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1.
BMC Prim Care ; 25(1): 89, 2024 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-38493288

RESUMO

BACKGROUND: Stress urinary incontinence (SUI), though a prevalent condition among women, is undertreated in primary care. EHealth with pelvic floor muscle training is an evidence-based alternative to care-as-usual. It is unknown, however, how eHealth usage is related to treatment outcome, and this knowledge is required for general practitioners to implement eHealth in their practice. This study examines the relation between usage of eHealth for SUI and treatment outcomes by examining log data. Baseline factors were also explored for associations with treatment success. METHOD: In this pre-post study, women with SUI participated in "Baasoverjeblaas.nl", a web-based intervention translated from the Swedish internet intervention "Tät®-treatment of stress urinary incontinence". Usage was based on log data and divided into three user groups (low, intermediate and high). Online questionnaires were sent before, after treatment and at six-months follow-up. The relation between usage and the primary outcome - treatment success (PGI-) - was studied with a binomial logistic regression analysis. Changes in the secondary outcomes - symptom severity (ICIQ-UI SF) and quality of life (ICIQ-LUTSqol) - were studied per user group with linear mixed model analysis. RESULTS: Included were 515 users with a mean age of 50.5 years (12.0 SD). The majority were low users (n = 295, 57.3%). Treatment success (PGI-I) was reached by one in four women and was more likely in high and intermediate users than in low users (OR 13.2, 95% CI 6.1-28.5, p < 0.001 and OR 2.92, 95% CI 1.35-6.34, p = 0.007, respectively). Symptom severity decreased and quality of life improved significantly over time, especially among high users. The women's expected ability to train their pelvic floor muscles and the frequency of pelvic floor muscle exercises at baseline were associated with treatment success. CONCLUSION: This study shows that usage of eHealth for SUI is related to all treatment outcomes. High users are more likely to have treatment success. Treatment success is more likely in women with higher expectations and pelvic floor muscle training at baseline. These findings indicate that general practitioners can select patients that would be more likely to benefit from eHealth treatment, and they can enhance treatment effect by stimulating eHealth usage. TRIAL REGISTRATION: Landelijk Trial Register NL6570;  https://onderzoekmetmensen.nl/nl/trial/25463 .


Assuntos
Telemedicina , Incontinência Urinária por Estresse , Feminino , Humanos , Pessoa de Meia-Idade , Terapia por Exercício , Diafragma da Pelve , Qualidade de Vida , Incontinência Urinária por Estresse/terapia , Incontinência Urinária por Estresse/diagnóstico , Adulto
2.
Trials ; 25(1): 212, 2024 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-38520030

RESUMO

BACKGROUND: Significant disparities continue to exist in the HIV care continuum, whereby Hispanic and Black people living with HIV (PLWH) are less likely to achieve viral suppression compared to their White counterparts. Studies have shown that intervention approaches that involve peer navigation may play an important role in supporting patients to stay engaged in HIV care. However, implementation may be challenging in real-world settings where there are limited resources to support peer navigators. Combining a peer navigation approach with scalable mobile health (mHealth) technology may improve impact and implementation outcomes. METHODS: We combined a peer navigation intervention with a mHealth application and are conducting a randomized controlled trial (RCT) to test the efficacy of this integrated "Peers plus mobile App for Treatment in HIV" (PATH) intervention to improve HIV care engagement, and ultimately sustained viral suppression, among Hispanic and Black PLWH. We will enroll up to 375 PLWH into a two-arm prospective RCT, conducting follow-up assessments every 3 months up to 12 months post-baseline. Participants randomized to the control arm will continue to receive usual care Ryan White Program case management services. Individuals randomized to receive the PATH intervention will receive usual care plus access to two main intervention components: (1) a peer navigation program and (2) a mHealth web application. The primary outcome is sustained HIV viral suppression (undetectable viral load observed at 6- and 12-month follow-up). Secondary outcomes are retention in HIV care, gaps in HIV medical visits, and self-reported ART adherence. Recruitment for the RCT began in November 2021 and will continue until June 2024. Follow-up assessments and medical chart abstractions will be conducted to collect measurements of outcome variables. DISCUSSION: The efficacy trial of PATH will help to fill gaps in our scientific understanding of how a combined peer navigation and mHealth approach may produce effects on HIV care outcomes while addressing potential implementation challenges of peer navigation in Ryan White-funded clinics. TRIAL REGISTRATION: The PATH trial is registered at the United States National Institutes of Health National Library of Medicine (ClinicalTrials.gov) under ID # NCT05427318 . Registered on 22 June 2022.


