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2.
JMIR Mhealth Uhealth ; 8(12): e22874, 2020 12 11.
Artículo en Inglés | MEDLINE | ID: mdl-33276318

RESUMEN

BACKGROUND: Telephones, internet-connected devices (phablets, personal computers), chat platforms, and mobile apps (eg, Skype, Facebook Messenger, WhatsApp) can be exploited for telemedicine applications. WhatsApp and similar apps are also widely used to facilitate clinical communication between physicians. Moreover, WhatsApp is used by emergency department (ED) physicians and consulting physicians to exchange medical information during ED consultations. This platform is regarded as a useful app in the consultation of dermatological and orthopedic cases. Preventing overcrowding in the ED is key to reducing the risk of disease transmission, and teleconsulting practice is thought to be effective in the diagnosis, treatment, and reduction of transmission risk of disease, most notably during the COVID-19 pandemic. Video consultation is highly recommended in some countries on the grounds that it is likely to reduce the risk of transmission. WhatsApp-like apps are among the video consultation platforms that are assumed to reduce the risk of contamination by minimizing patient-physician contact. OBJECTIVE: The aim of this study was to investigate the effects of WhatsApp video consultation on patient admission and discharge times in comparison to bedside consultation in the evaluation of potential patients with COVID-19 visiting a COVID-19 outpatient clinic during the pandemic. METHODS: Patients who presented to the ED COVID-19 outpatient clinic between March 11 and May 31, 2020, and for whom an infectious disease specialist was consulted (via WhatsApp or at bedside) were included in the study in accordance with the inclusion and exclusion criteria. Eventually, 54 patients whose consultations were performed via WhatsApp and 90 patients whose consultations were performed at bedside were included in our study. RESULTS: The median length of stay in the ED of discharged patients amounted to 103 minutes (IQR 85-147.75) in the WhatsApp group and 196 minutes (IQR 141-215) in the bedside group. In this regard, the length of stay in the ED was found to be significantly shorter in the WhatsApp group than in the bedside group (P<.001). Among the consulted and discharged patients, 1 patient in each group tested positive for SARS-CoV-2 by polymerase chain reaction test and thus was readmitted and hospitalized (P=.62). The median length of stay of the inpatients in the ED was found to be 116.5 minutes (IQR 85.5-145.5) in the WhatsApp group and 132 minutes (IQR 102-168) in the bedside group. The statistical analysis of this time difference revealed that the length of stay in the ED was significantly shorter for patients in the WhatsApp group than in the bedside group (P=.04). CONCLUSIONS: Consultation via WhatsApp reduces both contact time with patients with COVID-19 and the number of medical staff contacting the patients, which contributes greatly to reducing the risk of COVID-19 transmission. WhatsApp consultation may prove useful in clinical decision making as well as in shortening process times. Moreover, it does not result in a decreased accuracy rate. The shortened discharge and hospitalization timespans also decreased the length of stay in the ED, which can have an impact on minimizing ED crowding. TRIAL REGISTRATION: ClinicalTrials.gov NCT04645563; https://clinicaltrials.gov/ct2/show/NCT04645563.


Asunto(s)
/epidemiología , Servicio de Urgencia en Hospital/organización & administración , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Aplicaciones Móviles , Consulta Remota/métodos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos , Factores de Tiempo
3.
J Med Internet Res ; 22(11): e22081, 2020 11 26.
Artículo en Inglés | MEDLINE | ID: mdl-33152685

RESUMEN

BACKGROUND: The COVID-19 crisis has drastically changed care delivery with teleconsultation platforms experiencing substantial spikes in demand, helping patients and care providers avoid infections and maintain health care services. Beyond the current pandemic, teleconsultation is considered a significant opportunity to address persistent health system challenges, including accessibility, continuity, and cost of care, while ensuring quality. OBJECTIVE: This study aims at identifying the determinants of patients' intention to continue using a teleconsultation platform. It extends prior research on information technology use continuance intention and teleconsultation services. METHODS: Data was collected in November 2018 and May 2019 with Canadian patients who had access to a teleconsultation platform. Measures included patients' intention to continue their use; teleconsultation usefulness; teleconsultation quality; patients' trust toward the digital platform, its provider. and health care professionals; and confirmation of patients' expectations toward teleconsultation. We used structural equation modeling employing the partial least squares component-based technique to test our research model and hypotheses. RESULTS: We analyzed a sample of 178 participants who had used teleconsultation services. Our findings revealed that confirmation of expectations had the greatest influence on continuance intention (total effects=0.722; P<.001), followed by usefulness (total effects=0.587; P<.001) and quality (total effects=0.511; P<.001). Usefulness (ß=.60; P<.001) and quality (ß=.34; P=.01) had direct effects on the dependent variable. The confirmation of expectations had direct effects both on usefulness (ß=.56; P<.001) and quality (ß=.75; P<.001) in addition to having an indirect effect on usefulness (indirect effects=0.282; P<.001). Last, quality directly influenced usefulness (ß=.34; P=.002) and trust (ß=.88; P<.001). Trust does not play a role in the context under study. CONCLUSIONS: Teleconsultation is central to care going forward, and it represents a significant lever for an improved, digital delivery of health care in the future. We believe that our findings will help drive long-term teleconsultation adoption and use, including in the aftermath of the current COVID-19 crisis, so that general care improvement and greater preparedness for exceptional situations can be achieved.


