Assessing Telehealth in Palliative Care: A Systematic Review of the Effectiveness and Challenges in Rural and Underserved Areas.

The integration of telehealth into palliative care has garnered significant attention due to its potential to enhance both access and quality of care, particularly for patients in rural and underserved areas. This interest stems from the need to address geographical and logistical barriers that traditionally hinder palliative care delivery. Despite its potential benefits, the effectiveness of telehealth and the challenges associated with its implementation remain underexplored, necessitating further investigation. This study aims to critically evaluate the effectiveness of telehealth in palliative care by focusing on several key areas: its impact on access to care, symptom management, patient satisfaction, and cost-effectiveness. To achieve this, a systematic review was conducted, synthesizing data from various studies that investigated telehealth interventions within palliative care settings. The review employed a comprehensive search strategy across electronic databases, concentrating on randomized controlled trials (RTCs) published between 2014 and 2024. To ensure the reliability of the findings, low-quality and unrelated studies were excluded, and the remaining studies were meticulously analyzed for bias and methodological quality. The review's findings indicate that telehealth significantly enhances access to palliative care, allowing patients to receive timely and appropriate care without the need for extensive travel. It also improves symptom management and patient satisfaction, aligning to provide patient-centered care. Additionally, telehealth is cost-effective by reducing expenses associated with travel and in-person visits. These benefits highlight telehealth's potential to address some of the critical challenges in palliative care delivery. Despite its advantages, implementing telehealth in palliative care is not without challenges. Technological barriers, such as inadequate infrastructure and device limitations, pose significant hurdles. Integration issues, including the need for seamless incorporation into existing care systems, and varying levels of digital literacy among patients and caregivers, also impact the effectiveness of telehealth. Addressing these challenges is crucial for optimizing telehealth's implementation. Ensuring that telehealth solutions are accessible, user-friendly, and well-integrated into care practices is essential for fully leveraging its potential benefits.

Digital mental health intervention for schizophrenia spectrum and psychotic disorders: Protocol for a pragmatic feasibility study of Horyzons-Canada.

Background: Schizophrenia spectrum and other psychotic disorders (SSPD) are among the most debilitating of all mental disorders. While the evidence for psychosocial interventions such as cognitive behavioral therapy and peer support has significantly improved, access to these services remains limited. This paper describes a protocol for a pragmatic feasibility study of a digital mental health intervention (HoryzonsCa) that provides access to evidence-based psychosocial interventions, social networking, and clinical and peer support services through a secured, web-based platform for adults diagnosed with SSPD. Objective: The objectives are: (1) Adapt and translate HoryzonsCa for implementation in English and French; (2) Develop an implementation and training strategy; (3) Assess the acceptability, safety, and demand of HoryzonsCa; (4) Assess clinical outcomes and perceived impacts; (5) Examine the experiences and process of adapting and implementing HoryzonsCa; (6) Explore the role of sociocultural and demographic factors on HoryzonsCa outcomes and implementation. Methods: This feasibility study will use a single-group, pre-post, mixed-methods (QUAN-QUAL convergent) research design, with assessments at baseline and 12 weeks. The study aims to recruit 100 individuals (ages 18-50) diagnosed with SSPD from two healthcare settings in Canada. Data collection includes interview-based psychometric measures, self-reports, focus groups, and interviews with participants. The study will also collect qualitative data from moderators and the research team, and will be conducted entirely remotely. Conclusions: This study has been prospectively registered and is underway. It will provide timely information on the feasibility and potential impacts of using digital mental health services for individuals with chronic mental health conditions. Trial Registration: ISRCTN12561259; https://doi.org/10.1186/ISRCTN12561259 (250/max 250 words).

Advancing Antenatal Care in Ethiopia: The Impact of Tele-Ultrasound on Antenatal Ultrasound Access in Rural Ethiopia.