Assuntos
Infecções por HIV , Aplicativos Móveis , Telemedicina , Humanos , Hispânico ou Latino , Infecções por HIV/diagnóstico , Infecções por HIV/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Telemedicina/métodos , Negro ou Afro-Americano
3.
BMC Health Serv Res ; 24(1): 341, 2024 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-38486179

RESUMO

BACKGROUND: Telemedicine is often promoted as a possible solution to some of the challenges healthcare systems in many countries face, and an increasing number of studies evaluate the clinical effects. So far, the studies show varying results. Less attention has been paid to systemic factors, such as the context, implementation, and mechanisms of these interventions. METHODS: This study evaluates the experiences of patients and health personnel enrolled in a pragmatic randomized controlled trial comparing telemedicine-based follow-up of chronic conditions with usual care. Patients in the intervention group received an individual treatment plan together with computer tablets and home telemonitoring devices to report point-of-care measurements, e.g., blood pressure, blood glucose or oxygen saturation, and to respond to health related questions reported to a follow-up service. In response to abnormal measurement results, a follow-up service nurse would contact the patient and consider relevant actions. We conducted 49 interviews with patients and 77 interviews with health personnel and managers at the local centers. The interview data were analyzed using thematic analysis and based on recommendations for conducting process evaluation, considering three core aspects within the process of delivering a complex intervention: (1) context, (2) implementation, and (3) mechanisms of impact. RESULTS: Patients were mainly satisfied with the telemedicine-based service, and experienced increased safety and understanding of their symptoms and illness. Implementation of the service does, however, require dedicated resources over time. Slow adjustment of other healthcare providers may have contributed to the absence of reductions in the use of specialized healthcare and general practitioner (GP) services. An evident advantage of the service is its flexibility, yet this may also challenge cost-efficiency of the intervention. CONCLUSIONS: The implementation of a telemedicine-based service in primary healthcare is a complex process that is sensitive to contextual factors and that requires time and dedicated resources to ensure successful implementation. TRIAL REGISTRATION: The trial was registered in www. CLINICALTRIALS: gov (NCT04142710). Study start: 2019-02-09, Study completion: 2021-06-30, Study type: Interventional, Intervention/treatment: Telemedicine tablet and tools to perform measurements. Informed and documented consent was obtained from all subjects and next of kin participating in the study.


Assuntos
Clínicos Gerais , Telemedicina , Humanos , Seguimentos , Telemedicina/métodos , Atenção à Saúde , Glicemia
4.
Appl Clin Inform ; 15(1): 178-191, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38447966

