Are We Adequately Measuring Patient Satisfaction with Telemedicine? A Systematic Review with a Meta-Analysis.

Introduction: Telemedicine has gained significant attention as an effective means of providing health care remotely, particularly during the COVID-19 pandemic. Patient satisfaction is a critical aspect of implementing telemedicine, but we have no comprehensive understanding of satisfaction levels and the associated factors. The aim of this systematic review and meta-analysis was to assess patient satisfaction related to telemedicine consultations and to identify key factors influencing satisfaction levels. Results: The search yielded a total of 147 cross-sectional studies, of which 107 met the criteria for inclusion in the meta-analysis. Overall, patient satisfaction with teleconsultations was found to be high, with satisfaction levels ranging from 38 to 100 on a scale of 0 to 100. Only a small percentage (2.72%) of the studies reported satisfaction levels below 75%. Surprisingly, most studies used nonvalidated satisfaction questionnaires, which highlight the need for the development of standardized measurement instruments. Conclusions: This systematic review and meta-analysis provide evidence that patients generally exhibit high levels of satisfaction with telemedicine consultations. The use of nonvalidated satisfaction questionnaires in many studies, however, suggests a need for more standardized assessment tools. Factors such as the time interval between the consultation and the assessment were found to influence satisfaction levels. Understanding these factors can help health care providers improve telemedicine services and patient-provider relationships and optimize health care delivery in the context of telemedicine. Further research is warranted to develop validated satisfaction measurement instruments and explore any additional factors that influence patient satisfaction with telemedicine.

Telemedicine Versus Face-to-Face Care in Ophthalmology: Costs and Utility Measures in a Real-World Setting.

OBJECTIVES: Advances in telemedicine offer a unique opportunity to expand access to the health system. Nevertheless, few studies have described the impact of telediagnosis implementation on health and economic outcomes. METHODS: An ophthalmology telediagnosis service (TeleOftalmo) was compared with traditional face-to-face care provided by the Brazilian public health system. For both groups, utility data were collected at 2 time points using the Visual Function Questionnaire-Utility Index instrument from interviews with 536 patients. The cost per patient encounter was analyzed according to the time-driven activity-based costing. Value analyses were conducted to ascertain whether and how telemedicine service has the potential to generate cost savings for the health system. RESULTS: Visual function-related quality of life did not differ significantly between TeleOftalmo and face-to-face care groups. Using the current model, the telemedicine service assisted an average of 1159 patients per month at a median cost per telediagnosis of Int$97 (interquartile range, Int$82-Int$119) versus Int$77 (interquartile range, Int$75-Int$80) for face-to-face care. If the telemedicine service was redesigned, considering the opportunities for improvement identified, it could operate at a cost of Int$53 per telediagnosis (a 31% cost savings) and could serve 3882 patients per month. CONCLUSIONS: This study demonstrates the potential value of a telemedicine service. There was no difference in patient-perceived utility between a telediagnostic ophthalmology service and face-to-face care by an eye specialist. TeleOftalmo has the potential to be a cost-saving strategy for the Brazilian health system and could be a template for implementation of telediagnostic services in other regions.

Teaming-up nurses with ophthalmologists to expand the reach of eye care in a middle-income country: Validation of health data acquisition by nursing staff in a telemedicine strategy.