Introduction: Access to antenatal ultrasound is limited in low-income countries such as Ethiopia. Virtual care platforms that facilitate supervision and mentoring for ultrasound scanning may improve patient access by facilitating task-sharing of antenatal ultrasound with midlevel providers. The purpose of this study was to assess the feasibility of a large volume tele-ultrasound program in Ethiopia, its impact on antenatal care (ANC) and patient access, and its sustainability as it transitioned from a pilot project to a continuing clinical program. Methods: Health care providers at two health centers in the North Shoa Zone, Ethiopia, performed antenatal tele-ultrasound exams with remote guidance from obstetricians located in urban areas. Data regarding ANC and ultrasound utilization, participant travel, ultrasound findings, specialist referrals, and participant experience were collected through a mobile app. Results: Between November 2020 and December 2023, 7,297 tele-ultrasound exams were performed. Of these, 489 tele-ultrasound exams were performed during the period of data collection from October to December 2022. The availability of tele-ultrasound at the two health centers significantly reduced participant travel distance (4.2 km vs. 10.2 km; p < 0.01; one-way distance). Most participants (99.2%) indicated the tele-ultrasound service was very important or important, with high levels of satisfaction. Clinically significant findings were identified in 26 cases (5.3%), leading to necessary referrals. Conclusion: This study demonstrated the feasibility of a large volume tele-ultrasound program in Ethiopia, its impact on improving the quality of ANC, and its sustainability. These findings lay a foundation upon which low-income countries can develop tele-ultrasound programs to improve antenatal ultrasound access.

Growing inequities by immigration group among older adults: population-based analysis of access to primary care and return to in-person visits during the COVID-19 pandemic in British Columbia, Canada.

BACKGROUND: The onset of the COVID-19 pandemic drove a rapid and widespread shift to virtual care, followed by a gradual return to in-person visits. Virtual visits may offer more convenient access to care for some, but others may experience challenges accessing care virtually, and some medical needs must be met in-person. Experiences of the shift to virtual care and benefits of in-person care may vary by immigration experience (immigration status and duration), official language level, and age. We examined use of virtual care and return to in-person visits in the Canadian province of British Columbia (BC), comparing patterns by age and across immigration groups, including length of time in Canada and language level (official languages English and French) at time of arrival. METHODS: We used linked administrative health and immigration data to examine total primary care visits (virtual or in-person) and return to in-person visits during the COVID-19 pandemic (2019/20-2021/2) in BC. We examined the proportion of people with any primary care visits and with any in-person visits within each year as measures of access to primary care. We estimated the odds of any primary care visits and any in-person visits by immigration group and official language level assessed prior to arrival: non-immigrants, long-term immigrants, recent immigrants (< 5 years) with high assessed official language level and recent immigrants (< 5 years) with low assessed official language level (assessed prior to arrival), stratified by age. RESULTS: In general, changes in access to primary care (odds of any visits and odds of any in-person visits) were similar across immigration groups over the study period. However, we observed substantial disparities in access to primary care by immigration group among people aged 60 + , particularly in recent immigrants with low official language level (0.42, 0.40-0.45). These disparities grew wider over the course of the pandemic. CONCLUSION: Though among younger adults changes in access to primary care between 2019-2021 were similar across immigration groups, we observed significant and growing inequities among older adults, with particularly limited access among adults who immigrated recently and with low assessed official language level. Targeted interventions to ensure acceptable, accessible care for older immigrants are needed.

The telehealth surge: Speech-language pathology mode of service delivery and consumer characteristics during COVID-19.

PURPOSE: To examine the characteristics of speech-language pathology (SLP) consumers prior to and during the COVID-19 pandemic, with respect to the mode of service delivery within a local health district in New South Wales, Australia, to inform future health service planning. METHOD: Observational study examining SLP occasions of service data pre-COVID-19 (2019-2019; n = 6413) and during the COVID-19 pandemic (2020-2021; n = 6908). Spatial mapping and multilevel models were used to examine associations between sociodemographic characteristics, telehealth utilisation, and videoconferencing. RESULT: During COVID-19, SLP occasions of service increased by 7.7% compared to pre-COVID-19. Model 1 found odds of adopting telehealth (telephone or videoconference) during COVID-19 were significantly higher for those aged 0-4 and 5-17 years compared to older age groups. Consumers in inner regional areas were significantly less likely to adopt telehealth than in major city areas, whereas females were significantly more likely to adopt telehealth. Those living in areas experiencing higher relative disadvantage were less likely to use telehealth. Model 2 found odds of adopting videoconferencing only were also significantly higher for the younger age groups (0-4 and 5-17 years) and females. CONCLUSION: A rapid transition to a virtual model of care was critical to the successful delivery of SLP services during COVID-19. Immediate prioritisation and integration of targeted models of care, where suitability is high and benefits most likely to be experienced, is feasible.

