Telemedicine and e-Health最新文献

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.

Background: Telehealth improves access to health care and potentially leads to better clinical outcomes. However, digital competence could be an essential factor in ensuring its adoption, particularly among older adults. This study evaluated the acceptability and perception of a mobile application platform among Thai older patients with chronic diseases according to their demographics and digital skills. Methods: The demographic information and internet usage profiles of patients with nonmalignant chronic diseases, including chronic viral hepatitis, were collected. Participants were grouped based on their self-perceived digital familiarity. The chi-square test was used to evaluate the associations between the parameters. Results: Among 710 participants (61.7% women, mean age: 66.2 years), digital familiarity was significantly higher among individuals aged <70 years, men, those with a bachelor's degree or higher, those with higher incomes, and Bangkok residents (p < 0.001). In this study, regular use of smartphones and the internet, but not messaging applications, was associated with self-perceived digital familiarity. Of these, 100 participants completed a survey evaluating their satisfaction with and perceptions of telehealth. Participants with greater digital familiarity demonstrated significantly higher satisfaction with telemedicine compared with those with limited ability or relied on caretakers (χ² = 70.145, p < 0.001). Conclusion: Our data indicated that a user-friendly mobile application is feasible and acceptable for the management of chronic diseases in older patients. Digital familiarity is an important factor associated with satisfaction with the platform, underscoring the need to bridge digital skill gaps and ensure equitable health care delivery.

Objective: One potential solution to limited health care in rural and remote regions is remote presence robotic tele-presentation to allow health care providers to care for patients in their home community via a robotic interface. We synthesized evidence regarding the use of remote presence robotic tele-presentation in rural and/or remote Canadian health settings. Methods: Medline, PubMed, and Embase were searched up to August 2023. Remote presence robotic tele-presentation refers to any robotic device used for the purpose of presenting and/or collecting patient information. Primary research was included if the patient was located in remote and/or rural Canada, featured remote presence robotic tele-presentation, and assessed patient, family, or clinician satisfaction, patient transport to nearby regional or urban center, health care costs, clinical outcomes, infrastructure outcomes, adverse events, or telementoring. Results: Six studies were included. Patients, nurses, and physicians all reported high levels of satisfaction when using the remote presence robotic tele-presentation. Fifty to sixty-three percent of patients were managed in their home community and did not require transfer to another center. Remote presence robotic sonography resulted in adequate imaging in 81% of first trimester ultrasound limited exams but was less useful for second trimester complete obstetric ultrasounds (20% adequate imaging). Two of eight laparoscopic colorectal surgeries had to be converted to open surgeries. Telerobotic ultrasound clinics resulted in a diagnosis in 70% of cases. Conclusions: Evidence suggests remote presence robotic tele-presentation is a safe and cost-effective approach to providing care in distant communities and can prevent some transfers and evacuations to tertiary hospitals.

Introduction: Early diagnosis of skin cancer is crucial for improving prognosis. Teledermatology (TD) usage can optimize referrals and reduce waiting times. This study aims to evaluate waiting times at the critical referral nodes in teleinterconsultations that raised suspicion of skin malignancy in the Chilean TD platform of the public health care system. Materials and Methods: A cross-sectional observational study that analyzed asynchronous teleinterconsultations and raised suspicion for skin malignancy following the teledermatologist evaluation was uploaded on the Chilean Ministry of Health's TD platform from January 1 to June 30, 2022. Results: Out of 20,522 teleinterconsultations, 1,853 raised suspicion of skin cancer. Among them, 1,119 patients were assessed by in-person examination, while 669 were still on the waiting list. Response times averaged 3.98 days for TD diagnostic suggestions. Overall referral times averaged 75.98 days from initial teleinterconsultation to the final specialist in-person evaluation. Waiting times showed significant differences among health care services and geographic regions. Discussion: In resource-limited settings, TD serves as a valuable tool to optimize referrals and manage the demand for oncologic dermatological consultation. The long waiting times emphasize the need for targeted interventions, especially in regions with longer delays. Conclusion: While TD has shown to be an effective tool in optimizing referrals, waiting times still exceed international recommendations, even in urban centers. The considerable heterogeneity in referral times within health care services and geographic regions highlights the necessity of establishing standardized referral protocols and explicit deadlines to fulfill teleinterconsultations that raise suspicion of skin malignancy in the Chilean public system.

Background: Heart failure (HF) is responsible for a high number of hospitalizations, caused by a progressive worsening quality of life. Telemedicine allows for better management of patients' complex conditions, improving the care released. However, the risk of remaining at a testing stage often limits the integration of remote care in daily pathways for HF patients. The aim of this study is to outline the steps needed to integrate telemedicine activities into ordinary HF clinic practices. This methodology is applied to observe activities and trend improvements over a 12-month routine phase. Method: Three steps have been defined for an efficient introduction of remote care services in ordinary activities, integrating them with traditional in-person care: (i) introduction of temporary telemedicine projects, (ii) systematization of telemedicine pathways, and (iii) evaluation of monitoring phase. Observational data have been collected from structured interviews to show the rate of telemedicine activities achieved in clinical practice over the last year. Results: The methodology has been proposed in the HF clinic of the Italian hospital ASST Bergamo Est. After an initial testing phase, in which usability and user experience have been tested, four different remote activities were added: (i) telemonitoring for patients with an implantable device, (ii) follow-up televisits, (iii) nursing telephone support, and (iv) high-intensity telesurveillance pathways for patients after an HF acute event. During the last year, 218 telemonitoring pathways, 75 televisits, 500 telephone calls, and nine telesurveillance pathways have been performed. Success rates were high, and patients gave positive feedback. Conclusion: By integrating multiple telemedicine activities, it has been possible to better manage complex patients, keep track of disease progression, and improve their participation in care.

Background: Augmented reality enables the wearer to see both their physical environment and virtual objects. Holograms could allow 3D video of providers to be transmitted to distant sites, allowing patients to interact with virtual providers as if they are in the same physical space. Our aim was to determine if Tele-Stroke augmented with Holo-Stroke, compared with Tele-Stroke alone, could improve satisfaction and perception of immersion for the patient. Methods: Kinect cameras positioned at 90-degree intervals around the hub practitioner were used. Cameras streamed real-time optical video to a unity point-cloud program where the data were stitched together in a 360-degree view. The resultant hologram was positioned in 3D space and was visible through the head-mounted display by the patient. Radiology images were shared in Tele-Stroke and via hologram. Likert satisfaction questions were administered. Wilcoxon signed-rank testing was used. Results: Each of the 30 neurology clinic participants scored both Tele-Stroke and Holo-Stroke. Out of these, 29 patients completed the assessments (1 failure owing to computer reboot). Average age was 52 years, with 53.3% of the patients being female, 70.0% being White, and 13.3% being Hispanic. Likert scale score median "Overall" was 32 Tele-Stroke versus 48 Holo-Stroke (p < 0.00001), "Immersion" was 5 versus 10 (p < 0.00001), "Beneficial Technique" was 6 versus 10 (p < 0.00001), and "Ability to See Images" was 5 versus 10 (p < 0.00001). Discussion: Holo-Stroke 3D holographic Tele-Stroke exams resulted in feasibility, satisfaction, and high perception of immersion for the patient. Patients were enthusiastic for the more immersive, personal discussion with their provider and a robust way to experience radiology images. Though further assessments are needed, Holo-Stroke can help the provider "be there, not just see there!"