Asunto(s)
/epidemiología , Intención , Consulta Remota/métodos , Adolescente , Adulto , Humanos , Persona de Mediana Edad , Pandemias , Pacientes , Adulto Joven
4.
Trials ; 21(1): 968, 2020 Nov 25.
Artículo en Inglés | MEDLINE | ID: mdl-33239100

RESUMEN

OBJECTIVES: Patients with diabetes are - compared to people without diabetes - at increased risk of worse outcomes from COVID-19 related pneumonia during hospitalization. We aim to investigate whether telemetric continuous glucose monitoring (CGM) in quarantined hospitalized patients with diabetes and confirmed SARS-CoV-2 infection or another contagious infection can be successfully implemented and is associated with better glycaemic control than usual blood glucose monitoring (finger prick method) and fewer patient-health care worker contacts. Furthermore, we will assess whether glucose variables are associated with the clinical outcome. The hypothesis is that by using remote CGM to monitor glucose levels of COVID-19 infected patients and patients with other contagious infections with diabetes, we can still provide satisfactory (and maybe even better) in-hospital diabetes management despite patients being quarantined. Furthermore, the number of patient-personnel contacts can be lowered compared to standard monitoring with finger-prick glucose. This could potentially reduce the risk of transmitting contagious diseases from the patient to other people and reduces the use of PPE's. Improved glucose control may reduce the increased risk of poor clinical outcomes associated with combined diabetes and infection. TRIAL DESIGN: This is a single centre, open label, exploratory, randomised, controlled, 2-arm parallel group (1:1 ratio), controlled trial. PARTICIPANTS: The trial population is patients with diabetes (both type 1 diabetes, type 2 diabetes, newly discovered diabetes that is not classified yet, and all other forms of diabetes) admitted to Nordsjællands Hospital that are quarantined due to COVID-19 infection or another infection. INCLUSION CRITERIA: 1. Hospitalized with confirmed COVID-19 infection by real-time PCR or another validated method OR hospitalized with a non-COVID-19 diagnosis and quarantined at time of inclusion. 2. A documented clinically relevant history of diabetes or newly discovered during hospitalization as defined by The World Health Organizations diagnostic criteria for diabetes. 3. Written informed consent obtained before any trial related procedures are performed. 4. Male or female aged over 18 years of age. 5. Must be able to communicate with the study personnel. 6. The subject must be willing and able to comply with trial protocol. EXCLUSION CRITERIA: 1. Known hypersensitivity to the band-aid of the Dexcom G6 sensors INTERVENTION AND COMPARATOR: Participants will be randomized to either real-time CGM with the Dexcom G6, a CGM system that does not need to be calibrated, or finger-prick glucose monitoring. Blinded CGM will be mounted in the finger-prick group. In the open CGM group, the glucose values will be transmitted to a Smartdevice in the nurse office where glucose levels can be monitored remotely. MAIN OUTCOMES: The primary endpoint is the difference between groups in distribution of glucose values being in time in range (TIR), defined as 3.9 to 10 mmol/l. In addition, the primary endpoint is reported as the percentage of days of the whole admission, the patient reaches TIR. Secondary endpoints are the estimated number of saved patient-personnel contacts related to blood glucose measurements, incl. time healthcare providers spent on diabetes related tasks and PPE related tasks, during the patients' hospitalization. Furthermore, we will assess additional glucose outcomes and associations of glucose variables and patient outcomes (As specified in the protocol). RANDOMISATION: The service used for generating the randomization lists is www.random.org . Randomization is stratified by COVID-19 status and an allocation ratio of 1:1 to either CGM or finger-prick groups. BLINDING (MASKING): The design of the trial is open, however blinded CGM is recorded in the finger-prick group. NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): A sample size of N=72 is required for the primary endpoint analysis based on 80% power to detect a 10% difference between groups in TIR and to allow for a 15% dropout. The 72 participants will be randomized 1:1 to open CGM or finger-prick with 36 in each group. TRIAL STATUS: This structured protocol summary is based on the CGM-ISO protocol version 1.3, dated 13.05.2020. Date of first patient enrolled: 25.05.2020. Expected last recruiting is May 2021. Patients enrolled to date: 20 in total. 8 with confirmed COVID-19 infection and 12 with other infections. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04430608 . Registered 12.06.2020 FULL PROTOCOL: The full protocol is attached as an additional file from the Trial website (Additional file 1). In the interest of expediting dissemination of this material, the familiar formatting has been eliminated; This Letter serves as a summary of the key elements of the full protocol.