Stakeholders' perspective on the development of a virtual clinic for patients with spinal cord injury: a qualitative study.

PURPOSE: This study aims to explore the priorities, preferences, and feedback of multiple healthcare professionals to inform the future development of virtual clinics for community-dwelling adults with spinal cord injury (SCI) in Ontario, Canada. METHODS: Interpretive description methodology was used to guide our exploration. Semi-structured interviews were conducted with 15 expert healthcare professionals (HCPs) involved in the care of patients with SCI. Interviews were recorded and transcribed verbatim. Interview transcripts were then analyzed using a six-phase thematic analysis approach. RESULTS: HCPs perceived virtual care to improve access to care over the long term, particularly to those living in rural areas, as well as increase connections between different providers. However, participants highlighted that in-person care is still required for management of severe SCI-related sequelae that can be life-threatening, such as pressure ulcers, spasticity, respiratory issues, and bowel and bladder complications. CONCLUSION: Our findings can be used to inform policymakers, HCPs, and stakeholders involved with SCI rehabilitation when establishing a virtual clinic for patients with SCI. Results of this study found that policymakers and HCPs should consider hybridized (blend of virtual and in-person) healthcare and uptake of multidisciplinary approaches within the virtual healthcare systems.

Healthcare professionals (HCPs) perceived virtual care to be accessible, convenient, and a practical approach to enhance access to care over the long term, particularly for those persons with spinal cord injury (SCI) living in remote areas.Persons with SCI could benefit from hybridized healthcare models (blend of in-person and virtual care) as it offers efficient care pathways, leads to a continuum of care, and creates more accessible healthcare for those with limited SCI healthcare options.HCPs and policymakers should consider the uptake of multidisciplinary approaches within virtual healthcare systems to optimize care delivery by digitally connecting providers from multiple disciplines and team members involved in caring for persons with SCI.

Evaluation of Virtual Care in Kidney Transplant Recipients in the Early Posttransplant Period.

BACKGROUND: Though virtual care was widely adopted during the COVID-19 pandemic, evidence to support its use in kidney transplant recipients early after transplantation is limited. METHODS: We conducted a retrospective cohort study comparing post kidney transplant outcomes in patients who received in-person transplant care before the COVID-19 pandemic with those who received mainly virtual transplant care during the COVID-19 pandemic. The usual-care group included 69 patients who received a kidney transplant from March 1, 2019 to September 1, 2019, and the virtual-care group included 64 patients who received a kidney transplant from September 1, 2020 to March 1, 2021. RESULTS: At 6 months, five patients in the usual-care group and three patients in the virtual-care group died. There was one graft loss and one episode of acute rejection in the usual-care group, and two episodes of acute rejection in the virtual-care group (p = 0.60). Estimated glomerular filtration rate was higher for patients in the virtual-care group (59 mL/min/1.73 m2 vs. 52 mL/min/1.73 m2, p = 0.046) and serum creatinine was not different (138 µmol/L vs. 127 µmol/L, p = 0.27). There was no difference in mean blood pressure or hospitalizations. CONCLUSION: Outcomes were similar among recipients of a kidney transplant prior to the COVID-19 pandemic when care was mainly in person and during the pandemic when care was mainly virtual, without a signal of harm. Patient and donor selection may have led to unmeasured differences between groups.

Virtual Versus In-Person Follow-up After a Psychiatric Emergency Visit: A Population-Based Cohort Study: Suivi virtuel opposé à en personne après une visite à l'urgence psychiatrique : une étude de cohorte dans la population.

