Telemedicine reports最新文献

Background: Despite ongoing digital and technological developments, incorporation of new developments in outpatient care tends to be slow. Regarding an increasing demand for outpatient care, digitalization of health care carries the potential of a much needed more efficient and patient-oriented system.

Objective: To optimize classic face-to-face outpatient clinic follow-up consultations and evaluate the added value of an upfront digital consult preparation (DCP).

Methods: A cross-sectional observational study was conducted at Rijnstate Hospital (Arnhem, the Netherlands) among all consecutive patients, 18 years or older, who visited the Cardiology (in June 2021) or Neurology (in September 2021) outpatient clinic. All received a DCP survey before their scheduled outpatient clinic appointment, containing three questions regarding their upcoming visit. In addition, the involved health care providers were approached by using a questionnaire to share their experience regarding the DCP. Data concerning the experience of patients and health care providers was anonymous and gathered using Qualtrics.com.

Results: All 25 involved health care providers (12 cardiologists, 13 neurologists) provided feedback. According to the health care providers DCP decreased the workload and improved theirs and patients' preparation. In total, 785 of 1626 (48.3%) patients filled-in the DCP before their appointment within a predetermined period. Only 4% of the patients wanted to change or cancel the consultation. A total of 122 of the 300 (40.1%) patients approached, filled-in a questionnaire to reflect on the DCP. Patients experienced DCP as an improvement of consultation, more time-efficient, increasing patients' and health care providers' preparation, increasing a feeling of acknowledgement and improving co-decision on type of consultation. The DCP did not attribute to co-deciding on treatment.

Conclusion: DCP was perceived as an improvement of the standard outpatient care by both health care providers and patients with automated integration into the electronic patient record being of key importance.

Background: e-Health interventions can potentially improve health care. My Viva Plan^® (MVP) is a web-based program that focuses on mindfulness, nutrition, and physical fitness. The aim of this study was to evaluate the effects of this platform on stress indicators and diet quality among first-year university students.

Methods: Ninety-seven university students were enrolled in a randomized, controlled clinical trial. Participants were randomized into control (n = 49) and MVP (n = 48) groups. Perceived stress was measured using the self-report Stress Indicator Questionnaire. Diet quality was assessed by the nutrient-rich foods index, and body composition was assessed by a hand-to-foot, multifrequency, bioelectrical impedance analysis.

Results: There were no differences in physical, sleep, behavioral, emotional, and personal habit indicators between groups. Diet quality and body composition were similar between groups, except among women in the MVP group with decreased body fat (-1.2 ± 2.6 kg, p < 0.05). Participant engagement was low: 50% of the MVP group did not access the platform.

Conclusions: The MVP web-based intervention was not associated with improvements in stress indicators, diet quality, and body composition, likely due to the characteristics of our cohort of healthy young individuals. Future studies should focus on enhancing motivational approaches to explore the potential of e-health interventions that improve health behavior.

Clinical Trial Registration number: NCT03579264A.

Background: Latinx populations in the United States bear a disproportionate burden of diabetic eye disease. Teleophthalmology with and without artificial intelligence (AI)-based image interpretation are validated methods for diabetic eye screening, but limited literature exists on patient perspectives. This study aimed at understanding the perspectives of Latinx patients with diabetes on teleophthalmology, AI-based image interpretation, and general virtual care to prevent avoidable blindness in this population.

Methods: We conducted semi-structured, individual interviews with 20 Latinx patients with diabetes at an urban, federally qualified health center in Madison, WI. Interviews were transcribed verbatim, professionally translated from Spanish to English, and analyzed using both inductive open coding and deductive coding.

Results: Most participants had no prior experience with teleophthalmology but did have experience with virtual care. Participants expressed a preference for teleophthalmology compared with traditional in-person dilated eye exams but were willing to obtain whichever method of screening was recommended by their primary care clinician. They also strongly preferred having human physician oversight in image review compared with having images interpreted solely using AI. Many participants preferred in-person clinic visits to virtual health care due to the ability to have a more thorough physical exam, as well as for improved non-verbal communication with their clinician.

Discussion: Leveraging primary care providers' recommendations, human oversight of AI-based image interpretation, and improving communication may enhance acceptance and utilization of teleophthalmology, AI, and virtual care by Latinx patients.

Conclusions: Understanding Latinx patient perspectives may contribute toward the development of more effective telemedicine interventions to enhance health equity in Latinx communities.

Background: Type 1 and type 2 diabetes during pregnancy requires intensive glucose monitoring to ensure optimal health outcomes for mothers and infants. Standard practice includes patients monitoring their glucose four to six times a day using a standard glucometer and paper diary. Remote patient monitoring (RPM) offers an alternative method for diabetes management. This study aimed at measuring the patient's satisfaction with and feasibility of using a cellular-enabled RPM device for glucose management in pregnancies complicated by type 1 or type 2 diabetes.

Methods: In a mixed-methods pilot study, 59 pregnant women with type 1 or type 2 diabetes were given a cellular-enabled iGlucose glucometer. Participants completed a pre-survey, used the device for 30 days, and then completed a post-survey and semi-structured interview.

