Telemedicine reports最新文献

Introduction: The Web- and Android-based Telemedicine Platform (WATP) is a digital tool designed to facilitate remote medical consultation and data exchange through mobile devices. It addresses health care gaps in underserved rural regions, such as Ecuador, where access to specialized care is limited. This study validated the platform in the Ecuadorian context, focusing on its use in rural clinical settings and its potential integration into academic and health care institutions as a scalable solution for nationwide implementation.

Materials and methods: A mixed-methods approach was used, including technical, clinical, and educational validation. Technical validation involved 10 general practitioners and five specialists who evaluated task completion times, error rates, and user satisfaction. Clinical validation analyzed three teleconsultations, one pediatric and two dermatological, conducted between October 2022 and December 2023, with a focus on diagnostic precision and case clarity. The educational validation involved 17 final-year medical students, 2 faculty members, and 2 observers in a gynecology course in a simulation center to evaluate its impact on learning outcomes.

Results: Technical validation demonstrated low error rates, high user satisfaction, and average task completion times of 5 min for general practitioners and 3 min for specialists. Clinical validation achieved 100% diagnostic accuracy through cross-validation with five independent specialists. Educational validation showed significant improvements in the students' diagnostic skills and clinical case documentation abilities.

Conclusion: This study highlights the potential of WATP to improve health care access and enhance diagnostic skills among medical students, offering a scalable solution tailored to rural challenges in Ecuador.

Introduction: Increased use of telehealth technology during the COVID-19 pandemic helped reduce the impact of some barriers to health care access (e.g., geographical distance) while amplifying the negative impact of others (e.g., poor internet availability). This quality improvement project evaluated a program established at a specialized hospital for children and adolescents with neurodevelopmental disabilities to improve access of patients and families to technologies necessary for telehealth-based care.

Methods: Our telehealth access and device distribution program utilized Federal Communications Commission funding to distribute 336 iPads and 279 Wi-Fi hotspots to 414 patients recommended for the program by their clinicians. An average of 1.6 years later, participants received a satisfaction survey via text or email.

Results: The referred patient cohort had higher economic disadvantage (average Area Deprivation Index = 7.67) and more language diversity (16% Spanish) compared with hospital averages. About 27% (n = 112) of caregivers completed the satisfaction survey. Most respondents, including 92% of Spanish speakers, reported receiving instructions in their preferred language. Approximately 80% of caregivers stated that the devices enabled telehealth visits. Notably, device abandonment/disuse was considerable, with only 63% of iPads and 36% of Wi-Fi hotspots still in use an average of 1.6 years after device distribution.

Discussion: Program efforts were largely successful in facilitating telehealth access via the dissemination of iPads and Wi-Fi hotspots to a patient subpopulation with economic disadvantage and language differences. Follow-up feedback from participants suggests that additional check-ins and device monitoring may be necessary to prevent device abandonment/disuse and maintain longevity of telehealth access.

Background: Increasing intensivist shortages and demand, coupled with the escalating bed occupancy rate due to increased demand for neonatal intensive care units (NICUs), have created enthusiasm for tele-critical care (TCC) in the form of teleconsultations. Consequently, this study aimed to describe the role of TCC intervention in enhancing NICU capacity to manage discharge, bed occupancy, and neonatal mortality rates.

Methods: This was an uncontrolled, retrospective, interventional descriptive study conducted over 22 months from January 2021 to October 2022 in a public hospital in Najran, Saudi Arabia. We employed the scheduled care model of TCC, in which an intensivist provides daily rounds, overnight calls, and critical care consultations upon request. Real-time outcomes, including mortality, discharge, and bed occupancy rates, were monitored in real-time by the National Healthcare Command Center.

Results: Implementing the TCC program was associated with an overall reduction of 10.7% in the neonatal mortality rate from 10.3 to 9.2 deaths per 1000 live births. The discharge rate increased from 0% in the early months of the TCC application to 34.12% after 4 months of application despite the increased bed occupancy rate. The study revealed no statistically significant difference in mortality rates between the means of pre- and post-TCC (M = 9.74, SD = 4.32), (M = 10.28, SD = 7.99) respectively, p = 0.856 with a 95% confidence interval of -5.58 to 6.66.

Conclusions: TCC in virtual scheduled consultations with a real-time dashboard was proven successful in controlling neonatal mortality and discharge rates. Further studies are required with extended follow-up periods and involving parameters such as the acceptance of physicians, long-term effects beyond the NICU, and the impact of TCC on logistics and resources.

Background: Advancing digital health requires a realistic conversation that moves past innovation and evaluates digital tools the same as any other device being introduced into the health system. There needs to be a focus on return on investment.