OBJECTIVE: With increased utilization of virtual care in mental health, examining its appropriateness in various clinical scenarios is warranted. This study aimed to compare the risk of adverse psychiatric outcomes following virtual versus in-person mental health follow-up care after a psychiatric emergency department (ED) visit. METHODS: Using population-based health administrative data in Ontario (2021), we identified 28,232 adults discharged from a psychiatric ED visit who had a follow-up mental health visit within 14 days postdischarge. We compared those whose first follow-up visit was virtual (telephone or video) versus in-person on their risk for experiencing either a repeat psychiatric ED visit, psychiatric hospitalization, intentional self-injury, or suicide in the 15-90 days post-ED visit. Cox proportional hazard models generated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs), adjusted for age, income quintile, psychiatric hospitalization, and intentional self-injury in the 2 years prior to ED visit. We stratified by sex and diagnosis at index ED visits based on the International Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD-10-CA) coding. RESULTS: About 65% (n = 18,354) of first follow-up visits were virtual, while 35% (n = 9,878) were in-person. About 13.9% and 14.6% of the virtual and in-person groups, respectively, experienced the composite outcome, corresponding to incidence rates of 60.9 versus 74.2 per 1000 person-years (aHR 0.95, 95% CI 0.89 to 1.01). Results were similar for individual elements of the composite outcome, when stratifying by sex and index psychiatric diagnosis, when varying exposure (7 days) and outcome periods (60 and 30 days), and comparing "only" virtual versus "any" in-person follow-up during the 14-day follow-up. CONCLUSIONS AND RELEVANCE: These results support virtual care as a modality to increase access to follow-up after an acute care psychiatric encounter across a wide range of diagnoses. Prospective trials to discern whether this is due to the comparable efficacy of virtual and in-person care, or due solely to appropriate patient selection may be warranted.

Virtual care pathways for people living with HIV: A mixed-methods systematic review.

BACKGROUND: The COVID-19 pandemic prompted an unprecedented surge in virtual services, necessitating a rapid shift to digital healthcare approaches. This review focuses on evaluating the evidence of virtual care (VC) in delivering HIV care, considering the complex nature of HIV and the need for tailored-approaches, especially for marginalized populations. METHODS: A mixed-methods systematic review was performed with searches on five databases, covering studies from January 1946 to May 2022. Inclusion criteria involved two-way virtual consultations between healthcare workers and people living with HIV (PLHIV), with detailed descriptions and outcomes. Qualitative and quantitative studies were included, and the risk of bias was assessed using the Newcastle-Ottawa score and Stenfors' framework. RESULTS: Among 4143 identified records, 26 studies met the criteria, with various models of care described. The majority of studies were observational, and videoconferencing was the primary mode of virtual consultation employed. Quantitative analysis revealed PLHIV generally accept VC, with high attendance rates (87%). Mean acceptability and satisfaction rates were 80% and 85%, respectively, while 87% achieved HIV viral suppression. The setting and models of VC implementation varied, with some introduced in response to COVID-19 while others were as part of trials. CONCLUSIONS: VC for PLHIV is deemed an acceptable and effective approach and is associated with good virological outcomes. Data on other health outcomes is lacking. The review underscores the importance of diverse models of care, patient choice and comprehensive training initiatives for both staff and patients. Establishing a 'gold standard' for VC models is crucial for ensuring appropriate and effective reviews of PLHIV in virtual settings.

Postoperative outcomes among patients evaluated via telemedicine-based preoperative consultations for inguinal hernia care.

PURPOSE: In an era where telehealth is gaining traction within healthcare systems, its integration into preoperative assessment protocols presents both challenges and opportunities. Preoperative assessments have an important role in determining the best plan of action for each patient. Recent studies have reported adequate operative outcomes after telemedicine preoperative consultations. This study examines telehealth's efficacy relative to traditional in-person evaluations in the context of preoperative consultations for inguinal hernia repairs and provides a deeper insight into how telemedicine might be utilized for pre-surgical assessments. METHODS: We analyzed a prospectively maintained single-center database at a tertiary referral hospital with a dedicated hernia and abdominal wall reconstruction center for pre, intra and postoperative variables comparing patients that received telemedicine (phone or video) preoperative consultations versus in-person clinic visits only. Secondary analysis with propensity score matching was employed to adjust for possible confounders. RESULTS: 265 patients that underwent inguinal hernia repair were included, with 60 encounters being telemedicine only and the rest in-person. This analysis found no difference in rates of postoperative complications between the telemedicine and in-person groups. The telemedicine group required less preoperative encounters with their surgeon (P < 0.001). In the preoperative in-person group, 41% switched to virtual follow-ups, while in the virtual group, only 18% chose in-person follow-ups (P = 0.003). CONCLUSIONS: Based on our analysis, the use of telemedicine for preoperative assessments in inguinal hernia repairs as a feasible and safe choice for patients opting for this approach, potentially reshaping the preoperative paradigm in surgical practices.