RESUMO

BACKGROUND: Unplanned intensive care unit (ICU) admissions from medical/surgical floors and increased boarding times of ICU patients in the emergency department (ED) are common; approximately half of these are associated with adverse events. We explore the potential role of a tele-critical care consult service (TC3) in managing critically ill patients outside of the ICU and potentially preventing low-acuity unplanned admissions and also investigate its design and implementation needs. METHODS: We conducted a qualitative study involving general observations of the units, shadowing of clinicians during patient transfers, and interviews with clinicians from the ED, medical/surgical floor units and their ICU counterparts, tele-ICU, and the rapid response team at a large academic medical center in St. Louis, Missouri, United States. We used a hybrid thematic analysis approach supported by open and structured coding using the Consolidated Framework for Implementation Research (CFIR). RESULTS: Over 165 hours of observations/shadowing and 26 clinician interviews were conducted. Our findings suggest that a tele-critical care consult (TC3) service can prevent avoidable, lower acuity ICU admissions by offering a second set of eyes via remote monitoring and providing guidance to bedside and rapid response teams in the care delivery of these patients on the floor/ED. CFIR-informed enablers impacting the successful implementation of the TC3 service included the optional and on-demand features of the TC3 service, around-the-clock availability, and continuous access to trained critical care clinicians for avoidable lower acuity (ALA) patients outside of the ICU, familiarity with tele-ICU staff, and a willingness to try alternative patient risk mitigation strategies for ALA patients (suggested by TC3), before transferring all unplanned admissions to ICUs. Conversely, the CFIR-informed barriers to implementation included a desire to uphold physician autonomy by floor/ED clinicians, potential role conflicts with rapid response teams, additional workload for floor/ED nurses, concerns about obstructing unavoidable, higher acuity admissions, and discomfort with audio-visual tools. To amplify these potential enablers and mitigate potential barriers to TC3 implementation, informed by this study, we propose two key characteristics-essential for extending the delivery of critical care services beyond the ICU-underlying a telemedicine critical care consultation model including its virtual footprint and on-demand and optional service features. CONCLUSION: Tele-critical care represents an innovative strategy for delivering safe and high-quality critical care services to lower acuity borderline patients outside the ICU setting.


Assuntos
Telemedicina , Humanos , Cuidados Críticos , Unidades de Terapia Intensiva , Centros Médicos Acadêmicos , Serviço Hospitalar de Emergência
5.
Inquiry ; 61: 469580241238671, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38450625

RESUMO

In 2018, the US Congress enacted a policy permitting Medicare Advantage (MA) plans to cover telehealth services in a beneficiary's home and through audio-only means as part of the basic benefit package of services, where prior to the policy change such benefits were only allowed to be covered as a supplemental benefit. MA plans were afforded 2 years of lead time for strategizing, negotiating, and capital investment prior to the start date (January 1, 2020) of the new coverage option. Our data analysis found basic benefit telehealth was offered by plans comprising 71% of enrollment in 2020 and increased to 95% in 2021. At the same time, remote access telehealth was offered as a supplemental benefit for 69% of enrollees in 2020, a decrease of 23% compared to 2019. These efforts by MA plans may have enabled traditional Medicare (TM) to leverage an existing telehealth infrastructure as a solution to the access issues created by public health policies requiring sheltering in place and social distancing during the COVID-19 pandemic. The success of this MA policy prompts consideration of additional flexibility beyond the standard basic benefit package, and whether such benefits reduce costs while improving access and/or outcomes in the context of a managed care environment like MA. Subject to oversight, such flexibility could potentially improve value in MA, and facilitate future changes in TM, as appropriate.


Assuntos
COVID-19 , Medicare Part C , Telemedicina , Idoso , Estados Unidos , Humanos , Pandemias , Programas de Assistência Gerenciada
6.
Sci Rep ; 14(1): 5168, 2024 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-38431641

RESUMO

Magnetic resonance imaging is a medical imaging technique to create comprehensive images of the tissues and organs in the body. This study presents an advanced approach for storing and compressing neuroimaging informatics technology initiative files, a standard format in magnetic resonance imaging. It is designed to enhance telemedicine services by facilitating efficient and high-quality communication between healthcare practitioners and patients. The proposed downsampling approach begins by opening the neuroimaging informatics technology initiative file as volumetric data and then planning it into several slice images. Then, the quantization hiding technique will be applied to each of the two consecutive slice images to generate the stego slice with the same size. This involves the following major steps: normalization, microblock generation, and discrete cosine transformation. Finally, it assembles the resultant stego slice images to produce the final neuroimaging informatics technology initiative file as volumetric data. The upsampling process, designed to be completely blind, reverses the downsampling steps to reconstruct the subsequent image slice accurately. The efficacy of the proposed method was evaluated using a magnetic resonance imaging dataset, focusing on peak signal-to-noise ratio, signal-to-noise ratio, structural similarity index, and Entropy as key performance metrics. The results demonstrate that the proposed approach not only significantly reduces file sizes but also maintains high image quality.


