Uganda successfully improved communication between couples on the topic.

Introduction: The aim of this study was to evaluate the distribution of virtual voice therapy during the coronavirus disease 2019 (COVID-19) lockdown in Italy via the collection of opinions of speech-language pathologists (SLPs). Methods: All SLPs who regularly carried out their professional activity in public hospitals, private hospitals, or private practices in Italy were asked to fill out an online survey consisting of two sections: (1) demographic information (age, gender, work setting, seniority, working time, and regular use of virtual voice therapy) and (2) opinions regarding telerehabilitation (motivation, personal satisfaction, effectiveness, and future needs and uses). Results: A total of 299 SLPs (mean age 39.1 ± 12.4 years) completed the survey. Overall, a regular use of virtual voice therapy was declared by 31.1% (93/299) of SLPs, with the highest prevalence for SLPs working in fully private facilities (46.7%; p < 0.001). Among all respondents, 25.4% had a highly positive opinion on the possible use of virtual voice therapy, even in nonemergency situations, and 55.8% planned to maintain this rehabilitation modality in the future. Discussion: Italian SLPs, regardless of age, had a positive impact with the new telerehabilitation practices. Investments in training and updating SLPs through specific courses would help to break down the strong barriers to telepractice acceptance, such as lack of familiarity with new technologies and lack of adequate preparation. Virtual voice therapy, which had never been experienced in such a way in Italy before the COVID-19 pandemic, promises to be a valuable future addition to the current traditional rehabilitation approaches.

Objective: Patient satisfaction is an imperative factor in integrating telehealth services as a treatment modality in health care systems. Here, we compared patient satisfaction from telehealth versus in-person health care visits in a large heterogeneous population. Methods: We conducted a retrospective cohort study of patients making telehealth or in-person primary care visits between January 2021 and August 2022. Patient satisfaction with both service types was evaluated using a validated survey. Logistic regression models were employed to assess the association between type of visit (in-person/telehealth) and patient satisfaction (satisfied/unsatisfied) while accounting for sociodemographic and clinical characteristics. Results: Of the 247,087 surveys included in the study, 86,580 (35%) were answered following telehealth visits. Telehealth visitors were more satisfied than in-person visitors in aspects related to doctor-patient interactions, such as "courtesy and respect," "attentive listening," and "coherent explanations" (aOR = 1.17, 95% CI: 1.14-1.21; aOR = 1.16, 95% CI: 1.12-1.19; aOR = 1.15, 95% CI: 1.12-1.18, respectively), and less satisfied in aspects related to indirect services, such as adherence to appointment scheduling, effort required on the part of the patient, and staff cooperation (aOR = 0.95, 95% CI: 0.93-0.97; aOR = 0.89, 95% CI: 0.87-0.91; aOR = 0.85, 95% CI: 0.83-0.87, respectively). Importantly, considerably more telehealth visits were delayed (44%) than in-person visits (27%). Adjustment for this factor further strengthened the observed association between telehealth services and patient satisfaction. Conclusions: While telehealth was associated with high levels of satisfaction in doctor-patient interaction, improvements are still needed in indirect services. Addressing issues related to staff cooperation and streamlining processes to reduce delays could improve overall patient satisfaction with telehealth.

Background: Telemedicine offers a promising solution to enhance the delivery and personalization of headache care. Integrating electronic (e-)tools enables the objective monitoring of migraine. Objectives: This study aims to demonstrate the relevance of e-tools for personalized headache care, assess patient and caregiver compliance and satisfaction, and present their use in enhancing care. Methods: Firstly, a systematic review was performed to validate the diagnostic accuracy of e-diaries for diagnosing migraine. Secondly, we collected e-diary data prospectively from diagnosed adult migraine patients at the Leiden Headache Center. Finally, questionnaires were sent to evaluate satisfaction of patients and health care providers with the Leiden e-headache diary and video consultations. Results: In the systematic review, the Leiden Headache Center's e-diary was the only validated tool. Patients (n = 1,009) were followed for a median of 181 days (interquartile range [IQR] 84-240). Compliance was 96.4% (IQR 85.2 - 99.1%), with 10.8% of days missing. Factors positively associated with compliance were older age (p < 0.001), female sex (p < 0.001), higher e-diary grade (p < 0.001), and clinical use (p = 0.04). The e-diary received a median score of 8/10 and was well-liked by patients (n = 535) and providers (n = 23). Video consultations were a good alternative for physical visits according to 76.9% of patients and 84.6% of providers. Conclusion: Validated e-headache diaries and video consultations in telemedicine enhance headache care accessibility, providing convenient care at preferred times and locations.

