Telemedicine reports最新文献

Introduction: COVID-19 has accelerated the adoption of telemedicine for counseling, follow-up examination, and treatment purposes. The official guidelines in Thailand were launched to regulate or frame the protocols for health care professions and teams in different organizations.

Objectives: To explore the trend of telemedicine utilization in selected hospitals in Thailand and to understand the characteristics of patients who used telemedicine from 2020 to 2023.

Methods: This retrospective secondary data analysis was conducted in four hospitals in Thailand: two tertiary care (T1 and T2) hospitals, one secondary care (SN) hospital, and one specialized (SP) hospital. Data were routinely collected when services were provided and were categorized into telemedicine outpatient department (OPD) visits or onsite OPD visits. The data included demographic information (age, sex), date and year of service, location (province and health region), and primary diagnosis (using International Statistical Classification of Diseases and Related Health Problems 10th Revision codes). Descriptive analysis was conducted using R and STATA software.

Results: All four hospitals reported an increase in telemedicine use from 2020 to 2023. The majority of telemedicine users were female (>65%) at all hospitals except for the SP hospital (44%). Participants aged 25-59 years reported greater utilization of telemedicine than did the other age-groups. The within-hospital comparison between OPD visits before and after telemedicine was significant (p < 0.001).

Conclusion: The situation during the COVID-19 pandemic and the transition to the post-COVID-19 era impacted telemedicine utilization, which could support national monitoring and evaluation policies. However, further studies are needed to explore other aspects, including changes in telemedicine utilization over time for longer timeframes, effectiveness of telemedicine, and consumer satisfaction.

Background: Schedule design may contribute to successful completion of synchronous telehealth visits by video (versus audio-only). Clustering telehealth visits on schedules may minimize workflow inefficiencies.

Methods: We analyzed data from 21 primary care sites in an urban public health care system from March 1 to September 30, 2022. We used linear regression to test for associations between the number of consecutive telehealth visits scheduled per clinicians' half-day sessions (1 to 9+) and the proportion of telehealth visits scheduled and, separately, completed as video (versus audio-only).

Results: For each additional consecutive telehealth visit scheduled, there was a 6.85% [95% confidence interval 4.80 - 8.90%] increase in the absolute percentage of visits scheduled as video visits. For each additional consecutive telehealth visit scheduled, there was a 2.88% [0.59 - 5.18%] increase in the absolute percentage of visits completed as video visits.

Conclusions: Clustered telehealth visits are positively associated with scheduling and completion of telehealth visits by video.

Telehealth has the potential to improve access to health care by mitigating barriers related to geography, time, and finances. However, the increased adoption of ambulatory telehealth has inadvertently widened access gaps for socially disadvantaged and marginalized populations. Quality improvement approaches are a valuable strategy to address health care access inequities and disparities, involving data-driven implementation, assessment, and adaptation of tests of change over time. Because these iterative changes and interventions are data-driven, a critical element of quality improvement requires ongoing data collection and monitoring. This perspective describes the development and validation processes of a telehealth equity dashboard. This dashboard is currently available for use by our health system leaders, providers, and clinic staff. The overall objective of this dashboard is to identify and track inequities and to improve equitable ambulatory telehealth access across diverse patient groups. Lessons learned from creating this dashboard can inform other health care systems of how to develop and validate telehealth data feedback systems to promote quality improvement efforts to advance telehealth equity and accessibility.

Background: There has been an exponential growth in the use of telemedicine services to provide clinical care. However, the safety and effectiveness of telemedicine in cancer-related colostomy care during the early stages of discharge remain unclear. This study aimed to support that the safety and effectiveness of telemedicine in cancer-related colostomy care were not inferior to those of outpatient care.

Methods: This was a prospective randomized noninferiority study. A total of 76 consecutive patients who underwent cancer-related colostomy stoma were enrolled and randomly divided into a telemedicine group or an outpatient group with an equal allocation ratio (1:1). The outpatient group was provided in-person interview mode colostomy care, whereas the telemedicine group was provided video interview mode colostomy care. The stoma-related complications, self-care ability, and quality of life reflected the safety and effectiveness of colostomy care in the early stages of discharge.

Results: The incidence of stoma-related complications within two weeks and one month after discharge was not significantly different between the two groups (p _2-weeks = 0.772 and p _1-month = 0.760). The mean NCI-CTCAE score for stoma-related complications was less than level 2. The ESCA and C-COH-QOL-OQ scores were not significantly different between the telemedicine and outpatient groups at two weeks and one month after discharge (all p > 0.05).

Conclusion: The results revealed that the safety and effectiveness of telemedicine for cancer-related colostomies in the early stages of discharge were not inferior to those of outpatient care alone.

