Telemedicine in specialist outpatient care during COVID-19: a qualitative study.

BACKGROUND: COVID-19 accelerated healthcare changes, introducing various telehealth services. Work is needed to determine the suitability of telemedicine in the post-pandemic era. AIMS: To explore perceptions and experiences of telemedicine among patients and providers (clinicians and health administrators) who were involved in telemedicine appointments in hospital outpatient clinics in 2020-2022. DESIGN, SETTING AND PARTICIPANTS: Qualitative study: semi-structured interviews were conducted with 37 participants (16 patients and 21 providers) in various hospital specialist outpatient clinics in a New South Wales local health district. RESULTS: Patients were generally satisfied with telemedicine consultations, especially during COVID restrictions, because of the convenience of accessing care from home and minimising the risk of COVID exposure. However, patients considered that the inability to receive a physical examination was a significant disadvantage of telemedicine. Providers had ambivalent perceptions and expressed concerns about mis- and under-diagnoses because of the inability to conduct physical examinations. They considered telemedicine suitable for review appointments but noted an associated increased workload and stressed the need for sustainable funding models (Medicare items). Both patients and providers recognised the need for education/training and better integration of telemedicine platforms into existing infrastructure to facilitate an optimal hybrid model of care. CONCLUSION: Despite expressing some concerns over its limitations, patients valued telemedicine for its convenience and for meeting their needs during the pandemic. While acknowledging that patients experienced some benefits from telemedicine, clinicians expressed concerns about potential missed diagnoses, uncertain clinical outcomes and lack of administrative and technological infrastructure. The ultimate test of telemedicine will be its impact on clinical outcomes versus longstanding models of in-person care.

Efficacy of self-management mobile applications for patients with breathlessness: Systematic review and quality assessment of publicly available applications.

INTRODUCTION: Apps can play a role in self-management of symptoms such as breathlessness. This systematic review aims to evaluate the clinical efficacy of breathlessness apps and assess the quality of those publicly available. METHODS: The full protocol for this systematic review is available on PROSPERO (CRD42021246277). Studies published between January 2010 to 2022 were obtained from six academic databases and included if they evaluated apps that offered breathlessness education and personalised feedback. Outcomes of interest included change in breathlessness and quality of life. Additionally, quality assessment was conducted on apps addressing breathlessness publicly available from Google Play, iOS app store, and regulatory agency libraries. RESULTS: A total of 2774 records were screened and 16 studies included in the systematic review. Disease groups addressed were chronic obstructive pulmonary disease, asthma, fibrotic lung disease, lung cancer, and heart failure. Use of mobile apps was found to result in clinical benefit especially when utilised for longer periods of time. For publicly available apps, a total of 776 apps were screened and 6 apps included. The mean quality rating using the Mobile App Rating Scale was 3.43 out of 5. Most apps were found to have good functionality and aesthetics; however, they were lacking in their quality of information and engagement. CONCLUSION: This review suggests that apps may provide clinical benefit to patients with breathlessness and can support clinical practice. However, few of those researched are available for public use and those accessible publicly were lacking in quality and compliance with m-Health best practices.