US cat caregivers' attitudes on veterinary video telemedicine.

OBJECTIVES: Many cats do not see a veterinarian on an annual basis, and their caregivers face many barriers to accessing veterinary care. A potential solution to overcome some of these barriers is video telemedicine. Thus, the aim of this study was to understand companion cat caregivers' perceptions of using veterinary video telemedicine with their cats. METHODS: An online quantitative questionnaire was used to survey US cat caregivers on their experiences of and attitudes to using video telemedicine with their cats. Participants were required to reside in the USA, be the primary caregiver of at least one cat and be aged 18 years or older. RESULTS: The majority (97.3%) of the 1254 respondents indicated they had never used a video telemedicine appointment with their cat(s) before; however, most (85.7%) indicated they were very or somewhat interested in using video telemedicine with their cat. Overall, caregivers perceived video telemedicine visits as less stressful for themselves (P <0.0002) and their cats (P <0.0001), and as increasing their access to veterinary care (P <0.0001) compared with in-clinic visits. Participants also indicated they would prefer a video telemedicine appointment over an in-clinic appointment for most cat behavioral concerns but preferred in-clinic appointments for most health concerns. Most respondents (51.3%) indicated they would be willing to pay a little less for a telemedicine appointment than an in-clinic visit. CONCLUSIONS AND RELEVANCE: Cat caregivers represent an important population that could benefit from the implementation of video telemedicine into veterinary care. Our results suggest many US cat caregivers indicate an interest and willingness to pay for video telemedicine visits to increase their access to veterinary care and reduce stress associated with veterinary visits for both themselves and their cats. Caregivers showed more interest in using video telemedicine for behavioral concerns than health concerns.

Video and phone visit use differed by language preference among U.S. Latino and Chinese adults during the first 9 months of the COVID-19 pandemic: a cross-sectional electronic health record study.

BACKGROUND: During the first nine months of the COVID-19 emergency, patients were encouraged to use virtual versus clinic visits if in-person care was not deemed necessary by clinical staff. This study examined the association of spoken language preference and ethnicity with use of video versus phone virtual visits by US Latino and Chinese adult patients who got care in the same healthcare system. METHODS: We analyzed electronic health record data for four groups of adults aged 26-85y who had ≥ 1 primary or specialty care outpatient clinician visits during April-December 2020: 80,869 Latino adults preferring Spanish (LEP Latino); 214,765 Latino adults preferring English (non-LEP Latino); 23,430 Chinese adults preferring a Chinese dialect (LEP Chinese); and 49,710 Chinese adults preferring English (non-LEP Chinese). Prevalence of the following utilization outcomes were compared by language preference (LEP/non-LEP) within ethnicity and by ethnicity within language preference for four age subgroups (26-39y, 40-64y, 65-75y, and 76-85y): ≥ 1 virtual (video or phone) visit, ≥ 1 video visit, ≥ 1 phone visit, ≥ 1 clinic visit, video visits only, and phone visits only. We also compared ethnicity x language group differences within age subgroups using absolute difference and adjusted prevalence ratios derived from modified log-Poisson regression models that controlled for age and sex. RESULTS: Among virtual users, LEP Latino and Chinese adults were significantly less likely to use video visits and more likely to use phone visits than non-LEP Latino and Chinese adults in the same age strata. The LEP/non-LEP difference in video visit use was significantly larger among Latino than Chinese patients, with no similar ethnic group difference observed for phone visits. Within the LEP and non-LEP language groups, Chinese adults were significantly more likely than Latino adults to use video visits and less likely to use phone visits. CONCLUSIONS: During the first nine months of the COVID-19 pandemic, uptake of video and phone virtual visits by Latino and Chinese adults significantly differed by LEP/non-LEP status within ethnicity and by ethnicity within LEP/non-LEP language group. These findings underscore the importance of disaggregating data by ethnicity and language preference when attempting to understand and study patient use of different virtual visit modalities.