Methods: As part of a symposium, we presented hypothetical pitches to an expert panel. The experts include representatives from health systems, payers, and investors. The pitches were related to remote patient monitoring, tele-triage in the emergency department, and comprehensive in-patient telemedicine program including virtual sitting and e-nursing.

Results: Although each pitch led to a different discussion, there was uniform agreement that health systems should focus on whether the proposal helps solve an institutional problem; the payment model in which the product can be used (value-based, fee-for-service, or both) needs to be identified; fitting the new product into preexisting workflow (included electronic health system integration) is critical; there needs to be an understanding of whether patients and providers engage with it; and there needs to be a clear return on investment.

Discussion: Navigating complex decision-making in health care requires a blend of strategic foresight, practical considerations, and a deep understanding of organizational dynamics. Rather than a specific strategic plan focused on digital or virtual care, there should be a focus on the enterprise strategic plan and how can digital enable that.

Background: The emergency department (ED) provides a significant portion of health care services in the United States, and its utilization has increased over the past decade. ED overcrowding remains a considerable challenge to many EDs. The objectives of this study were (1) to evaluate the knowledge of telehealth and readiness to use it among patients who visit EDs in a nonurgent triage category and (2) to estimate their willingness-to-use and willingness-to-pay for telehealth consultations.

Methods: A structured questionnaire was administered using a tablet to adult patients who visited the ED of a large medical center and who were triaged into a nonurgent category. Respondents were asked about their sociodemographic and ED visit characteristics and health and telehealth utilization history. Then, we presented them with a hypothetical scenario for visiting a board-certified ED doctor through telehealth instead of in-person visits, and, using a double-bound dichotomous choice iterative bidding algorithm, we solicited their willingness-to-pay for such a telehealth visit.

Results: A total of 171 patients agreed to participate in the study. More than half of the respondents (n = 107; 62.6%) said they have health insurance. Almost half of the respondents (n = 71; 41.5%) reported the main reason for going to the ED was an ongoing condition or concern. More than two-thirds of the respondents identified themselves as being very proficient with using a smartphone or tablet (n = 116; 67.8%), and only a few (n = 21; 12.3%) reported not having any internet-capable device. Most respondents (n = 148; 86.5%) had never heard about telehealth. However, after a brief description of telehealth, we found that approximately two-thirds of the patients would be willing to use or consider using telehealth (n = 107; 62.6%), and one-third (n = 64; 37.4%) would not be interested. We did not observe any statistically significant differences in willingness-to-use. However, we observed statistically significant differences in the willingness-to-pay $50 by gender (p < 0.01), by currently having a regular doctor/clinic (p < 0.05), and by health insurance status.

Conclusions: Hospitals should consider investigating telehealth services that can be provided to their communities as an option instead of visiting their EDs. While technology does not seem to be a barrier to telehealth, more educational initiatives to inform the public about telehealth are desirable. A targeted advertisement campaign to recommend telehealth for nonlife-threatening ED visits could be developed once more user characteristics are collected.

Background: The use of telemedicine can contribute to patient satisfaction, support hygienic concepts by avoiding physical contact when not required, and reduce waiting and travel time. We aimed to evaluate our recently implemented telemedical approach of remote pre-anesthesia assessment.

Methods: We designed a questionnaire to assess patient satisfaction with remote pre-anesthesia assessment procedures, completeness of understanding, and technical feasibility. In total, 250 patients were asked to voluntarily complete the questionnaire after their pre-anesthesia assessment via telephone. Digital anesthesia records were subsequently reviewed for unexpected events and complications to investigate the quality and safety of the approach.

Results: Patients included in our study were 51 years old (median, range 18-85 years), mostly female (58%) and had an American Society of Anesthesiologists (ASA) physical status of 1-3 (22.8%, 56.4%, and 20.8%, respectively). Patient satisfaction was high with ratings of "very good" or "good" in over 90% of all questions related to the pre-anesthesia assessment via telephone. Patient's evaluation for the use of telemedicine in general also showed a wide acceptance with 84.4% rating the idea as "very good" (55.6%) or "good" (28.8%). Duration of patient-physician interaction positively correlated with age (p = 0.005) and ASA status (p = 0.003). Upon review of the digital anesthesia records, there were no intraoperative complications or unexpected events related to the remote pre-anesthesia assessment.

Conclusion: Remote pre-anesthesia assessment via telephone is safe, technically feasible, and satisfactorily accepted in selected patients. These results encourage the continuing implementation of telemedical approaches for pre-anesthesia assessment.

Background: Inpatient teledermatology (ITD) is a growing telemedicine modality aimed at addressing the shortage of dermatologists in hospitals, particularly for the management of complex skin disorders. Generalized pustular psoriasis (GPP) is a rare and potentially life-threatening condition characterized by widespread sterile pustules and systemic inflammation. Despite advances in targeted therapies, treatment is often limited to traditional agents such as cyclosporine and infliximab, due to restrictions in formulary access and insurance coverage.

