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2.
Value Health ; 24(3): 421-430, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33641777

RESUMEN

OBJECTIVES: Recent evidence suggests that e-mental health interventions can be effective at improving mental health but that there is still a notable hesitation among patients to use them. Previous research has revealed that they are perceived by patients as being less helpful than face-to-face psychotherapy. The reasons for this unfavorable perception are, however, not yet well understood. The aim of our study was to address this question by eliciting preferences for individual components of e-mental health interventions in a discrete choice experiment. METHODS: Using a stepwise qualitative approach, we developed the following 5 attributes of eMHIs: introductory training, human contact, peer support, proven effectiveness, content delivery, and price. Additionally, we asked questions about respondents' demographics, attitudes, and previous experience of traditional psychotherapy, as well as their distress level. RESULTS: A total of 1984 respondents completed the survey. Using mixed logit models, we found that personal contact with a psychotherapist in blended care, proven effectiveness, and low price were highly valued by participants. Participants were indifferent toward the mode of content delivery but showed a slight preference for introductory training via phone, as well as for peer support via online forum alongside coach-led group meetings on site. DISCUSSION: Our results suggest a clear preference for blended care that includes face-to-face contact with a psychotherapist. This preference remained stable irrespective of sociodemographics, previous experience of psychotherapy, distress level, and the 2 context scenarios used in our discrete choice experiment. Further investigations looking at the potential benefits and risks of blended care are needed.


Asunto(s)
Trastornos Mentales/terapia , Prioridad del Paciente/psicología , Psicoterapia/organización & administración , Telemedicina/organización & administración , Adulto , Anciano , Actitud Frente a la Salud , Conducta de Elección , Técnicas de Apoyo para la Decisión , Femenino , Humanos , Aprendizaje , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Grupo Paritario , Factores Socioeconómicos
3.
Soc Work Health Care ; 60(1): 8-29, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33657982

RESUMEN

The COVID-19 pandemic has wrought widespread devastation upon children and families across the United States, widening existing health disparities and inequities that disproportionately affect communities of color. In health care settings specifically, social work is the key workforce tasked with responding to patient and family psychosocial needs, both of which have increased substantially since the emergence of COVID-19. There is a need to understand ways in which hospital social workers' roles, responsibilities, and integration within interprofessional teams have evolved in response to these challenges. In this qualitative study, focus groups were conducted with 55 social workers employed across multiple settings in a large, urban, pediatric hospital in Spring 2020. Thematic analyses revealed salient superordinate themes related to the pandemic's impact on social work practice and social workers themselves, institutional facilitators and impediments to effective social work and interprofessional practice, and social work perspectives on future pandemic recovery efforts. Within each theme, a number of interrelated subthemes emerged elucidating nuances of telehealth adoption in the context of remote work, the salience of social determinants of health, and the critical role of social work in social justice oriented pandemic preparedness and response efforts. Implications for interprofessional practice and the profession at large are discussed.


Asunto(s)
/epidemiología , Servicio Social/organización & administración , Trabajadores Sociales/psicología , Grupos Focales , Procesos de Grupo , Humanos , Relaciones Interprofesionales , Salud Laboral , Pandemias , Grupo de Atención al Paciente/organización & administración , Rol Profesional , Investigación Cualitativa , Administración de la Seguridad/organización & administración , Servicio Social/normas , Factores Socioeconómicos , Telemedicina/organización & administración , Estados Unidos/epidemiología
4.
JAMA Netw Open ; 4(3): e212618, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33755167