Asunto(s)
Automonitorización de la Glucosa Sanguínea/métodos , Consulta Remota/métodos , /genética , Adulto , Dinamarca/epidemiología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Femenino , Personal de Salud , Hospitalización , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Masculino , Cuarentena/estadística & datos numéricos
5.
Semergen ; 46(8): 560-565, 2020.
Artículo en Español | MEDLINE | ID: mdl-33239153

RESUMEN

With the current pandemic, there is now the possibility of using technological tools, such as teleconsultation or remote consultation. In rural or even semi-urban areas, access to medical services may be restricted due to transportation problems. In other places access to the consultations is limited to avoid contagion from the patient or healthcare personnel. This is why technological solutions are used to allow us to monitor our patients remotely, especially in the case of chronic patients, or as a form of triage to potential patients with coronavirus. Unfortunately, this type of system has not been used with the same continuity as in other countries, and very often our health personnel do not know the correct way to carry out a teleconsultation (by phone or video). With this document, an initial guide is presented on how to make a teleconsultation in Primary Care.


Asunto(s)
Medicina Familiar y Comunitaria/métodos , Atención Primaria de Salud/métodos , Consulta Remota/métodos , Algoritmos , Toma de Decisiones Clínicas/métodos , Accesibilidad a los Servicios de Salud , Humanos , Relaciones Médico-Paciente , Teléfono , Comunicación por Videocoferencia
6.
Injury ; 51(12): 2757-2762, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33162011

RESUMEN

AIMS: Approximately 75% of fractures are simple, stable injuries which are often unnecessarily immobilised with subsequent repeated radiographs at numerous fracture clinic visits. In 2014, the Glasgow Fracture Pathway offered an alternative virtual fracture clinic (VFC) pathway with the potential to reduce traditional fracture clinic visits, waiting times and overall costs. Many units have implemented this style of pathway in the non-operative management of simple, undisplaced fractures. This study aims to systematically review the clinical outcomes, patient reported outcomes and cost analyses for VFCs. MATERIALS AND METHODS: Two independent reviewers performed the literature search based on PRISMA guidelines, utilizing the MEDLINE, EMBASE and COCHRANE Library databases. Studies reporting outcomes following the use of VFC were included. Outcomes analysed were: 1) clinical outcomes, 2) patient reported outcomes, and 3) cost analysis. RESULTS: Overall, 15 studies involving 11,921 patients with a mean age of 41.1 years and mean follow-up of 12.6 months were included. In total, 65.7% of patients were directly virtually discharged with protocol derived conservative management, with 9.1% using the Helpline and 15.6% contacting their general practitioner for advice or reassurance. A total of 1.2% of patients experienced fracture non-unions and 0.4% required surgical intervention. The overall patient satisfaction rate was 81.0%, with only 1.3% experiencing residual pain at the fracture site. Additionally, the mean cost per patient for VFC was £71, with a mean saving of £53 when compared to traditional clinic models. Subgroup analysis found that for undisplaced fifth metatarsal or radial head/neck fractures, the rates of discharge from VFC to physiotherapy or general practitioners were 81.2% and 93.7% respectively. DISCUSSION AND CONCLUSION: This study established that there is excellent evidence to support virtual fracture clinic for non-operative management of fifth metatarsal fractures, with moderate evidence for radial head and neck fractures. However, the routine use of virtual fracture clinics is presently not validated for all stable, undisplaced fracture patterns. LEVEL OF EVIDENCE: IV; Systematic Review of all Levels of Evidence.