Evaluating the impact of COVID-19 on medication adherence and health care utilization among individuals with psychotic disorders who are prescribed long-acting injectables (LAIs) or clozapine: A population-based study in Manitoba, Canada.

BACKGROUND: Ongoing psychiatric follow-up and medication adherence improve outcomes for patients with psychotic disorders. Due to COVID-19, outpatient care may have been disrupted, impacting healthcare utilization. METHODS: A retrospective population-wide study was conducted for adults in Manitoba, Canada. Medication adherence and healthcare utilization were examined from 2019 to 2021. The presence of a diagnosed psychotic disorder was identified in the five years before the index date in each year. The LAI and clozapine cohorts consisted of those who received at least two prescriptions in each year 180 days before the March 20th index date. The change in adherence was measured using the average Medication Possession Ratio. Healthcare utilization rates were compared using Generalized Estimating Equation models. RESULTS: There were no significant differences between LAI and clozapine discontinuation rates before and during the pandemic. In the LAI cohort, general practitioner visits decreased significantly (-3.5 %, p = 0.039) across four quarters of 2021 versus 2019. All-cause hospitalizations decreased by 16.8 % in 2020 versus 2019 (p = 0.0055), while psychiatric hospitalizations decreased by 18.7 % across four quarters in 2020 (p = 0.0052) and 13.7 % in 2021 (p = 0.0425), versus 2019 in the LAI cohort. There was a significant transition to virtual care during the first wave of COVID-19 (71 % in clozapine, 51 % in LAI cohorts). Trends in total outpatient visits and non-psychiatric hospitalizations remained stable. CONCLUSION: COVID-19 had no substantial impact on LAI and clozapine discontinuation rates for patients previously adherent. Outpatient care remained stable, with a significant proportion of visits being done virtually at the outset of the pandemic.

Exploring Student Perspectives and Experiences of Online Opportunities for Virtual Care Skills Development: Sequential Explanatory Mixed Methods Study.

BACKGROUND: Caring profession students require skills and competencies to proficiently use information technologies for providing high-quality and effective care. However, there is a gap in exploring the perceptions and experiences of students in developing virtual care skills within online environments. OBJECTIVE: This study aims to better understand caring professional students' online learning experiences with developing virtual care skills and competencies. METHODS: A sequential explanatory mixed methods approach, integrating both a cross-sectional survey and individual interviews, was used to better understand caring professional students' online learning experiences with developing virtual care skills and competencies. RESULTS: A total of 93 survey and 9 interview participants were drawn from various faculties, including students from education, nursing, medicine, and allied health. These participants identified the barriers, facilitators, principles, and skills related to learning about and delivering virtual care, including teaching methods and educational technologies. CONCLUSIONS: This study contributes to the growing body of educational research on virtual care skills by offering student insights and suggestions for improved teaching and learning strategies in caring professions' programs.

Virtual physical examination in teleconsultation: A scoping review.

BACKGROUND: The conduct of virtual physical examination has provided significant information for the diagnosis during a teleconsultation session, especially during the COVID-19 pandemic, where in-person physical examinations have been greatly compromised. OBJECTIVE: The aim of this scoping review was to provide a comprehensive overview of the available evidence concerning virtual physical examination (VPE) in all healthcare settings during the COVID-19 pandemic. The review focuses on types of VPE, technological and non-technological approaches, patient and clinician experiences, as well as barriers and facilitators of VPE. METHODS: A literature search was conducted across three databases, namely MEDLINE, Embase, and Scopus. Only studies in the English language with primary research data collected from December 2019 to January 2023 were included. A narrative analysis, highlighting patients' and clinicians' experiences, was conducted on the included studies. This scoping review was reported using The PRISMA extension for scoping reviews (PRISMA-ScR) Checklist. RESULTS: A total of 25 articles meeting eligibility criteria were identified. Three major types of VPE included were musculoskeletal, head and neck, and chest exams. Sixteen studies involved specific technological aids, while three studies involved non-technological aids. Patients found VPE helped them to better assess their disease conditions, or aided their clinicians' understanding of their conditions. Clinicians also reported that VPE had provided enough clinically relevant information for decision-making in 2 neurological evaluations. Barriers to conducting VPE included technological challenges, efficacy concerns, confidence level of assistants, as well as patient health conditions, health literacy, safety, and privacy. CONCLUSIONS: Patients found virtual physical examination (VPE) helpful in understanding their own conditions, and clinicians found it useful for better assessing patient's conditions. From the clinicians' point of view, VPE provided sufficient clinically relevant information for decision-making in neurological evaluations. Major barriers identified for VPE included technological issues, patient's health conditions, and their health literacy.

