Telemedicine reports最新文献

Background: Non-scarring alopecia, including androgenetic alopecia (AGA), alopecia areata (AA), telogen effluvium (TE), and traction alopecia (TA), significantly impacts psychosocial well-being. Access to specialized dermatologic care for these conditions is often limited, particularly in underserved populations. Asynchronous teledermatology has emerged as a potential solution to extend care to these groups.

Objective: To evaluate the diagnostic utility and treatment patterns of asynchronous teledermatology for non-scarring alopecia and examine its role in improving care access across diverse populations within the University of Pittsburgh Medical Center (UPMC) network.

Methods: A retrospective study of 321 asynchronous teledermatology cases of non-scarring alopecia from 2022 to 2023 was conducted using the UPMC medical record system. Diagnosist, treatment type, and demographic data were analyzed. Longitudinal outcomes and adherence data were not consistently available.

Results: AA was the most common diagnosis (59.5%), followed by AGA (26.5%), TE (7.5%), and TA (5.0%). A definitive diagnosis was made remotely in 91.3% of cases; only 8.7% required in-person follow-up. Treatment included over-the-counter therapies such as minoxidil and clobetasol, with prescription medications used for moderate to severe cases. Racial demographics reflected high engagement from Black (22.7%) and Asian (12.9%) patients, with 41.7% of patients residing outside Pittsburgh.

Conclusion: Asynchronous teledermatology is an effective tool for diagnosing and managing non-scarring alopecia, facilitating timely intervention and improving access to dermatologic care. Future studies should access patient satisfaction, long-term outcomes, and implementation strategies to further expand equitable teledermatology access.

Background: Telemedicine has become an important mechanism for delivering health care in the wake of the COVID-19 pandemic. While some medical subspecialties were able to rapidly integrate telecare into their workflow, ophthalmology is one field in which telemedicine has not been as widely adopted. In this systematic review, we analyze published studies assessing patient and provider viewpoints on telemedicine for eye care. Our aim is to understand how adoption of teleophthalmology is being studied and whether definitive conclusions regarding patient and provider perspectives on telecare can be drawn from published literature.

Methods: We performed a systematic PubMed search for studies utilizing surveys to assess patient and provider perspectives regarding remote eye care. Articles were excluded if they were irrelevant to teleophthalmology, did not assess patient or eye care provider perspectives regarding teleophthalmology, assessed specific platforms or aspects of eye care, were reviews without primary data, or if the survey used was not available. The questionnaires from the included articles were analyzed for validation status, subspecialty, question wording, and response format.

Results: The PubMed search returned 92 articles, 22 of which were included in the final dataset after exclusions. Only four studies utilized externally validated questionnaires, although several additional studies were based on validated items. Survey length, wording, and response formatting varied across the studies. These 22 studies contained responses from 3,796 patients and 2,388 eye care professionals, but the lack of standardization between the surveys makes high power conclusions impossible.

Discussion: The results of this review demonstrate a need to develop a standardized and validated survey instrument specifically for assessing teleophthalmology to identify barriers to widespread implementation.

Background: Lichen planus (LP) is a chronic inflammatory dermatosis with limited teledermatology data guiding its management.

Objective: To assess whether asynchronous teledermatology provides timely, guideline-adherent LP care comparable to in-person visits.

Methods: A retrospective study of 102 LP patients seen via asynchronous teledermatology (n = 45) or in-person (n = 57) from 2020 to 2024. Variables included demographics, response time, diagnostic concordance, treatment, and follow-up compliance.

Results: Teledermatology provided rapid access (mean response time: 15 h) to dermatologic care. Diagnostic concordance between teledermatologists and in-person dermatologists was high (90.5%), while concordance with primary care providers was lower (18.5%, p < 0.001). Teledermatologists followed LP care standards, including hepatitis C virus screening (91.1%) and topical corticosteroid initiation (90%). Black patients used eVisits more frequently than in-person care (38.9% vs. 8.8%, p < 0.01), and follow-up compliance was lower among asynchronous patients (57.8% vs. 92.7%, p < 0.001).

Conclusion: Asynchronous teledermatology enables timely, high-quality LP care. However, strategies to improve follow-up are needed, particularly for younger teledermatology patients.

Introduction: Cardiovascular disease is a leading global cause of death, with coronary artery disease often requiring coronary artery bypass grafting (CABG). Inadequate rehabilitation increases health risks and costs, and low adherence to center-based rehabilitation has prompted interest in telerehabilitation. Despite technological advances, the global implementation of telerehabilitation for CABG patients remains underexplored. This study investigates factors influencing the implementation of a telerehabilitation device for CABG patients in the Faroe Islands.