Asunto(s)
/prevención & control , Medicina Basada en la Evidencia/métodos , Fracturas Óseas/diagnóstico , Ortopedia/métodos , Consulta Remota/métodos , /epidemiología , Control de Enfermedades Transmisibles/normas , Análisis Costo-Beneficio , Medicina Basada en la Evidencia/economía , Medicina Basada en la Evidencia/normas , Fracturas Óseas/terapia , Humanos , Ortopedia/economía , Ortopedia/organización & administración , Ortopedia/normas , Satisfacción del Paciente , Consulta Remota/economía , Consulta Remota/organización & administración , Consulta Remota/normas , Resultado del Tratamiento
7.
Rev. esp. cardiol. (Ed. impr.) ; 73(11): 910-918, nov. 2020. tab
Artículo en Español | IBECS | ID: ibc-192006

RESUMEN

La pandemia producida por la infección por el coronavirus SARS-CoV-2 (COVID-19) ha cambiado la forma de entender nuestras consultas. Para reducir el riesgo de contagio de los pacientes más vulnerables (aquellos con cardiopatías) y del personal sanitario, se han suspendido la mayoría de las consultas presenciales y se han puesto en marcha las consultas telemáticas. Este cambio se ha implementado en muy poco tiempo, pero parece que ha venido para quedarse. No obstante, hay grandes dudas sobre aspectos organizativos, legales, posibilidades de mejora, etc. En este documento de consenso de la Sociedad Española de Cardiología, tratamos de dar las claves para mejorar la calidad asistencial en nuestras nuevas consultas telemáticas, revisando las afecciones que el cardiólogo clínico atiende con más frecuencia en su consulta ambulatoria y proponiendo unos mínimos en ese proceso asistencial. Estas enfermedades son la cardiopatía isquémica, la insuficiencia cardiaca y las arritmias. En los 3 escenarios tratamos de clarificar los aspectos fundamentales que hay que revisar en la entrevista telefónica, a qué pacientes habrá que atender en una consulta presencial y cuáles serán los criterios para su seguimiento en atención primaria. El documento también recoge distintas mejoras que pueden introducirse en la consulta telemática para mejorar la asistencia de nuestros pacientes


The coronavirus disease 2019 (COVID-19) pandemic has changed how we view our consultations. To reduce the risk of spread in the most vulnerable patients (those with heart disease) and health personnel, most face-to-face consultations have been replaced by telemedicine consultations. Although this change has been rapidly introduced, it will most likely become a permanent feature of clinical practice. Nevertheless, there remain serious doubts about organizational and legal issues, as well as the possibilities for improvement etc. In this consensus document of the Spanish Society of Cardiology, we attempt to provide some keys to improve the quality of care in this new way of working, reviewing the most frequent heart diseases attended in the cardiology outpatient clinic and proposing some minimal conditions for this health care process. These heart diseases are ischemic heart disease, heart failure, and arrhythmias. In these 3 scenarios, we attempt to clarify the basic issues that must be checked during the telephone interview, describe the patients who should attend in person, and identify the criteria to refer patients for follow-up in primary care. This document also describes some improvements that can be introduced in telemedicine consultations to improve patient care


Asunto(s)
Humanos , Telecardiología , Consulta Remota/métodos , Infecciones por Coronavirus/epidemiología , Isquemia Miocárdica/epidemiología , Insuficiencia Cardíaca/epidemiología , Arritmias Cardíacas/epidemiología , Pautas de la Práctica en Medicina/tendencias , Pandemias/estadística & datos numéricos , Cuarentena/estadística & datos numéricos , Distancia Social , Infecciones por Coronavirus/transmisión , Mejoramiento de la Calidad/tendencias
8.
Rev. clín. esp. (Ed. impr.) ; 220(8): 472-479, nov. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-192192

RESUMEN

OBJETIVO: Evaluar si la telemedicina con telemonitorización es una herramienta clínicamente útil y segura para el seguimiento de pacientes con COVID-19. MÉTODOS: Estudio observacional prospectivo de los pacientes con diagnóstico de COVID-19 por PCR positiva y considerados de alto riesgo que se siguieron con telemedicina y telemonitorización en el Área Sanitaria de Lugo entre el 17 de marzo y el 17 de abril de 2020. Se incluyeron dos grupos de pacientes: seguimiento ambulatorio desde el inicio y tras el alta hospitalaria. Cada paciente remitió un cuestionario clínico al día con su temperatura y saturación de oxígeno 3 veces al día. El seguimiento fue proactivo contactando con todos los pacientes al menos una vez al día. RESULTADOS: Se incluyeron 313 pacientes (52,4% mujeres) con edad media 60,9 (DS 15,9) años. Otros 2 pacientes rehusaron entrar en el programa. Desde el inicio se siguieron ambulatoriamente 224 pacientes y 89 tras su alta hospitalaria. Entre los primeros, 38 (16,90%) se remitieron a Urgencias en 43 ocasiones con 18 (8,03%) ingresos y 2 fallecidos. En los domicilios no hubo fallecimientos ni urgencias vitales. Incluyendo a los pacientes tras hospitalización, el seguimiento se realizó en 304 casos. Un paciente reingresó (0,32%) y otro abandonó (0,32%). El tiempo medio de seguimiento fue 11,64 (SD 3,58) días y en los 30 días del estudio 224 (73,68%) pacientes fueron dados de alta. CONCLUSIONES: Nuestros datos sugieren que la telemedicina con telemonitorización domiciliaria, utilizada de forma proactiva, permite un seguimiento clínicamente útil y seguro en pacientes con COVID-19 de alto riesgo