Background: Telemedicine has shown benefits in continuous care during the COVID-19 pandemic. This article discusses its practice in elderly patients with COVID-19, considering its limitations and benefits.

Methods: Patients with COVID-19, aged 60 years or older, were followed up through phone calls three times a week for 10 days at the Telemedicine Section of the Clinical Center of the University of Caxias do Sul (UCS) in the south of Brazil. The outcomes evaluated were referrals to hospital, basic health unit (BHU)/emergency care unit (ECU), and psychology and physiotherapy services; instructions about vaccination, isolation period, tests for COVID-19, taking a specific medication, and measuring oxygen saturation; guidance to family members; and avoiding going to hospitals.

Results: A total of 64 patients were followed up, the mean age was 69.28 years and 15.62% had at least one comorbidity. Among the patients, 7.81% were instructed about the vaccine, 23.43% about post-diagnostic tests, 25% about medication, 62.5% about isolation, 31.35% received guidance on saturation monitoring and 28.12% received guidance for family members, and 3.12% were referred to the hospital and 7.81% to the BHU/ECU (n = 5/64). Physiotherapy and psychology services were indicated for 4.68% of patients each, hospital visits were avoided in 31.25% and 93.75% recommended telemonitoring.

Discussion: In this experience, it is suggested that the telehealth service maximizes patient care and the health care effectiveness for patients with COVID-19. Furthermore, the sample studied showed good adherence and suggested the need for more guidance than face-to-face consultation.

Background: Adults with mental health symptoms stemming from childhood interpersonal trauma require specialized trauma-focused psychological interventions. Limitations in accessing treatment interventions for this population necessitate innovative solutions. This study explored the feasibility of a protocol for a blended e-health psychoeducational treatment intervention for this population called the Trauma PORTAL (Providing Online tRauma Therapy using an Asynchronous Learning platform), combining asynchronous online modules and weekly live virtual group sessions.

Method: From October 2021 to February 2022, this prospective, single-arm study recruited participants who were waitlisted for trauma therapy at an academic hospital. The primary outcome was protocol feasibility, including recruitment, adoption, and intervention acceptability. Secondary outcomes were pre- and post-intervention post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for DSM-5 [PCL-5]), depression/anxiety/stress (Depression and Anxiety Stress Scale [DASS-21]), and emotion regulation (Difficulties in Emotion Regulation Scale [DERS-18]), which were compared using paired t-tests and presented as mean differences (MDs) and 95% confidence intervals (CIs).

Results: A total of 66 participants (median age = 37, female = 61) were enrolled, and they completed on average 53.5% of the online modules. There were 51 (77%) participants who completed post-intervention questionnaires. Acceptability was very high, with 49 respondents (98%) reporting that the intervention increased their access to health care. There were reductions from pre- to post-intervention on the PCL-5 (49.1 vs. 36.7, MD -12.4, 95% CI 8.3-16.5), DERS-18 (51.8 vs. 48.8, MD -3.3, 95% CI 0.2-6.4), and DASS-21 (60.1 vs. 50.7, MD -9.4, 95% CI 2.3-16.6).

Conclusion: The Trauma PORTAL intervention was feasible to implement, well-adopted, and highly acceptable in an ambulatory trauma therapy program. The findings show promising evidence for symptom reduction. Further evaluation of the Trauma PORTAL's efficacy in a randomized trial is warranted.

Objective: The aim of this systematic review is to evaluate the effectiveness of physiotherapy treatment provided remotely via the Internet in the postoperative treatment of orthopedic patients and compare it with standard physiotherapy (face-to-face treatment or home-based treatment) in terms of motor performance, pain symptoms, and functional recovery.

Methods: A systematic search of MEDLINE, Physiotherapy Evidence Database; EMBASE, SCOPUS, and CINHAL was conducted. Two independent reviewers performed study selection, data extraction, risk of bias (ROB) assessment using Cochrane ROB 2 tools, and summarize the results by Grading of Recommendations Assessment, Development, and Evaluation.

Results: Eleven randomized controlled trial were selected. Pooled results showed improvement in motor performance in favor of the telerehabilitation group at 4-6 weeks (standardized mean difference -0.24, 95% confidence interval -0.45, -0.02, p = 0.03), and these differences were close to the minimum clinically important difference for Time Up and Go test. For pain and functional recovery, the results showed differences not statistically important. The certainty of evidence ranged from moderate to very low.

Conclusion: For joint replacement patients, treatment conducted via telerehabilitation appears able to provide levels of motor performance better to that achieved through home-based treatment. In contrast, conclusive evidence that telerehabilitation is comparable to standard face-to-face treatment are not available.