Results: Participants were divided into two groups based on duration of device use: high-use >50 days and low-use ≤50 days. A significant difference (p < 0.0001) in Appraisal of Diabetes scores was seen between the pre- and post-survey for both groups, which indicates that the use of iGlucose glucometer significantly improved participants' appraisal of their diabetes. There was a significant difference (p = 0.0409) in pre-post General Life Satisfaction in the high-use group, which indicates that iGlucose glucometer significantly improved participants' life satisfaction when used for an extended amount of time. Participants scored high on system usability for all groups and reported positive associations with iGlucose use.

Conclusion: The use of cellular-enabled RPM glucometers is a valuable tool for the management of type 1 diabetes mellitus and type 2 diabetes mellitus during pregnancy.

Background: To examine counselors' perceptions of their formal preparation for engaging in telemental health (TMH) counseling with the intent of gaining an understanding of their lived experiences.

Materials and methods: Semistructured interviews were conducted with seven seasoned counselors who regularly engage in technology-mediated distance counseling.

Results: The results highlighted themes within two emerging categories: the counselor and training/education. Themes related to motivation and specific counselor attributes emerged from the first category and themes of availability, inadequacy, and modality emerged from the second category.

Discussion: The implications from this study suggest a lack of availability and standardization of effective training on TMH delivery.

Conclusion: This study identifies areas of potential future research related to counselors' preparation experiences as well specific areas of need for TMH training in counseling graduate programs and other natural opportunities.

Objective: To complete a review of the literature on patient experience and satisfaction as relates to the potential for virtual triage (VT) or symptom checkers to enhance and enable improvements in these important health care delivery objectives.

Methods: Review and synthesis of the literature on patient experience and satisfaction as informed by emerging evidence, indicating potential for VT to favorably impact these clinical care objectives and outcomes.

Results/conclusions: VT enhances potential clinical effectiveness through early detection and referral, can reduce avoidable care delivery due to late clinical presentation, and can divert primary care needs to more clinically appropriate outpatient settings rather than high-acuity emergency departments. Delivery of earlier and faster, more acuity level-appropriate care, as well as patient avoidance of excess care acuity (and associated cost), offer promise as contributors to improved patient experience and satisfaction. The application of digital triage as a front door to health care delivery organizations offers care engagement that can help reduce patient need to visit a medical facility for low-acuity conditions more suitable for self-care, thus avoiding unpleasant queues and reducing microbiological and other patient risks associated with visits to medical facilities. VT also offers an opportunity for providers to make patient health care experiences more personalized.

Background: The field of telehealth is rapidly growing and expanding access to quality health care, although there have been varied implementation outcomes in telehealth modalities. Dissemination and implementation (D&I) research can provide a systematic approach to identifying barriers and facilitators to telehealth implementation processes and outcomes.

Methods: An interdisciplinary research and clinical team developed an implementation science telehealth toolkit to guide D&I evaluations of new and existing telehealth innovations.

Results: The toolkit includes a separate section to correspond to each step in the D&I evaluation process. Each section includes resources to guide evaluation steps, telehealth specific considerations, and case study examples based on three completed telehealth evaluations.

Discussion: The field of telehealth is forecasted to continue to expand, with potential to increase health care access to populations in need. This toolkit can help guide health care stakeholders to develop and carry out evaluations to improve understanding of telehealth processes and outcomes to maximize implementation and sustainability of these valuable innovations.

Introduction: Telemedicine use has increased for the past few years, and data security-related issues have also accompanied this. Barriers such as poor digital literacy, unaffordability, and ethical and legal issues have also affected the uptake of digital health. Telemedicine guidelines can help in promoting a suitable environment for wider uptake of telemedicine services by focusing on training, supervision, and monitoring of service providers. This policy review compares the telemedicine guidelines of countries in World Health Organization (WHO) South-East Asia Region (SEAR) as these countries have similar sociocultural backgrounds.

Methodology: Latest telemedicine guidelines of the South Asia Region of the WHO were accessed using the official government websites of the countries. The guidelines that were not in the English language were translated into English using Google Translate. The guidelines were analyzed and presented under the following subheadings: (1) Definitions, Purpose, and Tools of Telemedicine; (2) Clinical Aspects of Telemedicine; and (3) Operational and Technical Aspects of Telemedicine.

Results: Investigating the telemedicine guidelines in the SEAR of the WHO revealed that only 5 out of 11 countries, that is, India, Bangladesh, Thailand, Indonesia and Nepal, have guidelines specifically for telemedicine. Besides Thailand, the other four countries either published (India, Nepal, and Bangladesh) or updated (Indonesia) their telemedicine guidelines after the onset of the COVID-19 pandemic. Guidelines from India and Bangladesh are detailed and robust compared with those from Nepal, Indonesia, and Thailand.

Conclusion: Telemedicine guidelines need to be more robust to improve the uptake of the service. Further research is needed to explore the effectiveness of implementing these guidelines.