Assuntos
Compressão de Dados , Telemedicina , Humanos , Compressão de Dados/métodos , Imageamento por Ressonância Magnética/métodos , Neuroimagem , Razão Sinal-Ruído
7.
Sci Rep ; 14(1): 5173, 2024 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-38431653

RESUMO

eHealth tools usage is vital for health care systems and increased significantly after the COVID-19 pandemic, which aggravated mental health issues. This cross-sectional study explored whether sociodemographic characteristics and mental health indices (stress and symptoms of anxiety and depression) were linked to the behavioral intention to use eHealth tools and eHealth tools usage in a representative sample from Poland using a network approach. Measurements were conducted in March 2023 among 1000 participants with a mean age of 42.98 (18-87) years, with 51.50% women. The measures included the behavioral intention to use eHealth tools (BI) based on the UTUAT2; eHealth tool use frequency (use behavior) including ePrescription, eSick leave, eReferral, electronic medical documentation (EMD), Internet Patient Account (IKP), telephone consultation, video consultation, mobile health applications, and private and public health care use; and the PSS-4, GAD-2, and PHQ-2. Furthermore, sociodemographic factors (sex, age, children, relationship status, education, and employment) were included in the research model. Network analysis revealed that mental health indices were weakly related to eHealth tools use. Higher stress was positively linked with mobile health application use but negatively linked to video consultation use. Use of various eHealth tools was intercorrelated. Sociodemographic factors were differentially related to the use of the eight specific eHealth tools. Although mental health indices did not have strong associations in the eHealth tools use network, attention should be given to anxiety levels as the factor with the high expected influence.


Assuntos
Pandemias , Telemedicina , Criança , Humanos , Feminino , Adulto , Masculino , Estudos Transversais , Saúde Mental , Encaminhamento e Consulta , Telefone , Inquéritos e Questionários
8.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2024 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-38437500

RESUMO

PURPOSE: This study examined the determinants of mobile health (M-Health) application, adoption, usage and discontinuation among corporate workers diagnosed with hypertension and diabetes in Ghana. DESIGN/METHODOLOGY/APPROACH: The diffusion innovation and reasoned action theories were employed using an exploratory design. Three hundred corporate workers diagnosed with diabetes and hypertension from three health facilities for the past six months were sampled for the study using a multi-stage sampling technique and administered questionnaires. Descriptive statistics and logistic regression tools were employed in the analysis of data. FINDINGS: The study found a significant number of factors influencing m-health applications adoption, usage and discontinuity. These factors include nature and demand of job, perceived advantage, compatibility, complexity, triability, aesthetics and trust. Aesthetics emerged as the strongest predictive factor for the adoption, usage and discontinuity of use among diabetic and hypertensive corporate workers. With the adoption of M-Health applications, compatibility, as well as nature and demand of job, were significant predictors. With the usage of M-Health applications, complexity, triability, aesthetics and trust were significant predictors. Moreover, perceived advantage, compatibility, complexity and triability influenced significantly the choice to discontinue using M-Health applications. The study concluded that M-Health application functionalities play a valuable role in patients' intention to adopt, use and discontinue the use of an M-Health application in Ghana. ORIGINALITY/VALUE: This exploratory study offers in-depth insight into how major M-Health application features affect its adoption, usage and discontinuity, providing crucial information for future research and the improvement of chronic condition healthcare delivery.


Assuntos
Diabetes Mellitus , Hipertensão , Telemedicina , Humanos , Gana , Instalações de Saúde
9.
J Ambul Care Manage ; 47(2): 51-63, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38441558

RESUMO

Learning collaboratives are seldom used outside of health care quality improvement. We describe a condensed, 10-week learning collaborative ("Telemedicine Hack") that facilitated telemedicine implementation for outpatient clinicians early in the COVID-19 pandemic. Live attendance averaged 1688 participants per session. Of 1005 baseline survey respondents, 57% were clinicians with one-third identifying as from a racial/ethnic minoritized group. Practice characteristics included primary care (71%), rural settings (51%), and community health centers (28%). Of three surveys, a high of 438 (81%) of 540 clinicians had billed ≥1 video-based telemedicine visit. Our learning collaborative "sprint" is a promising model for scaling knowledge during emergencies and addressing health inequities.