AIM: To asses if telemedicine with telemonitoring is a clinically useful and secure tool in the tracking of patients with COVID-19. METHODS: A prospective observational study of patients with COVID-19 diagnosis by positive PCR considered high-risk tracked with telemedicine and telemonitoring was conducted in the sanitary area of Lugo between March 17th and April 17th, 2020. Two groups of patients were included: Outpatient Tracing from the beginning and after discharge. Every patient sent a daily clinical questionnaire with temperature and oxygen saturation 3 times a day. Proactive monitoring was done by getting in touch with every patient at least once a day. RESULTS: 313 patients (52.4% female) with a total average age of 60.9 (DS 15.9) years were included. Additionally, 2 patients refused to join the program. Since the beginning, 224 were traced outpatient and 89 after being discharged. Among the first category, 38 (16.90%) were referred to Emergency department on 43 occasions; 18 were hospitalized (8.03%), and 2 deceased. Neither deaths nor a matter of vital emergency occurred at home. When including patients after admissions monitoring was done in 304 cases. One patient re-entered (0.32%) to the hospital, and another one left the program (0.32%). The average time of monitoring was 11.64 (SD 3.58) days, and 224 (73.68%) patients were discharged during the 30 days of study. CONCLUSIONS: Our study suggests that telemedicine with home telemonitoring, used proactively, allows for monitoring high-risk patients with COVID-19 in a clinically useful and secure way


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Telemedicina/métodos , Telemonitorización , Infecciones por Coronavirus , Monitoreo Ambulatorio/métodos , Consulta Remota/métodos , Estudios Prospectivos , Evaluación de Eficacia-Efectividad de Intervenciones , Factores de Riesgo , Pandemias/estadística & datos numéricos , Evaluación del Resultado de la Atención al Paciente
9.
Inflamm Bowel Dis ; 26(11): e134-e136, 2020 10 23.
Artículo en Inglés | MEDLINE | ID: mdl-33029612
10.
J Med Internet Res ; 22(11): e23482, 2020 11 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031045

RESUMEN

BACKGROUND: There has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed. OBJECTIVE: This study aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing. METHODS: Searches were conducted in MEDLINE, Embase, HMIC, PsycINFO, and CINAHL for literature published since the databases' inception to February 2020. Peer-reviewed studies conducted in primary health care settings were included. All remote consultation types were considered, and studies were required to report any quantitative measure of antibiotic prescribing to be included in this systematic review. Studies were excluded if there were no comparison groups (face-to-face consultations). RESULTS: In total, 12 studies were identified. Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis, but conflicting results were found for patients with acute respiratory infections. Mixed evidence was found for follow-up visit rates after remote and face-to-face consultations. CONCLUSIONS: There is insufficient evidence to confidently conclude that remote consulting has a significant impact on antibiotic prescribing in primary care. However, studies indicating higher prescribing rates in remote consultations than in face-to-face consultations are a concern. Further, well-conducted studies are needed to inform safe and appropriate implementation of remote consulting to ensure that there is no unintended impact on antimicrobial resistance.


Asunto(s)
Antibacterianos/uso terapéutico , Atención Primaria de Salud/métodos , Consulta Remota/métodos , /efectos de los fármacos , Adulto , Antibacterianos/farmacología , Femenino , Humanos , Masculino
11.
J Plast Reconstr Aesthet Surg ; 73(12): 2127-2135, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33051176

RESUMEN

Coronavirus disease-2019 (COVID-19) has generated a need to rapidly increase online consulting in secondary care, an area in which it has previously been underutilised. We sought to review the guidance on conducting remote consultations and found that while there is a large amount of information about the implementation of remote consultations at an organisation level, there is a paucity of high-quality papers considering the guidelines for online consultations alongside practical advice for their implementation at the individual level. We reviewed guidelines from reputable medical sources and generated practical advice to assist practitioners to perform safe and effective video consultation. Additionally, we noted reports in the literature of a lack of transparency and resulting confusion regarding the choice of telemedicine platforms. We, therefore, sought to summarise key characteristics of a number of major telemedicine platforms. We recognised a lack of clarity regarding the legal status of performing remote consultations, and reviewed advice from medico-legal sources. Finally, we address the sources of these individual uncertainties, and give recommendations on how these might be addressed systematically, so the practitioners are well trained and competent in the use of online consultations, which will inevitably play an increasingly large role in both primary and secondary care settings in the future.