Introduction: The COVID-19 pandemic crisis brought great challenges on health care systems around the world, forcing many services to slow or temporarily shut down, including medical services in Saudi Arabia (SA). Health care institutions had to adapt new strategies such as virtual clinics to continue delivering care in light of the situation. Virtual clinics and telemedicine are relatively new and limited literature is available regarding patient's experience in SA. Therefore, the aim of this study is to assess and evaluate the levels of patients' satisfaction with the experience of services provided by virtual clinics at the Ministry of National Guard Health Affairs. Method: A retrospective cross-sectional study based on secondary data collected by the corporate patient experience department at MNGHA. The analysis included all virtual clinics' visits from four MNGHA regions (Central, Eastern, Western, and AlMadinah) between April 19 and May 15, 2020. Findings: The results showed that more than half of our study participants were females (57%) (N = 7,803) and (64%) (N = 8,696) were between the age of 21-64 years. Most of the participants were from the Central region (73%) (N = 10,026). More than half of virtual visits were to hospitals (66%) (N = 9,098). Results from the ordinal regression showed that age, gender, region and, survey method were significantly associated with extreme satisfaction score (4.21-5.0). Males were more likely to be extremely satisfied than females (OR = 1.088), and patients between the ages of 6-20 were extremely satisfied compared with the age group 41-64 (OR = 1.309). Eastern region was more likely to be extremely satisfied than central region (OR = 1.121). Patients surveyed by calls were more likely to be extremely satisfied compared with SMS surveys (OR = 1.808), whereas facility type showed no significance. The overall satisfaction score was 4.1 out of 5. Interpretation: According to our findings, the majority of patients were satisfied with the experiences of virtual clinics at MNGHA. Therefore, we recommend exploring more frequent use of virtual clinics when appropriate beyond the pandemic. Virtual clinics can minimize the risk of disease transmission, save travel time, and is considered a cost-effective alternative to traditional clinics.

Introduction: The COVID-19 pandemic accelerated telemedicine adoption, impacting appointment no-show rates. This study examines neurology appointment preferences among individuals with previous no-shows. Methods: We analyzed transitions between in-person and telemedicine modalities at the Tulane Center for Clinical Neurosciences from August 2020 to February 2021 by race, sex, and insurance type. Logistic regression was used to assess which individual characteristics were associated with switching modalities. Results: A total of 118 patients were included. Transitions to telemedicine visits were significantly higher for female (odds ratio [OR] = 1.868, p = 0.051), Medicaid (OR = 0.433, p = 0.035), and Medicare (OR = 0.228, p = 0.001) beneficiaries compared with males and those with private coverage. Telemedicine to in-person transitions were significantly higher for Medicaid compared with private coverage (OR = 8.133, p = 0.018). Discussion: Females are more likely to switch to telemedicine following an in-person no-show, whereas Medicare beneficiaries are less likely. Medicaid beneficiaries are more likely to revert to in-person appointments. Telemedicine may enhance equitable neurological care, particularly because of its high utilization among females.

Introduction: Telehealth is an emerging tool used to improve access to care for patients. However, there is a lack of literature comparing the use of telehealth between patients of different age groups in dermatology. Our study aims to determine whether differences exist in teledermatology usage between elderly and younger dermatology patients. Methods: We conducted a cross-sectional study using the 2020-2021 Medical Expenditure Panel Survey. Our study population included a weighted total of 150,290,604 patients: Of these, 16.35% were young adults (18-44 years old), 26.32% were midlife adults (45-64 years old), and 57.33% were elderly (65+ years old). Results: Our results showed that elderly patients had significantly lower rates of teledermatology use than young adults (odds ratio [OR] = 0.184, (confidence interval [CI]: 0.081-0.421)), p < 0.000) and midlife adults (OR = 0.193, [CI: 0.091-0.406], p < 0.000). Midlife adults had similar rates of telehealth use when compared with young adults (OR = 1.044, [CI: 0.508-2.145], p = 0.907). Our results were adjusted for sex, race, ethnicity, insurance type, education level, income, travel time, and medical comorbidities. Discussion: We found that elderly patients seeking dermatology care are less likely to use telehealth than younger dermatology patients. Our results demonstrate that barriers to telehealth use for the elderly may be more prohibitive than expected. Understanding these differences in teledermatology use is essential for improving teledermatology delivery across all age groups.

Introduction: This systematic review and meta-analysis aimed to investigate adherence and retention rates to home-based video exercise programs and identify key factors associated with these rates in older adults to understand the effectiveness of home-based video exercise interventions. Methods: We searched PubMed, Web of Science, and Scopus for articles addressing adherence to and retention of home-based video exercise programs. The study was conducted following PRISMA recommendations. Results: A total of 26 articles, including 1,292 participants older than 65, were included in the final qualitative and quantitative syntheses. The weighted mean of the retention rate was 91.1, and of the attendance rate was 85.0, with low I² = 3.5, not significant p = 0.409 heterogeneity. The generalized regression models showed a positive effect of session duration on the attendance rate (%), where the possible change from <20 min to >60 min duration could decrease the attendance rate (%) B = -24.390 (p <0.001). The delivery method had a significant effect, where the absence of live contact with the coach in web-based or DVD-delivered interventions could decrease the attendance rate (%) compared to the online sessions B = -11.482 (p = 0.010). The lockdown during the COVID-19 pandemic had a positive effect on both the attendance rate (%) B = 10.321 (p = 0.019) and retention rate (%) B = 9.577 (p = 0.032). Conclusions: This systematic review and meta-analysis indicate that supervised home-based video exercise programs lasting less than 60 min might be a suitable and sustainable exercise mode to keep older adults active, especially in times resembling feelings of confinement.