Assuntos
COVID-19 , Telemedicina , Humanos , Pandemias , Pacientes Ambulatoriais , COVID-19/epidemiologia , Centros Comunitários de Saúde
11.
BMC Res Notes ; 17(1): 65, 2024 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-38444033

RESUMO

OBJECTIVES: This study evaluates a multi-centered complementary medicine (CM) student-led telehealth clinic during the COVID-19 pandemic. Likert and qualitative responses explore student and educator learning and teaching perceptions of the implementation of a successful telehealth clinic. RESULTS: 51 students and 17 educators completed the survey. Respondents agreed that support from educators (90%) and orientation (70%) assisted effective performance. Over 90% (93%) of all respondents supported telehealth in student-led clinics, whilst 87% encountered barriers such as technical and infrastructure issues. Respondents agreed that telehealth practice skills improved in case history taking (90%), treatment (90%) and building patient rapport (60%). Respondents (61%) disagreed that physical examination was effectively performed, and 100% of respondents agreed telehealth was a valuable learning experience. This study is the first to explore student and educator perceptions of telehealth in an Australian University multi-centered CM student-led clinic. To be successful in an educational environment, students and educators require digital literacy and adequate telehealth practice infrastructure. Whilst some in-person practice skills are transferable to telehealth, educators need to adapt curriculum to ensure counselling and physical examination skills are specifically taught for virtual consultations. Telehealth in clinical practice requires continued investigation and educational development.


Assuntos
Terapias Complementares , Telemedicina , Humanos , Pandemias , Austrália , Estudantes
12.
J Parkinsons Dis ; 14(2): 221-226, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38457153

RESUMO

Persons with Parkinson's disease (PD) and society at large can profit from a strategic investment into a forward leaning, practical, preventative, and proactive multidisciplinary care policy. The American healthcare system is not easily bent to accommodate this type of care, and thus a tax benefit is an attractive option. An individual federal income tax benefit of $6200 each year for every person residing in the US with a diagnosis of PD, could among other offerings provide monthly access to a licensed clinical social worker and access to mental health services. The implementation of more coordinated care has the potential reduce the burden of depression, anxiety, and demoralization. Personal training would also be covered and directed by physical and occupational therapists. The combination of home-based and telemedicine services would have the added benefit of improving access. The tax benefit would also provide access to a dietician. This type of care strategy could be designed to proactively identify early signs of aspiration and urinary tract infections to 'head off' significant morbidity. A $6200/year individual tax benefit for those diagnosed with PD will thus translate into more fall prevention, more care in the home setting, less hospitalizations, less depression, less anxiety, less demoralization, better diets, and less persons placed in nursing facilities. Additionally, this tax benefit will provide the potential for billions of dollars in savings to the healthcare system. A tax benefit for PD is a practical preventative and proactive strategy which can serve to advantage both this generation and the next.


Assuntos
Doença de Parkinson , Telemedicina , Humanos , Estados Unidos , Doença de Parkinson/diagnóstico , Doença de Parkinson/prevenção & controle , Atenção à Saúde
13.
Transl Vis Sci Technol ; 13(3): 2, 2024 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-38427348