Asunto(s)
/epidemiología , Pandemias , Consulta Remota/organización & administración , Contraindicaciones , Médicos Hospitalarios , Humanos , Programas Nacionales de Salud/organización & administración , Guías de Práctica Clínica como Asunto , Consulta Remota/legislación & jurisprudencia , Consulta Remota/métodos , Reino Unido/epidemiología
12.
J Fr Ophtalmol ; 43(10): 983-988, 2020 Dec.
Artículo en Francés | MEDLINE | ID: mdl-33121795

RESUMEN

INTRODUCTION: Ophthalmologic care needings increase whereas the numbers of ophthalmologist decrease. Oldest people who are often vulnerable and dependent populations are particularly affected in difficulty to access to health services. To resolve the problem, the use of telemedicine in ophthalmology could be an alternative. MATERIALS AND METHODS: From June 2018 to November 2018, patients from Janzé Hospital (Ille et Vilaine) did an ophthalmologic teleconsultation during their stay. Teleconsultation was based on visual acuity, intraocular pressure measurement, wild-field retinophotography and optical coherence tomography performed by an orthoptist and a videoconference with an ophthalmologist. RESULTS: Sixty-seven patients underwent teleconsultation (60 % women, 40 % men). Mean age was 83 (standard deviation±8). Fifty-four percent (36) of consultations were complete. Retinophotography was missing in 45 % of cases (30) and optical coherence tomography in 53 % of cases (35). Ophtalmologic pathologies were detected in 37 patients (55 %) and we start medical care in 14 (38 %) of the patients. We gave glasses prescription to 45 % (30) of the patients. Eighteen percent (10) of the patients required a physical consultation. LogMar distance visual acuity was significantly improved from 0.67 (±0.76) to 0.52 (±0.72) (P<0.0001) and LogMar near visual acuity was significantly improved from 0.68 (±0.84) to 0.53 (±0.76) (P<0.0001). Low vision proportion was significantly decreased from 54 % to 39 % (P=0.02; OR=1.86; IC95 % [1.06-3.28]) after our intervention. DISCUSSION: This experiment gives the opportunity to old, vulnerable and dependent population that has no longer access to classical consultation to access eye care. At the same time, consultation informs the nursing home caregivers about the visual health status and provides environment improvement. CONCLUSION: Teleconsultation is an alternative to classical consultation especially in dependent population. This experiment could be a starting point to the development of this solution in social health-care institutions.


Asunto(s)
Hogares para Ancianos , Casas de Salud , Oftalmología , Telemedicina , Anciano , Anciano de 80 o más Años , Retroalimentación , Femenino , Francia/epidemiología , Hogares para Ancianos/organización & administración , Humanos , Masculino , Tamizaje Masivo/métodos , Tamizaje Masivo/organización & administración , Casas de Salud/organización & administración , Oftalmología/métodos , Oftalmología/organización & administración , Medicina Preventiva/métodos , Medicina Preventiva/organización & administración , Consulta Remota/métodos , Consulta Remota/organización & administración , Estudios Retrospectivos , Telemedicina/métodos , Telemedicina/organización & administración , Baja Visión/diagnóstico , Baja Visión/epidemiología , Agudeza Visual
14.
Australas Psychiatry ; 28(6): 639-643, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33016772

RESUMEN

OBJECTIVE: To analyse the smaller Australian state/territory service impact of the introduction of new COVID-19 psychiatrist video and telephone telehealth Medicare Benefits Schedule (MBS) items. METHOD: MBS item service data were extracted for COVID-19 psychiatrist video and telephone telehealth item numbers corresponding to the pre-existing in-person consultations for the Australian Capital Territory (ACT), Northern Territory (NT), South Australia (SA) and Tasmania. RESULTS: The overall rate of consultations (face-to-face and telehealth) increased during March and April 2020, compared to the monthly face-to-face consultation average, excepting Tasmania. Compared to an annual monthly average of in-person consultations for July 2018-June 2019, total telepsychiatry consultations were higher for April than May. For total video and telephone telehealth consultations combined, video consultations were lower in April and higher in May. As a percentage of combined telehealth and in-person consultations, telehealth was greater for April and lower for May compared to the monthly face-to-face consultation average. CONCLUSIONS: In the smaller states/territories, the private practice workforce rapidly adopted COVID-19 MBS telehealth items, with the majority of psychiatric consultation shifting to telehealth initially, and then returning to face-to-face. With a second wave of COVID-19 in Australia, telehealth is likely to remain a vital part of the national mental health strategy.