Aims: We compared the efficacy, fidelity, acceptability, and feasibility of a creative movement (CM) intervention for children with autism spectrum disorder (ASD), delivered face-to-face (F2F) or through telehealth (TH).

Methods: Fifteen children with ASD received the CM intervention F2F or through TH. Motor assessments were used to evaluate effects of F2F and TH interventions on children's motor skills, while video coding was used to assess affect, socially directed verbalization, interpersonal synchrony, and motor coordination during training. Stakeholder feedback and training fidelity data on the intervention were also collected.

Results: Children in both subgroups showed similar baseline performance and training-related improvements in motor skills, positive/interested affect, socially directed verbalization, interpersonal synchrony, and dual/multilimb coordination. Parents in the TH subgroup considered the intervention feasible and acceptable; however, they reported greater effort to supervise and redirect their child's attention compared to the F2F subgroup. Trainers for the TH subgroup reported more communication difficulties, technological issues, and longer session lengths, but found greater parental involvement compared to the F2F subgroup.

Conclusions: CM interventions are consistent, acceptable, feasible, and effective in improving social, behavioral-affective, and motor skills of children with ASD, regardless of the method of delivery. Clinicians should make efforts to reduce communication/technological issues and parental burden when delivering CM interventions through TH. ClinicalTrials.Gov Study ID-NCT04258254.

Introduction: Virtual care utilization has increased in recent years bringing questions of how to best inform patients regarding their use. Decision aids (DAs) are tools created to assist patients in making informed decisions about their health care. This study seeks to determine whether a DA or previous experience could better educate and influence patient's preference on virtual care.

Methods: One hundred fifty participants from an orthopedic clinic of a multi-hospital system were divided into three groups. Group 1 (Virtual Care Cohort) had at least one previous virtual care visit and was surveyed with the Telemedicine Satisfaction Questionnaire (TSQ). Group 2 (In-person with Decision Aid) and Group 3 (In-person without Decision Aid) had no virtual care experience. Group 2 received a validated virtual care DA with a knowledge test. Both groups were also administered the TSQ.

Results: After the DA, patients improved their score on 3 of 4 virtual care knowledge questions. Each cohort demonstrated a positive perception of virtual care; however, the specific reasons for their favorable views varied. The DA cohort did not show increased preference toward virtual care compared with the non-DA group and only responded significantly higher regarding encounter comfort. Patients with previous experience in virtual care responded most favorably to the majority of survey questions regarding their virtual care preferences when compared with both virtual care naive cohorts.

Discussion and conclusion: We found that patient experience was the most important factor in influencing patient preference toward virtual care. Although the DA increased their virtual care knowledge it did not increase their preference; therefore, efforts should be placed at encouraging patient to experience virtual care.

Background: Patients with uncontrolled type 2 diabetes mellitus (T2DM) require close follow-up, support, and education to achieve glycemic control, especially during the initiation or intensification of insulin therapy and self-care management. This study aimed to describe and evaluate the impact of implementing a hybrid model of in-person and telemedicine care and education on glycemic control for patients with uncontrolled T2DM (hemoglobin A1c [HbA1c] ≥9%) during the coronavirus disease pandemic.

Methods: This prospective multicenter-cohort pre-/post-intervention study was conducted on patients with uncontrolled T2DM. This study included three chronic illness centers affiliated with the Family and Community Medicine Department at Prince Sultan Military Medical City in Riyadh, Saudi Arabia. A hybrid model of in-person (onsite) and telemedicine care and education was developed. This involved implementing initial in-person care at the physicians' clinic and initial in-person education at the diabetes education clinic, followed by telemedicine services of tele-follow-ups, support, and education for an average 4-month follow-up period.

Results: Of the enrolled 181 patients, more than half of the participants were women (n = 103, 56.9%). The mean age of participants (standard deviation) was 58.64 ± 11.23 years and the mean duration of diabetes mellitus was 13.80 ± 8.55 years. The majority of the patients (n = 144; 79.6%) were on insulin therapy. Overall, in all three centers, the hybrid model had significantly reduced HbA1c from 10.47 ± 1.23% to 7.87 ± 1.59% (mean difference of reduction 2.59% [95% confidence interval (CI) = 2.34-2.85%], p < 0.001). At the level of each center, HbA1c was reduced significantly with mean differences of 3.17% (95% CI = 2.81-3.53%), 2.49% (95% CI = 1.92-3.06%), and 2.16% (95% CI = 1.76-2.57%) at centers A, B, and C, respectively (all p < 0.001).

Conclusion: The findings showed that the hybrid model of in-person and telemedicine care and education effectively managed uncontrolled T2DM. Consequently, the role of telemedicine in diabetes management could be further expanded as part of routine diabetes care in primary settings to achieve better glycemic control and minimize nonessential in-person visits when appropriate.