Translating in-person care to telehealth: analysis of GP consultations on musculoskeletal conditions.

BACKGROUND: The COVID-19 pandemic led to a rapid transition to telehealth particularly in general practice (GP) where continuous care for chronic conditions such as musculoskeletal (MSK) is provided. AIM: To determine the appropriateness of telehealth for MSK by identifying whether in-person tasks can be supported remotely via telehealth. DESIGN & SETTING: This study is a secondary analysis of the HaRI dataset. This dataset comprises of 281 videos of recorded GP consultations. The data set includes 10 general practitioners, across 8 separate clinics and was collected during 2017 in the United Kingdom. METHOD: Content analysis was conducted to identify the clinical tasks, physical examinations and physical artefacts used during the consultations. A scoring method applying two key metrics was developed to assess the translatability of clinical tasks to telehealth. RESULTS: Across the 31 MSK consultations analysed, 12 clinical tasks, five physical examinations and 12 physical artefacts were observed. Of clinical tasks, 17% (2/12) were deemed to be 'easily translatable over telehealth' and 50% (5/12) were deemed 'relatively easy to be translated over telehealth'. Only 17% (2/12) of tasks were rated 'moderately translatable over telehealth', and 17% (2/12) were deemed 'potentially translatable over telehealth'. No clinical tasks in this study were categorised as untranslatable to telehealth. The average telehealth translatability score was 7.1/10. CONCLUSION: Most clinical tasks observed during in-person GP consultations with MSK patients are translatable to telehealth. Further research is necessary to investigate the long-term efficacy and safety of telehealth utilisation for MSK in primary care.

Reliability, usability, and efficiency of video versus print instructions to teach parents a procedural task: A cross-sectional study.

OBJECTIVE: To compare the reliability, usability, and efficiency of video versus print instructions to teach parents a procedural measurement task. We hypothesized that videos would outperform print in all outcomes. STUDY DESIGN: This cross-sectional study included parents/caregivers of children aged 0-18 years with deep vein thrombosis attending the Thrombosis Clinic at The Hospital for Sick Children for post-thrombotic syndrome (PTS) assessment. Participants were randomly assigned to three instruction types: (i) video, which followed the technique used by clinicians; (ii) long pamphlet, which also followed the clinicians' technique; and (iii) short pamphlet, which explained a simplified technique. After measuring their children's arms or legs using the randomly assigned material, participants completed a usability questionnaire. The reliability of the instructions was estimated by comparing parents/caregivers versus clinicians' measurements using the intraclass correlation coefficient (ICC). Reliability, usability, and efficiency (time to task completion) were compared among the three instruction types. RESULTS: In total, 92 participants were randomized to video (n = 31), long pamphlet (n = 31), and short pamphlet (n = 30). While the video had the highest usability, the short pamphlet was the most reliable and efficient. ICCs were .17 (95% confidence interval [CI]: .00-.39) for the video, .53 (95% CI: .30-.72) for the long pamphlet, and .70 (95% CI: .50-.81) for the short pamphlet. CONCLUSION: Although the video had higher usability, the short/simplified print instruction was more reliable and efficient. However, the reliability of the short pamphlet was only moderate/good, suggesting that whenever possible, measurements should still be obtained by trained clinicians.

A Virtual Assessment Model for At-Home Evaluation of Suspected Viral Hemorrhagic Fever Cases.