Materials and methods: A qualitative case study design was used to identify factors influencing the b-near® system implementation at Suðuroy Hospital in the Faroe Islands. Data collection involved document materials, direct nonparticipant observations, and semi-structured interviews with seven participants. Analysis with NVivo followed principles by Kvale and Brinkmann and the Normalization Process Theory.

Results: The case study identified both opportunities and barriers. At Suðuroy Hospital, the b-near system enhances training and communication between health care providers and patients, is easy for patients to manage, and eliminates the need for hospital transportation. However, barriers such as reduced social interaction and potential difficulties in understanding training audio were also revealed.

Discussion: Several factors were identified, highlighting the importance of integrating these findings into Suðuroy Hospital's implementation strategy. Overcoming barriers is crucial for the successful use of the b-near system and improved patient care. Further evaluation of the b-near system and similar devices in diverse health care settings is necessary to enhance patient outcomes and support broader implementation.

Introduction: Greenhouse gas (GHG) emissions trap in heat responsible for global warming. Stanford Tobacco Treatment Service uses telehealth for patient care.

Methods: To quantify the environmental benefits of the clinic, data were abstracted from the electronic health record between March 17, 2020, and September 20, 2022. Round trip distances from address zip code to clinic were calculated to quantify GHG. Reductions in cigarettes from baseline to 24-month follow up were analyzed.

Results: The sample of 556 patients averaged 2 sessions and 156.8 miles per round trip, saving 148.8 kg of GHG emissions per patient. Ninety-four patients had tobacco usage data at both timepoints; 83 (88%) used cigarettes and had an average decrease of 5.5 cigarettes per day.

Conclusions: Applying findings to the 1,820 patients treated, the clinic has averted 271 metric tons of GHG travel emissions via telehealth; equivalent to 693,101 miles driven. Investing in telehealth tobacco cessation can prevent illnesses, health care expenditures, and environmental hazards.

Objective: Compared with persons with normal body mass index (BMI), examine the profile and health care-seeking intent of individuals with obesity/overweight status engaging outpatient artificial intelligence-based virtual triage and care referral (VTCR).

Methods: VTCR encounters of patients with high and normal BMI were compared over a 56-month period to assess differences in demographics, clinical risks, symptoms, conditions, triage recommendations, and care intent.

Results: In 7,222,363 encounters, 29.6% of patients reported having obesity/overweight status, increasing with age and peaking at 45-59 years (46.4%). Mean age for the high BMI group was 35.2 years and 28.7 years in the normal BMI group. Patients with obesity/overweight status reported noncommunicable diseases twice as frequently, including hypertension (relative risk [RR] 2.6), hypercholesterolemia (RR 2.4), diabetes mellitus (RR 2.4), and asthma (RR 1.4) (p < 0.05). The group of individuals with obesity/overweight status frequently reported musculoskeletal disorders and gastroesophageal reflux, chronic fatigue symptoms, and were up to four times more likely to have hypertension, obstructive sleep apnea, chronic renal disease, chronic heart failure, cholecystolithiasis, and peripheral vascular disease (p < 0.05). Patients with high BMI were slightly more likely to receive triage recommendations for urgent outpatient consultation or emergency department evaluation. Over one-third of patients were uncertain about the appropriate level of care to engage, but this decreased by half (56.6%) following VTCR in both groups.

Conclusions: VTCR effectively identified individuals with high BMI and their associated comorbidities. The results suggest that patients with obesity/overweight status utilize health care services at higher rates. VTCR holds promise as a valuable patient engagement, screening, early diagnosis, and health monitoring tool in managing obesity/overweight status in populations.

Background: The coronavirus disease 2019 (COVID-19) pandemic has led to the worldwide development of information and communications technology and the widespread use of domestic telemedicine, but the activities and needs of international telemedicine conferences/consultations remain unclear. We examined the experiences, needs, resources, and barriers related to international doctor-to-doctor telemedicine following the COVID-19 pandemic in Japanese national university hospitals.

Methods: In November 2021, a questionnaire was sent to 163 Internationalization Project Team representatives at 43 Japanese national university hospitals. Eighty-two of the representatives were medical staff in charge of internationalization (MI), and 81 were technical staff responsible for telecommunications (TT).