Telemedicine can be used to conduct ophthalmological assessment of patients, facilitating patient access to specialist care. Since the teleophthalmology models require data collection support from other health professionals, the purpose of our study was to assess agreement between the nursing technician and the ophthalmologist in acquisition of health parameters that can be used for remote analysis as part of a telemedicine strategy. A cross-sectional study was conducted with 140 patients referred to an ophthalmological telediagnosis center by primary healthcare doctors. The health parameters evaluated were visual acuity (VA), objective ophthalmic measures acquired by autorefraction, keratometry, and intraocular pressure (IOP). Bland-Altman plots were used to analyze agreement between the nursing technician and the ophthalmologist. The Bland-Altman analysis showed a mean bias equal to zero for the VA measurements [95%-LoA: -0.25-0.25], 0.01 [95%-LoA: -0.86-0.88] for spherical equivalent (M), -0.08 [95%-LoA: -1.1-0.95] for keratometry (K) and -0.23 [95%-LoA: -4.4-4.00] for IOP. The measures had a high linear correlation (R [95%CI]: 0.87 [0.82-0.91]; 0.97 [0.96-0.98]; 0.96 [0.95-0.97] and 0.88 [0.84-0.91] respectively). The results observed demonstrate that remote ophthalmological data collection by adequately trained health professionals is viable. This confirms the utility and safety of these solutions for scenarios in which access to ophthalmologists is limited.

Telemedicine in Pediatric Intensive Care Units: Perspectives From a Brazilian Experience.

Purpose of Review: To present the implementation of a telemedicine project (TeleICU) in pediatric intensive care units (ICU) throughout different Brazilian regions. Recent Findings: Although telemedicine in pediatric ICUs has shown evidence of benefit in numerous studies with potential to 18 mitigate existing disparities, in Brazil, its use is still under development. Brazil has several opportunities for implementing this resource since, according to the National Registry of Healthcare 20 Establishments (NRHE), there is a discrepancy in the density of pediatric intensive care physicians per patient and the availability 21 of pediatric ICU beds per number of inhabitants. Summary: Health technologies are being widely used to fill gaps in the healthcare system. Telemedicine has been an important tool to meet demands in intensive care units, especially the demand for specialized assistance. TeleICU is a Brazilian model of telemedicine that performs multidisciplinary telerounds in remote pediatric ICUs and develops continuing education activities for the healthcare teams. The project aims to systematize and to qualify care, as well as to reduce risks for patients admitted to pediatric ICUs engaged in the project. Preliminary results have demonstrated a positive impact regarding this approach, providing medical care to 6640 inpatients-day in two Brazilian pediatric ICUs, for 616 patients during 946 daily telerounds. Supplementary Information: The online version contains supplementary material available at 10.1007/s40124-021-00242-z.

The use of telemedicine in the PICU: A systematic review and meta-analysis.

The use of telemedicine in ICUs has grown and is becoming increasingly recognized. However, its impact on PICUs remains unclear. This systematic review and meta-analysis aimed to evaluate whether telemedicine in the PICU has the potential to improve clinical and non-clinical outcomes. PubMed, Scopus, LILACS, and CINAHL electronic databases were searched to identify studies that assessed the impact of telemedicine on clinical outcomes, with no publication date restrictions. The reference lists of the selected articles were hand-searched for additional studies that had not been identified by the initial electronic search. Studies were included if they had a cohort design, used telemedicine, were conducted in PICUs or specialized PICUs, and were published in Portuguese, English, or Spanish. Two groups of reviewers independently screened titles and abstracts for inclusion. The same group of reviewers independently assessed the full-text articles for eligibility and extracted the following information: telecommunication method, intervention characteristics, patient characteristics, sample size, and main results. Studies were meta-analyzed using a random-effects model to estimate the pooled prevalence of PICU mortality and length of PICU stay. Risk of bias was assessed using the Newcastle-Ottawa Scale. Of 2703 studies initially identified, 2226 had their titles and abstracts screened. Of these, 53 were selected for full-text reading, of which 10 were included and analyzed. The main results of interest were length of PICU stay, number of deaths or mortality rate, and satisfaction of health professionals and family members. The results of meta-analysis show that the mortality rate reduced by 34% with an increase of the length of PICU stay in the PICUs with the use of telemedicine. Family members and health professionals were satisfied with the use of telemedicine. Telemedicine has the potential to improve PICU outcomes, such as mortality rate and family and staff satisfaction. However, it extended length of PICU stay in the studies included in this systematic review.

Correction to: Symptoms Suggestive of Dysphagia and the Quality of Life in Cocaine and/or Crack Users.

