Telemedicine reports最新文献

The United States faces a growing scarcity of primary care resources within an already overstressed and poorly accessible health care system. Many health care organizations are evaluating novel models of care and adoption of digital technologies to improve primary care access and efficiency of health care delivery. This article describes a virtual primary care (VPC) model that expands access and increases the efficiency of the traditional primary care team by utilizing on-demand and asynchronous digital tools. In the first year of operations, this service line provided >21,000 on-demand telemedicine visits and >4,000 asynchronous eVisits. The VPC service line improved access to primary care services in a financially successful and sustainable model.

Introduction: Lower limb function teleassessments in adult stroke survivors are critical due to the rise of telerehabilitation. This preliminary study aims to establish the safety, feasibility, and validity of teleassessments, exploring their predictive capacity for walking speed.

Methods: In this cross-sectional study, 17 chronic stroke participants (11 males, 6 females; mean age: 63 ± 8) underwent lab-based and tele-based assessment sessions. Outcome measures included the 30-second chair stand test (30CST), five times sit-to-stand (5XSTS), and 2-minute step test (TMST). 10-Meter walk test categorized participants into slow versus fast (below/above 0.8 m/s). Absolute agreement and bias analyses determined teleassessment validity, while sensitivity and specificity analyses evaluated their effectiveness in classifying slow versus fast walkers.

Results: Absolute agreements were good for 30CST (ICC = 0.885), poor for 5XSTS (ICC = 0.148), and excellent for TMST (ICC = 0.971). 30CST (p = 0.8), 5XSTS (p = 0.3), and TMST (p = 0.2) showed no systematic bias. Similarly, 30CST (R ² = 0.07, p = 0.25), 5XSTS (R ² = 0.04, p = 0.39), and TMST (R ² = 0.0008, p = 0.9) indicated no proportional bias. The TMST demonstrated higher sensitivity (80%) and specificity (50%) compared with 30CST (sensitivity 88% and specificity 12%) and 5XSTS (sensitivity 80% and specificity 25%).

Discussion: 30CST and TMST demonstrated adaptability for remote assessment via videoconferencing, establishing their safety, feasibility, and validity. These findings advocate for integrating teleassessments into adult stroke survivors' telerehabilitation programs.

Introduction: Telehealth has the potential to mitigate the lack of health care access in rural and underserved communities; however, telehealth is only viable where sufficiently high-speed internet broadband is available to patients. Existing broadband data sets may not accurately reflect the state of broadband, particularly in rural communities. We examined consumer internet speed test data from two organizations to see if the number of tests per 1,000 residents varied across county-level rurality.

Methods: We analyzed county-level data from Measurement Labs (M-Lab) and Ookla for Good (Ookla fixed and mobile) across the calendar years 2020 and 2021. We used the number of tests conducted per 1,000 residents within United States counties as the outcome variable, and Rural-Urban Continuum Codes (RUCC) as the main independent variable of interest.

Results: Using negative binomial models with robust standard errors, we found that the number of fixed speed tests conducted per 1,000 residents was generally lower in rural counties relative to counties with over one million residents. However, we found no associations between any categories of county-level rurality for the number of mobile tests conducted per 1,000 residents. Patterns of association with other covariates emerged as significant in some models and not in others, suggesting key differences among users generating speed tests among these data sources.

Conclusions: Our findings demonstrate the poor representation of residents from very rural counties in M-Lab and Ookla fixed data sets of user-generated internet speed tests. Additional data are needed to inform broadband infrastructure investment to identify those communities most left behind by broadband expansion efforts.

Introduction: The prevalence of telehealth has witnessed a significant increase in various medical domains, especially in endocrinology. Telehealth brings about considerable advantages for both patients and health care professionals. However, despite these positive aspects, the growing prominence of telehealth is accompanied by certain challenges. This systematic review aims to assess the role of telehealth in endocrinology, including its applications, effectiveness, challenges, and implications for patient care.

Methods: This study involved a thorough search using comprehensive techniques across databases such as PubMed/Medline, Embase, and Scopus. The studies were selected for a tailored adaptation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to enhance the clarity of our systematic review's reporting.

Results: This systematic review explores global telemedicine applications in endocrinology. Addressing various endocrine conditions, interventions utilize technology tools such as smartphones and applications, offering multifaceted utility from education and data gathering to screening and treatment. Notably, these interventions demonstrate adaptability during the COVID-19 pandemic. Positive outcomes include enhanced patient education, disease self-management, reduced complications, and improved glycemic control. However, drawbacks include the need for technical proficiency, perceived lower care quality, and potential privacy risks. These nuanced findings contribute to the discourse on telemedicine efficacy and limitations.

Conclusion: In conclusion, telehealth holds significant potential in transforming endocrine care. While there are challenges to its implementation, the benefits it offers underscore its value as a health care delivery model.

Background: Telehealth has untapped potential to improve health care for underserved communities. However, it remains underutilized, limiting opportunities to improve continuity of care and health care outcomes. This pilot study investigates attitudes and barriers to telehealth at Stony Brook HOME, Renaissance School of Medicine's student-run free-health clinic in Suffolk County, NY.