Asunto(s)
Infecciones por Coronavirus , Servicios de Salud Mental , Pandemias , Neumonía Viral , Pautas de la Práctica en Medicina , Práctica Privada , Consulta Remota/métodos , Comunicación por Videocoferencia , Adulto , Australia/epidemiología , Betacoronavirus , Control de Enfermedades Transmisibles/métodos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/psicología , Femenino , Humanos , Revisión de Utilización de Seguros , Masculino , Servicios de Salud Mental/organización & administración , Servicios de Salud Mental/tendencias , Innovación Organizacional , Neumonía Viral/epidemiología , Neumonía Viral/psicología , Pautas de la Práctica en Medicina/organización & administración , Pautas de la Práctica en Medicina/tendencias , Práctica Privada/organización & administración , Práctica Privada/tendencias , Telemedicina/métodos
15.
J Med Internet Res ; 22(9): e19550, 2020 09 28.
Artículo en Inglés | MEDLINE | ID: mdl-32985997

RESUMEN

BACKGROUND: The new generation of implantable cardioverter-defibrillators (ICDs) supports wireless technology, which enables remote patient monitoring (RPM) of the device. In Sweden, it is mainly registered nurses with advanced education and training in ICD devices who handle the arrhythmias and technical issues of the remote transmissions. Previous studies have largely focused on the perceptions of physicians, and it has not been explored how the patients' and nurses' experiences of RPM correspond to each other. OBJECTIVE: Our objective is to describe, explore, and compare the experiences and perceptions, concerning RPM of ICD, of patients with heart failure (HF) and nurses performing ICD follow-up. METHODS: This study has a cross-sectional, descriptive, mixed methods design. All patients with HF and an ICD with RPM from one region in Sweden, who had transitioned from office-based visits to implementing RPM, and ICD nurses from all ICD clinics in Sweden were invited to complete a purpose-designed, 8-item questionnaire to assess experiences of RPM. The questionnaire started with a neutral question: "What are your experiences of RPM in general?" This was followed by one positive subscale with three questions (score range 3-12), with higher scores reflecting more positive experiences, and one negative subscale with three questions (score range 3-12), with lower scores reflecting more negative experiences. One open-ended question was analyzed with qualitative content analysis. RESULTS: The sample consisted of 175 patients (response rate 98.9%) and 30 ICD nurses (response rate 60%). The majority of patients (154/175, 88.0%) and nurses (23/30, 77%) experienced RPM as very good; however, the nurses noted more downsides than did the patients. The mean scores of the negative experiences subscale were 11.5 (SD 1.1) for the patients and 10.7 (SD 0.9) for the nurses (P=.08). The mean scores of the positive experiences subscale were 11.1 (SD 1.6) for the patients and 8.5 (SD 1.9) for the nurses (P=.04). A total of 11 out of 175 patients (6.3%) were worried or anxious about what the RPM entailed, while 15 out of 30 nurses (50%) felt distressed by the responsibility that accompanied their work with RPM (P=.04). Patients found that RPM increased their own (173/175, 98.9%) and their relatives' (169/175, 96.6%) security, and all nurses (30/30, 100%) answered that they found RPM to be necessary from a safety perspective. Most patients found it to be an advantage with fewer office-based visits. Nurses found it difficult to handle different systems with different platforms, especially for smaller clinics with few patients. Another difficulty was to set the correct number of alarms for the individual patient. This caused a high number of transmissions and a risk to miss important information. CONCLUSIONS: Both patients and nurses found that RPM increased assurance, reliance, and safety. Few patients were anxious about what the RPM entailed, while about half of the nurses felt distressed by the responsibility that accompanied their work with RPM. To increase nurses' sense of security, it seems important to adjust organizational routines and reimbursement systems and to balance the workload.


Asunto(s)
Desfibriladores Implantables/normas , Insuficiencia Cardíaca/terapia , Pacientes/psicología , Consulta Remota/métodos , Anciano , Estudios Transversales , Femenino , Insuficiencia Cardíaca/cirugía , Humanos , Masculino , Persona de Mediana Edad , Enfermeras y Enfermeros , Percepción , Encuestas y Cuestionarios
18.
PLoS One ; 15(9): e0238806, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32931503