Results: The response rate was 94.2% (MI: 42/43 institutions; TT: 39/43 institutions). Fourteen institutions had been conducting international telemedicine programs with 62 countries. Public health was the most frequently cited topic, followed by nursing, surgery, pediatrics, and gastroenterology. All TT indicated that their institution had installed videoconferencing systems. Nineteen institutions indicated a need for international programs. The most serious barrier was the lack of "human resources" (84%), and this was noted more often by members in institutions without activity (p = 0.03). However, there was no difference between groups with and without a support department (p = 0.24) or MIs/TTs (p = 0.05).

Discussion: The technical barriers for international telemedicine were low after the pandemic. However, there are insufficient human resources to meet the growing needs. In addition to the international coordinators and administrative staff to support smooth communication with overseas partners, there is also a need for personnel to promote activities on their own.

Introduction: Musculoskeletal (MSK) conditions are highly prevalent among the Medicare population, and telerehabilitation has been shown to be equivalent to traditional in-person physical therapy for many patients.

Method: We studied the clinical outcomes of 100 consecutive Medicare Advantage patients from one insurer treated with a virtual physician-led MSK care team model. Patients had to have completed at least three clinical video visits to be eligible for participation. We also recorded rates of image ordering and referrals for in-person services.

Results: The average age of our patients was 72 years with sex equally divided. Fifty-two percent of our patients presented with symptoms in their lower back. All patients had an initial evaluation with a physician or nurse practitioner (NP) and a physical therapist during the same video visit encounter. The average number of follow-up physical therapy visits was 7.6, and 14% had a follow-up visit with the physician or NP. Forty-six percent of patients saw a health coach and 15% a registered dietitian for concomitant concerns. Imaging studies were ordered in two patients and referrals for in-person services were made in three. With all care provided through a telemedicine platform, we found a high degree of pain improvement (83%, p < 0.001) and physical health improvement (84-86%) in our cohort.

Conclusion: Our experience with Medicare Advantage patients demonstrates that multidisciplinary physician-led care in the telemedicine setting is effective in improving pain and physical function in older patients with MSK conditions.

The COVID-19 pandemic significantly accelerated the adoption of telehealth in primary care settings, with many health care systems planning to continue offering virtual care indefinitely. This brief report describes the implementation of virtual visit (VV) blocks to optimize telemedicine visits and expand clinic workforce capacity. VV blocks, dedicated time slots exclusively for telemedicine, were introduced to free up physical space for additional on-site providers. By pairing the introduction of VV blocks with new provider hires, our health system successfully expanded its workforce, increasing provider full-time equivalents in our pilot clinic from 8.51 to 10.25. These changes led to improved access, higher visit volumes, and similar patient satisfaction. Providers also reported benefits in terms of work-life balance and efficiency. The VV block model proved effective in addressing space and resource constraints, improving both operational outcomes and financial sustainability. The success of this pilot was replicated in a second clinic, demonstrating scalability. The long-term viability of telehealth initiatives hinges on the continuation of insurance payment parity and legislative support for telehealth policies. This article provides insights into how telehealth integration can optimize primary care delivery while navigating operational and financial challenges.

Introduction: The COVID-19 pandemic forced rapid increases in the use of telemedicine, which requires a different skillset than in-person visits. Both medical students and residents required urgent training in telemedicine to utilize the technology for patient care. This study compares evaluation outcomes using the same shared national curriculum for medical students and family medicine residents at the same institution.

Methods: Medical students and family medicine residents at Western Michigan University Homer Stryker M.D. School of Medicine completed and evaluated the Society of Teachers of Family Medicine Telemedicine Task Force national curriculum on best practices and foundations within the realm of telemedicine. A Mann-Whitney analysis was performed on Likert scale questions.

Results: Medical students had significantly greater knowledge, skill, or attitude acquisition from Module 1, the basics of telemedicine, than family medicine residents. There were no significant differences in knowledge, skill, or attitude acquisition in Module 2, 3, 4, or 5.

Discussion: The results from this single-institution sample of medical students and family medicine residents using a shared telemedicine curriculum illustrate important differences from the national data. Unlike the national data, there was a significant difference in knowledge, skill, or attitude acquisition in Module 1, while there was no difference in knowledge, skill, or attitude acquisition in the remaining four modules. Our results indicate changing utility of the telemedicine modules based on previous and ongoing experience. Learners of multiple levels find utility in a shared curriculum in teaching novel concepts.