The original version of this article unfortunately contained a mistake. The spelling of the Sheila Taminini de Almeida name was incorrect.

Symptoms Suggestive of Dysphagia and the Quality of Life in Cocaine and/or Crack Users.

Users of cocaine and/or crack may present symptoms of dysphagia due to changes in anatomical structures caused by the use of these substances. The objective of this study was to investigate the presence of symptoms suggestive of dysphagia in users of cocaine and/or crack seeking treatment, as well as to investigate the quality of life of these individuals related to their swallowing condition. A cross-sectional study from September 2015 to December 2016, with 121 users of cocaine and/or crack, was conducted. 59 of them called a telemarketing service and 61 sought treatment at the Centro de Atenção Psicossocial Álcool e Drogas in Porto Alegre (Psychosocial Alcohol and Drug Center). Users were screened and asked to fill the Eating Assessment Tool questionnaire. Users who presented themselves at the center were submitted to the Tool Volume-Viscosity Swallow Test. Users with symptoms of dysphagia responded to the Quality of Life in Swallowing questionnaire. Of all the interviewees, 22.3% (n = 27) reported symptoms suggestive of dysphagia and 2% of the individuals, submitted to swallowing test, presented cough in the liquid consistency. The scores showed a negative impact on quality of life, mainly related to fatigue, sleep, feeding duration, and fear of eating. Significant numbers of users of cocaine and/or crack referred to symptoms suggestive of dysphagia and significant impairments in quality of life, which require specific care in feeding this population in order to assist in their rehabilitation.

Recommendations for the Prevention of Bisphosphonate-Related Osteonecrosis of the Jaw: A Systematic Review.

OBJECTIVES: The aim of this study was to assess the quality of and outline the differences among recommendations of published clinical practice guidelines (CPGs) for the management of bisphosphonate-associated osteonecrosis of the jaw. METHODS: We conducted a systematic literature search in PubMed, Cochrane, Embase, Web of Science, and Google web site. We selected CPGs supported by a nongovernmental organization or national institutes, related to bisphosphonate-associated osteonecrosis of the jaw in adults, in English language, and dated from January 2008 onward. The validity of each included CPG was appraised according to 2 validated appraisal tools for CPG that were independently used by 2 reviewers. RESULTS: We identified 724 articles, of which 13 were included based on our eligibility criteria. Most CPGs were of good quality based on the appraisal tools for CPGs used in this study. CONCLUSION: We did not find consensus on all the recommendations of the evaluated CPGs. Thus, each clinical case must be assessed individually, considering the risks and benefits on the proposed dental treatment.

Factors Associated With Attrition in Randomized Controlled Trials of Vocal Rehabilitation: Systematic Review and Meta-Analysis.

OBJECTIVES/HYPOTHESIS: This study aimed to determine the dropout rates and the reasons for dropout in randomized clinical trials of vocal rehabilitation. STUDY DESIGN: This study used systematic review and meta-analysis (CRD42013003807). METHODS: We included randomized controlled trials for voice disorders. In June 2015, we searched the following databases: MEDLINE, EMBASE, Cochrane, Clinical Trials, and AJSLP. The titles and abstracts or full texts of articles were independently analyzed by two reviewers. Study quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) scale. Our initial research base included more than 8491 articles. RESULTS: A total of 51 articles were obtained using our eligibility criteria. The low-quality studies evaluated had higher dropout rates (odds ratio: 3.3, 95% confidence interval: 1.04-12.9). Studies with healthy patients (45%) or vocal training versus no training (25%) also had higher dropout rates. Methodological issues seemed to have a greater influence on the dropout rates of the studies included in the co-occurrence matrix. CONCLUSIONS: Dropout rates of approximately 15% occur in randomized clinical trials of speech therapy when assessed by the Grading of Recommendations Assessment, Development and Evaluation. Studies with lower methodological quality had higher patient loss rates. Methodological and clinical reasons accounted for the highest dropout rates in the studies included in this meta-analysis.