RESUMO

Purpose: To describe inequalities in the Monitoring for Neovascular Age-related Macular Degeneration Reactivation at Home (MONARCH) diagnostic test accuracy study for: recruitment; participants' ability to self-test; and adherence to testing using digital applications during follow-up. Methods: Home-monitoring vision tests included two tests implemented as software applications (apps: MyVisionTrack and MultiBit) on an iPod Touch device. Patients were provided with all hardware required to participate (iPod and MIFI device) and trained to use the apps. Regression models estimated associations of age, sex, Index of Multiple Deprivation, strata of time since first diagnosis, and baseline visual acuity at study entry on outcomes of willingness to participate, ability to perform tests, and adherence to weekly testing. Results: A minority of patients who were approached were willing-in-principle to participate. Increasing age was associated with being unwilling-in-principle to participate. Patients from the most deprived areas had a 47% decrease in odds of being willing compared to those from the middle quintile deprived areas (odds ratio, 0.53; 95% confidence interval = 0.32, 0.88). Increasing age and worse deprivation were not consistently associated either with ability to self-monitor with the index tests, or adherence to weekly testing. Conclusions: Associations of increasing age and worse deprivation index were associated with unwillingness-in-principle to participate despite the provision of hardware' highlighting the potential for inequality with interventions of the kind evaluated. Translational Relevance: The clear evidence of inequalities in participation should prompt future research on ways to encourage adoption of mobile health technologies by underserved populations.


Assuntos
Neovascularização de Coroide , Degeneração Macular , Telemedicina , Humanos , Idoso , Acuidade Visual , Degeneração Macular/diagnóstico , Degeneração Macular/epidemiologia
14.
PLoS One ; 19(3): e0298149, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38451971

RESUMO

INTRODUCTION: Cataract surgery is a relatively safe procedure with satisfactory postoperative results in most patients. However, in rare cases severe complications can occur shortly after the intervention. Therefore, patients are advised to undergo an ophthalmological examination postoperatively, which should be performed as soon as possible in case of emergencies. However, exactly when these follow-up visits should take place is still discussed. A time- and cost-saving alternative to this could be short-term postoperative telemedical approaches. The aim of this study was to analyze patient complaints as well as satisfaction with and the best timepoint to perform telephone calls after cataract surgery. METHODS: Patients scheduled for cataract surgery received a telephone call on the surgery day or the day after (study group) during which they were asked about complaints or additional examination visits. Patients without telephone calls served as control group. All patients had a follow-up visit one week after the intervention during which a questionnaire was filled out and the study group was asked about their satisfaction with the telephone calls. RESULTS: 181 patients were recruited in this study. Ocular surface problems were the most common postoperative symptom. More than 80% of the patients were very satisfied with the telephone calls, with patients being contacted on the day of surgery being more calmed than those called on the next day. No difference in additional and planned follow-up visits was found between the study and the control group (P > .40). Postoperative patient complaints (Phi 0.372, P < .001) and additional prescribed therapy (Phi 0.480, P < .001) were moderately associated with additional visits. CONCLUSION: Satisfaction with telephone reviews shortly after cataract surgery was very high and contacting patients on the evening of the day of the procedure could be a time- and cost-saving alternative to short-term in-house follow-up visits.


Assuntos
Extração de Catarata , Catarata , Telemedicina , Humanos , Satisfação do Paciente , Telefone
16.
BMJ Open ; 14(3): e077196, 2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38453199

RESUMO

OBJECTIVES: Remote monitoring of health has the potential to reduce the burden to patients of face-to-face appointments and make healthcare more efficient. Apps are available for patients to self-monitor vision at home, for example, to detect reactivation of age-related macular degeneration (AMD). Describing the challenges when implementing apps for self-monitoring of vision at home was an objective of the MONARCH study to evaluate two vision-monitoring apps on an iPod Touch (Multibit and MyVisionTrack). DESIGN: Diagnostic Test Accuracy study. SETTING: Six UK hospitals. METHODS: The study provides an example of the real-world implementation of such apps across health sectors in an older population. Challenges described include the following: (1) frequency and reason for incoming calls made to a helpline and outgoing calls made to participants; (2) frequency and duration of events responsible for the tests being unavailable; and (3) other technical and logistical challenges. RESULTS: Patients (n=297) in the study were familiar with technology; 252/296 (85%) had internet at home and 197/296 (67%) had used a smartphone. Nevertheless, 141 (46%) called the study helpline, more often than anticipated. Of 435 reasons for calling, all but 42 (10%) related to testing with the apps or hardware, which contributed to reduced adherence. The team made at least one call to 133 patients (44%) to investigate why data had not been transmitted. Multibit and MyVisionTrack apps were unavailable for 15 and 30 of 1318 testing days for reasons which were the responsibility of the app providers. Researchers also experienced technical challenges with a multiple device management system. Logistical challenges included regulations for transporting lithium-ion batteries and malfunctioning chargers. CONCLUSIONS: Implementation of similar technologies should incorporate a well-resourced helpline and build in additional training time for participants and troubleshooting time for staff. There should also be robust evidence that chosen technologies are fit for the intended purpose. TRIAL REGISTRATION NUMBER: ISRCTN79058224.