RESUMEN

Non-physician clinicians (NPCs) in low and middle-income countries (LMICs) often have little physical proximity to the resources-equipment, supplies or skills-needed to deliver effective care, forcing them to refer patients to distant sites. Unlike equipment or supplies, which require dedicated supply chains, physician/specialist skills needed to support NPCs can be sourced and delivered through telecommunication technologies. In LMICs however, these skills are scarce and sparsely distributed, making it difficult to implement commonly used real-time (synchronous), hub-and-spoke telemedicine paradigms. An asynchronous teleconsultations service was implemented in Turkana County, Kenya, connecting NPCs with a volunteer network of remote physicians and specialists. In 2017-18, the service supported over 100 teleconsultations and referrals across 20 primary healthcare clinics and two hospitals. This qualitative study aimed to explore the impact of the telemedicine intervention on health system stakeholders, and perceived health-related benefits to patients. Data were collected using Appreciative Inquiry, a strengths-based, positive approach to assessing interventions and informing systems change. We highlight the impact of provider-to-provider asynchronous teleconsultations on multiple stakeholders and healthcare processes. Provider benefits include improved communication and team work, increased confidence and capacity to deliver services in remote sites, and professional satisfaction for both NPCs and remote physicians. Health system benefits include efficiency improvements through improved care coordination and avoiding unnecessary referrals, and increased equity and access to physician/specialist care by reducing geographical, financial and social barriers. Providers and health system managers recognised several non-health benefits to patients including increased trust and care seeking from NPCs, and social benefits of avoiding unnecessary referrals (reduced social disruption, displacement and costs). The findings reveal the wider impact that modern teleconsultation services enabled by mobile technologies and algorithms can have on LMIC communities and health systems. The study highlights the importance of viewing provider-to-provider teleconsultations as complex health service delivery interventions with multiple pathways and processes that can ultimately improve health outcomes.


Asunto(s)
Consulta Remota/métodos , Prestación de Atención de Salud/organización & administración , Países en Desarrollo , Humanos , Kenia , Telemedicina/métodos
19.
J Cancer Res Ther ; 16(4): 703-707, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32930106

RESUMEN

Pathologists have been using their tool of trade, "the microscope," since the early 17th century, but now diagnostic pathology or tissue-based diagnosis is characterized by its high specificity and sensitivity. Technological telecommunication advances have revolutionized the face of medicine, and in pursuit of better health-care delivery, telepathology has emerged. Telepathology is the practice of diagnostic pathology performed at a distance, with images viewed on a video monitor rather than directly through the (light) microscope. This article aims to provide an overview of the field, including specific applications, practice, benefits, limitations, regulatory issues, latest advances, and a perspective on the current status of telepathology in Indian scenario based on literature review.


Asunto(s)
Sistemas de Computación/normas , Educación Médica Continua/métodos , Microscopía por Video/métodos , Consulta Remota/métodos , Telepatología/métodos , Humanos , India , Telepatología/normas , Telepatología/tendencias
20.
Australas Psychiatry ; 28(6): 644-648, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-32997521

RESUMEN

OBJECTIVE: Private practice psychiatry in Australia was largely office-based until the Commonwealth Government introduced new psychiatrist Medicare Benefits Schedule (MBS) telehealth items in response to the first wave of the COVID-19 pandemic. We investigate the uptake of (1) video and telephone telehealth consultations in April-May 2020, and (2) the overall changing rates of consultation, i.e. total telehealth and in-person consultations across the larger states of Australia. METHOD: MBS item service data were extracted for COVID-19 psychiatrist video- and telephone-telehealth item numbers and compared with a baseline of the 2018-2019-financial-year monthly average of in-person consultations for New South Wales, Queensland, Victoria, and Western Australia. RESULTS: Total psychiatry consultations (telehealth and in-person) rose during the first wave of the pandemic by 10%-20% compared to the previous year. The majority of private practice was conducted by telehealth in April but was lower in May as new COVID-19 case rates fell. Most telehealth provision was by telephone for short consultations of ⩽15-30 min. Video consultations increased from April into May. CONCLUSIONS: For large states, there has been a rapid adoption of the MBS telehealth psychiatrist items, followed by a trend back to face-to-face as COVID-19 new case rates reduced. There was an overall increased consultation rate (in-person plus telehealth) for April-May 2020.


Asunto(s)
Infecciones por Coronavirus , Servicios de Salud Mental , Pandemias , Neumonía Viral , Práctica Privada , Consulta Remota/métodos , Telemedicina/métodos , Comunicación por Videocoferencia , Adulto , Australia/epidemiología , Betacoronavirus , Control de Enfermedades Transmisibles/métodos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/psicología , Femenino , Humanos , Revisión de Utilización de Seguros , Masculino , Servicios de Salud Mental/organización & administración , Servicios de Salud Mental/estadística & datos numéricos , Innovación Organizacional , Neumonía Viral/epidemiología , Neumonía Viral/psicología , Práctica Privada/organización & administración , Práctica Privada/estadística & datos numéricos , Servicios Urbanos de Salud/organización & administración
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