Objective: This study aimed to characterize the clinical features, treatment outcomes, and the impact of ITD on the management of hospitalized GPP patients at the University of Pittsburgh Medical Center (UPMC), with a particular focus on hospitalization duration and time to pustule resolution.

Methods: A retrospective analysis of 35 patients with pustular skin disorders between January 2015 and August 2024 was conducted. Nine biopsy-confirmed GPP cases requiring hospitalization were included. Data on demographics, comorbidities, treatment regimens, and outcomes were collected. ITD consultations provided recommendations for corticosteroid tapering and immunosuppressive therapy initiation.

Results: The cohort included nine patients, predominantly White (88.9%), with a median age of 66 years. Preexisting psoriasis and obesity were the most common comorbidities (55.6%). Leukocytosis was the most frequent lab abnormality (77.8%). The average hospitalization duration was 6.1 ± 3.8 days, and readmission occurred in 33.3% of cases. ITD consultations led to early tapering of systemic corticosteroids and initiation of immunosuppressive therapy (55.6% with cyclosporine and 33.3% with infliximab). Significant pustule improvement was achieved in 16.1 ± 7.5 days, with full resolution in 22.5 ± 17.7 days.

Conclusion: ITD significantly reduced hospitalization duration for GPP patients compared with historical controls, likely due to timely therapeutic interventions. While newer biological therapies remain restricted in many hospitals, ITD facilitated the effective use of traditional immunosuppressive therapies, improving patient outcomes. This study supports the integration of ITD in hospital care models, especially in institutions lacking in-house dermatologists. Further research should explore long-term outcomes and the role of ITD in managing other emergent dermatologic conditions.

Background: Around 15% of pregnancies develop complications requiring detailed monitoring. With technological advancements, home cardiotocography has emerged as a potential alternative to the conventional approach, aiming to alleviate the stress and logistical challenges associated with in-clinic care. The objective of this study was to evaluate the capability of a portable device to collect data for accurate interpretation of the examination and to evaluate patient satisfaction, along with physical and emotional comfort during the monitoring process.

Methods: This retrospective study included 32 women with high-risk pregnancies, who independently performed 581 examinations utilizing the portable cardiotocography device Pregnabit Pro (Nestmedic, Poland). Moreover, participants were asked to provide feedback on their experiences through a comprehensive survey.

Results: In total, 95.7% of examinations successfully captured all necessary diagnostic data. Patients reported a high satisfaction rate, recognizing the potential of the home-based approach to improve their overall pregnancy experience. A preference for home-based testing over in-clinic visits was consistently noted among patients.

Discussion: This study shows evidence that home cardiotocography is a feasible and patient-preferred method for monitoring high-risk pregnancies. Our findings underline the importance of technological integration in prenatal care, advocating for a shift toward more patient-centered, accessible, and potentially cost-effective health care solutions.

Background: The introduction of new digital-based services such as telehealth, telemedicine, telepharmacy, and other digital health services is expected to continue to evolve, both for the benefit of science. Increasing pharmacists' roles in pharmaceutical services is critical and strategic in accelerating and recovering public health in the digital era because pharmacists can ensure the availability of appropriate, safe, and effective drugs while also monitoring the rational use of drugs to achieve therapeutic goals.

Objective: This study will look at patient and pharmacist preferences for telepharmacy. This study examines pharmacist preferences for telepharmacy.

Material and methods: This study includes a sample of 457 Indonesian pharmacists. This cross-sectional study was carried out on pharmacists throughout Indonesia in December 2023. The tool utilized was a questionnaire with an online data collection mechanism. The online questionnaire was designed to capture pharmacists' expectations for existing telepharmacy service practices using the inclusion criteria listed below. This study followed the standards of the Declaration of Helsinki, and electronic informed participant consent was acquired. The Medical Ethics Committee of the Faculty of Pharmacy, Universitas Airlangga, approved the study.

Conclusion: According to the study's findings, the vast majority of pharmacists support the extensive and integrated usage of telepharmacy. This is backed by the belief that pharmaceutical services will be a lucrative possibility in the future. Overall, the data show that patients and pharmacists are willing to adopt and incorporate telepharmacy services.

Libraries can play a valuable role in the delivery and support of telehealth services. This article is based on a panel of experts convened for the Virtual Care Symposium 2024, "From Novelty to Sustainability: How to Embed Virtual Care Into the Post-Pandemic Healthcare Delivery Template," to discuss ways to leverage community spaces to expand telehealth access. Strategies for successful implementation and operation are provided along with insights into possible challenges based on real-world examples. Libraries can play a crucial role in bridging the digital divide by providing internet access and digital devices to the public, particularly in rural and underserved communities.