Assuntos
Degeneração Macular , Aplicativos Móveis , Telemedicina , Humanos , Smartphone , Degeneração Macular/terapia
17.
Front Public Health ; 12: 1291916, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38435285

RESUMO

Purpose: In response to the growing challenges posed by an aging society, a telemedicine system was developed specifically for older adults postoperative patients, and its effectiveness was thoroughly investigated. Methods: Between May 2020 and May 2022, a total of 88 older adults postoperative patients were enrolled and randomly allocated into an experimental group and a control group. The experimental group received telemedicine services after discharge, while the control group received conventional medical services following the traditional protocol. One month after discharge, various indicators were evaluated for both groups, including number of visits, medical expenditures, postoperative recovery, anxiety, depression and satisfaction. Results: The number of visits and medical expenditures of the experimental group were less than those of the control group [1 (0, 1) vs. 1 (1, 2), Z = -3.977, p < 0.001; 25.25 (0.00, 277.40) yuan vs. 174.65 (49.63, 446.10) yuan, Z = -2.150, p = 0.032]. In both groups, there were 2 cases of incision infection, respectively. No significant difference was observed between the two groups (Fisher χ2, p = 0.259). In both groups, there was no instance of incision bleeding, incision dehiscence, readmission, or reoperation. Additionally, there was no significant difference in physical status between the two groups at discharge and after discharge (66.06 ± 8.92 vs. 65.45 ± 7.39 t = 0.287, p = 0.775; 73.33 ± 9.97 vs. 70.91 ± 7.50, t = 1.202, p = 0.235). And there was no significant difference in the change of physical status between the two groups after discharge [10.00 (0.00, 10.00) vs. 5.00 (0.00, 10.00), Z = -1.077, p = 0.281]. There was no significant difference in body weight change between the two groups after discharge [1.05 (0.38, 1.60) Kg vs. 0.80 (0.50, 1.43) Kg, Z = -0.265, p = 0.791]. There was no significant difference in the levels of anxiety and depression between the two groups at discharge (45.64 ± 8.10 vs. 44.60 ± 8.24, t = 0.520, p = 0.604, 48.33 ± 8.46 vs. 47.50 ± 6.85, t = 0.418, p = 0.677). But the levels of anxiety and depression in the experimental group were lower than those in the control group after discharge (34.92 ± 7.38 vs. 39.03 ± 8.42, t = -2.183, p = 0.032, 37.86 ± 7.29 vs. 41.93 ± 7.13, t = -2.281, p = 0.025); The change of anxiety level and depression level of the experimental group were more than those of the control group [-10.00 (-11.25, -8.75) vs. -5.00 (-7.81, -3.75), Z = -5.277, p < 0.001; -10.00 (-12.50, -7.50) vs. -5.00 (-7.75, -3.44), Z = -4.596, p < 0.001]. The level of satisfaction regarding medical services, daily care, and psychological comfort was higher in the experimental group compared to the control group [3 (3, 3.25) vs. 2 (1, 2), Z = -5.931, p < 0.001; 3 (3, 4) vs. 3 (2, 3), Z = -2.286, p = 0.022; 2 (1, 3) vs. 1 (0.75, 2), Z = -2.081, p = 0.037]. Conclusion: In the context of an aging society, telemedicine system can offer improved healthcare to older adults postoperative patients. This includes benefits such as reducing number of visits, saving medical expenditures, enhancing psychological comfort and daily care.