Methods: Surveys (n = 100) were electronically administered bimonthly during clinic waiting room time from May 2022 to August 2023 in both English (40%) and Spanish (60%). Surveys collected information on patient demographics, perceived patient barriers and attitudes to telehealth, and technological comfort levels.

Results: Most patients were Hispanic/Latino (68%), female (54%), and 40-60 years old (52%). Spanish speakers often come from high social vulnerability regions. English speakers were more likely to own a smartphone, computer, or tablet than Spanish speakers (p = 0.046). English speakers reported higher levels of technological comfort using a smartphone or tablet (p = 0.0033) and using it for their health care (p = 0.03). Finally, 100% of English speakers reported reliable internet access compared to 66.7% of Spanish speakers.

Discussion: These results demonstrate that barriers to telehealth are being disproportionately felt by Spanish speakers, thus necessitating survey-directed interventions to address this disparity.

Introduction: Store-and-forward telemedicine is a form of electronic transmission in which patient images or clinical information are transmitted to clinicians for asynchronous clinical decision making. This study evaluated the use, feasibility, savings, and patient satisfaction of postoperative store-and-forward wound checks following Mohs surgery.

Methods: Select patients were asked to participate in a virtual postoperative wound check after receiving Mohs surgery. Participants sent photos of their wound site and subsequently completed an anonymous survey.

Results: One hundred and ten patients were enrolled, mean age 68 (range 32-87). Patients saved an average of $14.16, 78.6 miles of travel, and 90 min of travel time. Ninety-eight percent of respondents felt their quality of care in teledermatology was "about the same" to "much better" than compared with traditional in-person care. Sixty-four of the respondents (90.1%) reported they would prefer their next Mohs wound check to be conducted through teledermatology.

Conclusion: Store-and-forward telemedicine in patients undergoing Mohs micrographic surgery is a safe, effective, and efficient method for postoperative wound care.

Background: During the COVID-19 pandemic, use of telemedicine (TM) increased dramatically, but it is unclear how use varies by characteristics of people with Alzheimer's disease (AD), multiple sclerosis (MS), or Parkinson's disease (PD).

Methods: This cross-sectional study used US PharMetrics Plus commercial claims data from January 1, 2019, to December 31, 2021. TM use (≥1 Current Procedural Terminology code) was assessed in each study year (2019, 2020, and 2021) among people with ≥1 inpatient or ≥2 outpatient diagnosis codes ≥30 days apart for AD, MS, or PD. Any TM use and disease-related visits (AD, MS, or PD diagnosis code within TM claim) were summarized, and characteristics of TM users versus nonusers during the pandemic (2020 and 2021) were described.

Results: Among people with AD, MS, or PD, 0.9% used TM in 2019 versus 58.0% in 2020 and 42.5% in 2021. Among TM users in 2020 and 2021, the majority had TM visits related to their neurological disorder (73.2% and 64.6%, respectively). During the pandemic, approximately 25% of total TM visits (n = 296,434) were provided by a neurologist. Mean (SD) age of TM users was similar to nonusers (60.5 [15.1] and 61.5 [15.3] years), but TM users were more likely to be female (62% vs 60%), enrolled in Medicare (33% vs 30%), and reside in western (64.2% vs 35.8%) or eastern (61.0% vs 39.0%) regions versus nonusers.

Conclusions: Although results indicate expanded use of and access to TM among people with AD, MS, or PD, differences in patient and health care provider characteristics for TM use were notable.

Background: Tele-cystoscopy involves trained advanced practice providers performing cystoscopy with real-time interpretation by an urologist. The goal of this externally validated care model is to expand the availability of cystoscopy to underserved rural areas. Herein we report on population demographics and describe the socioeconomic benefits of tele-cystoscopy for bladder cancer surveillance.

Methods: Using an IRB-approved protocol, patients were consented for dual, sequential cystoscopy wherein they experienced a standard-of-care cystoscopy along with tele-cystoscopy. Patients completed a questionnaire that contained both subjective and objective health and socioeconomic-related questions as well as a satisfaction survey. Patients were also probed about factors associated with transportation to their cystoscopy appointments including gasoline costs, travel time, and time off work. Using the Distressed Community Index, patients were ascribed an economic resource category ranging from prosperous to distressed.

Results: In total, 48 patients with a mean age of 55 completed surveys after completing dual cystoscopies. Thirteen patients (27%) were uninsured and 10 patients (20%) had Medicaid as primary insurance. The tele-cystoscopy clinic saved patients an average of 235 miles and 434 min of travel time. In total, 82% of patients resided in a distressed community indicating fewer economic resources. Satisfaction results showed a mean score of 31.38 (out of 32).

Conclusions: Patients were satisfied with tele-cystoscopy, noting increased access to health care and fewer disruptions impacting bladder cancer surveillance. Tele-cystoscopy may be a viable option to expand access and improve adherence to guidelines for bladder cancer surveillance, particularly benefiting patients in rural areas and those of lower socioeconomic status.

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.