The Sudan virus disease outbreak in 2022 prompted the Denver Health High-Risk Infection Team (HITeam) to evaluate and implement novel strategies to respond to viral hemorrhagic fever (VHF) events. To improve the VHF response, HITeam members developed a virtual assessment model (VAM) for at-home evaluation of individuals who are suspected of having a VHF. The VAM incorporates aspects of care that would normally be rendered in a high-level isolation unit-including assessment and monitoring, specimen collection, provider consultation, patient and family teaching, and pharmaceutical intervention-into a mobile framework in which team members respond to a suspected case at the individual's home. Building this capability allows for more thorough assessment of a suspect case in the field, as well as the postponement of a decision about activation of the high-level isolation unit until more information is available. Development, testing, and implementation of the VAM required input from an interdisciplinary group of partners that demonstrated the ability of nurses, physicians, laboratorians, paramedics, emergency medical technicians, and public health personnel to integrate into 1 cohesive care team. The resulting model recenters VHF care on the patient by allowing the care team to gather critical information in an environment that is more comfortable for the suspect case while keeping communities safe and lowering exposure risks. The VAM has long-term sustainability implications for global VHF programs and provides solutions for broader challenges in healthcare by modeling cost-effective, patient-centered care within the highly nuanced subspecialty of special pathogen care.

The benefits of a virtual emergency department observation unit for hospital observation patients.

BACKGROUND: The benefit of virtual emergency department observation unit (EDOU) care relative to traditional observation care in an inpatient bed is unknown. OBJECTIVE: To determine if virtual observation care in an EDOU is associated with improved length of stay, cost, inpatient admission rate, and adverse events relative to traditional observation care in non-observation unit (NOU) inpatient bed. METHODS: This is a retrospective observational cohort study of observation patients managed over 24 months in two urban teaching hospitals. Following an ED visit, observation care occurred in a virtual-EDOU or NOU inpatient setting based on bed availability, physician discretion, and observation guidelines. Primary outcomes were length of stay, total cost, inpatient admission rate, and adverse events (death or ICU admission). Hospital cost and clinical databases were used. Analysis with a doubly-robust regression with entropy balancing and propensity scores was used to control for subgroup differences. RESULTS: 30,191 observation patients were divided into 13,753 NOU patients and 16,438 EDOU patients with similar distributions for age and gender, and differences in health insurance and diagnosis. For both discharged and admitted patients, the mean cost was higher in the NOU setting at $7989 than the virtual-EDOU setting at $4876 with an adjusted difference of $1951 (95% CI: $1762-$2133). The mean total length of stay was higher in the NOU setting (60.5 h) than the virtual-EDOU setting (36.4 h) with an adjusted difference of 20.4 h (95% CI: 19.2 h - 21.3 h). NOU inpatient admission rates were higher (25.3% vs 18.4%). Cost and length of stays were lower in discharged observation patients, with differences favoring the virtual-EDOU group. Adverse events were higher in the NOU setting (2.1% vs 0.8%). 30-day ED recidivism did not differ significantly between NOU and virtual-EDOU study groups. The virtual-EDOU saved the two hospitals $16,036,913 and 6986 bed-days annually. CONCLUSION: Management of observation patients in a virtual-EDOU setting is superior to care in a traditional inpatient setting in terms of costs, length of stays, inpatient admission and adverse events rates.

An Approach to the Design and Development of an Accredited Continuing Professional Development e-Learning Module on Virtual Care.

Unlabelled: Virtual care appointments expanded rapidly during COVID-19 out of necessity and to enable access and continuity of care for many patients. While previous work has explored health care providers' experiences with telehealth usage on small-scale projects, the broad-level adoption of virtual care during the pandemic has expounded opportunities for a better understanding of how to enhance the integration of telehealth as a regular mode of health care services delivery. Training and education for health care providers on the effective use of virtual care technologies are factors that can help facilitate improved adoption and use. We describe our approach to designing and developing an accredited continuing professional development (CPD) program using e-learning technologies to foster better knowledge and comfort among health care providers with the use of virtual care technologies. First, we discuss our approach to undertaking a systematic needs assessment study using a survey questionnaire of providers, key informant interviews, and a patient focus group. Next, we describe our steps in consulting with key stakeholder groups in the health system and arranging committees to inform the design of the program and address accreditation requirements. The instructional design features and aspects of the e-learning module are then described in depth, and our plan for evaluating the program is shared as well. As a CPD modality, e-learning offers the opportunity to enhance access to timely continuing professional education for health care providers who may be geographically dispersed across rural and remote communities.