Assuntos
Telemedicina , Humanos , Idoso , Estudos de Viabilidade , Ansiedade , Transtornos de Ansiedade , Envelhecimento
19.
Acta Med Port ; 37(3): 198-206, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38430471

RESUMO

INTRODUCTION: The COVID-19 pandemic has accelerated the adoption of telemedicine as a means of reducing face-to-face contact and protecting professionals and patients. In Portugal, the number of hospital telemedicine consultations has significantly increased. However, the rapid implementation of telemedicine has also led to disparities in access to these services, resulting in inequalities in healthcare delivery. The aim of this study was to identify the main challenges to accessing hospital medical specialty consultations through telemedicine in Portugal during the COVID-19 pandemic. Additionally, this study aimed to establish a consensus on possible solutions for the challenges which were identified. METHODS: This study used the nominal group technique, which involved a panel of 10 experts. The panel generated a total of 71 ideas, which were then categorized into three groups: A) challenges relating to patients, which impact access to hospital-based medical specialty consultations through telemedicine; B) challenges relating to professionals, institutions and health systems, which impact access to hospital medical specialty consultations through telemedicine; C) recommendations to overcome the challenges faced in adopting telemedicine solutions. Each of the ideas was assessed, scored and ranked based on its relevance considering the study objectives. RESULTS: This study identified several significant challenges that impacted the adoption of telemedicine in Portugal during the COVID-19 pandemic. The challenges that related to patients (A) that were deemed the most relevant were low digital literacy, lack of information about telemedicine processes, low familiarity with technologies and distrust about the quality of services; the challenges that impacted healthcare professionals, institutions, and health systems (B) and were deemed the most relevant were the lack of integration of telemedicine in the patient's journey, low motivation to adopt telemedicine solutions, poor interoperability between systems, and the absence of the necessary technological equipment. The most relevant recommendations (C) included investing in healthcare institutions, developing clear guidelines for the safety and quality of telemedicine practices, and incorporating telemedicine into the curricula of health professions. CONCLUSION: This study identified several challenges that impacted the adoption and implementation of telemedicine services for hospital care in Portugal during the pandemic period. These challenges were related to digital health literacy, technological and operational conditions, and reluctance in technological adoption. To overcome these challenges, training programs for healthcare professionals and patients may be necessary, along with investment in technological infrastructures, interoperability between systems, effective communication strategies and the strengthening of specific regulations.


Assuntos
COVID-19 , Telemedicina , Humanos , COVID-19/epidemiologia , Pandemias , Portugal , Encaminhamento e Consulta , Hospitais
20.
J Allied Health ; 53(1): e43-e48, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38430503

RESUMO

Beginning in 2018, Mater Health was enacting its next stage of strategic planning focusing on services designed around consumers and strengthening technology to improve access to care and information for delivering better outcomes. Telehealth was part of the strategy. Allied health services sought to meet future community needs by increasing the number of its offsite or virtual services without the need for expensive infrastructure. Our aim was to reinforce allied health professional capability in telehealth, as part of sustainable allied health telehealth delivery. We used a Model for Improvement that included use of the Plan, Do, Study, Act cycles, incorporating a community of practice and evaluation framework with strategies such as appreciative inquiry designed to enhance communication and understanding among team members. Telehealth has proven of great value to health services and consumers during the COVID-19 pandemic. Scaling up of telehealth during the pandemic resulted in recognition of multiple factors needing to be addressed for telehealth to be sustainable. Our work provides insights into staff and consumer perspectives of TH, forming a basis for future telehealth research.


Assuntos
COVID-19 , Telemedicina , Humanos , Pandemias , Telemedicina/métodos , Serviços de Saúde , Pessoal Técnico de Saúde , COVID-19/epidemiologia
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