RESUMEN

Importance: This study assesses the role of telehealth in the delivery of care at the start of the COVID-19 pandemic. Objectives: To document patterns and costs of ambulatory care in the US before and during the initial stage of the pandemic and to assess how patient, practitioner, community, and COVID-19-related factors are associated with telehealth adoption. Design, Setting, and Participants: This is a cohort study of working-age persons continuously enrolled in private health plans from March 2019 through June 2020. The comparison periods were March to June in 2019 and 2020. Claims data files were provided by Blue Health Intelligence, an independent licensee of the Blue Cross and Blue Shield Association. Data analysis was performed from June to October 2020. Main Outcomes and Measures: Ambulatory encounters (in-person and telehealth) and allowed charges, stratified by characteristics derived from enrollment files, practitioner claims, and community characteristics linked to the enrollee's zip code. Results: A total of 36 568 010 individuals (mean [SD] age, 35.71 [18.77] years; 18 466 557 female individuals [50.5%]) were included in the analysis. In-person contacts decreased by 37% (from 1.63 to 1.02 contacts per enrollee) from 2019 to 2020. During 2020, telehealth visits (0.32 visit per person) accounted for 23.6% of all interactions compared with 0.3% of contacts in 2019. When these virtual contacts were added, the overall COVID-19 era patient and practitioner visit rate was 18% lower than that in 2019 (1.34 vs 1.64 visits per person). Behavioral health encounters were far more likely than medical contacts to take place virtually (46.1% vs 22.1%). COVID-19 prevalence in an area was associated with higher use of telehealth; patients from areas within the top quintile of COVID-19 prevalence during the week of their encounter were 1.34 times more likely to have a telehealth visit compared with those in the lowest quintile (the reference category). Persons living in areas with limited social resources were less likely to use telehealth (most vs least socially advantaged neighborhoods, 27.4% vs 19.9% usage rates). Per enrollee medical care costs decreased by 15% between 2019 and 2020 (from $358.32 to $306.04 per person per month). During 2020, those with 1 or more COVID-19-related service (1 470 721 members) had more than 3 times the medical costs ($1701 vs $544 per member per month) than those without COVID-19-related services. Persons with 1 or more telehealth visits in 2020 had considerably higher costs than persons having only in-person ambulatory contacts ($2214.10 vs $1337.78 for the COVID-19-related subgroup and $735.87 vs $456.41 for the non-COVID-19 subgroup). Conclusions and Relevance: This study of a large cohort of patients enrolled in US health plans documented patterns of care at the onset of COVID-19. The findings are relevant to policy makers, payers, and practitioners as they manage the use of telehealth during the pandemic and afterward.


Asunto(s)
Atención Ambulatoria , Pautas de la Práctica en Medicina , Telemedicina , Adulto , Atención Ambulatoria/economía , Atención Ambulatoria/métodos , Atención Ambulatoria/estadística & datos numéricos , /prevención & control , Estudios de Cohortes , Costos y Análisis de Costo , Femenino , Humanos , Control de Infecciones/métodos , Seguro de Salud/estadística & datos numéricos , Masculino , Innovación Organizacional/economía , Pautas de la Práctica en Medicina/economía , Pautas de la Práctica en Medicina/organización & administración , Pautas de la Práctica en Medicina/estadística & datos numéricos , Telemedicina/economía , Telemedicina/organización & administración , Telemedicina/estadística & datos numéricos , Estados Unidos/epidemiología
5.
BMC Pregnancy Childbirth ; 21(1): 171, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33648450

RESUMEN

BACKGROUND: Psychological stress and coping experienced during pregnancy can have important effects on maternal and infant health, which can also vary by race, ethnicity, and socioeconomic status. Therefore, we assessed stressors, coping behaviors, and resources needed in relation to the COVID-19 pandemic in a sample of 162 perinatal (125 pregnant and 37 postpartum) women in the United States. METHODS: A mixed-methods study captured quantitative responses regarding stressors and coping, along with qualitative responses to open-ended questions regarding stress and resources needed during the COVID-19 pandemic. Logistic and linear regression models were used to analyze differences between pregnant and postpartum participants, as well as differences across key demographic variables. Qualitative content analysis was used to analyze open-ended questions. RESULTS: During the COVID-pandemic, food scarcity and shelter-in-place restrictions made it difficult for pregnant women to find healthy foods. Participants also reported missing prenatal appointments, though many reported using telemedicine to obtain these services. Financial issues were prevalent in our sample and participants had difficulty obtaining childcare. After controlling for demographic variables, pregnant women were less likely to engage in healthy stress-coping behaviors than postpartum women. Lastly, we were able to detect signals of increased stressors induced by the COVID-19 pandemic, and less social support, in perinatal women of racial and ethnic minority, and lower-income status. Qualitative results support our survey findings as participants expressed concerns about their baby contracting COVID-19 while in the hospital, significant others missing the delivery or key obstetric appointments, and wanting support from friends, family, and birthing classes. Financial resources, COVID-19 information and research as it relates to maternal-infant health outcomes, access to safe healthcare, and access to baby supplies (formula, diapers, etc.) emerged as the primary resources needed by participants. CONCLUSIONS: To better support perinatal women's mental health during the COVID-19 pandemic, healthcare providers should engage in conversations regarding access to resources needed to care for newborns, refer patients to counseling services (which can be delivered online/via telephone) and virtual support groups, and consistently screen pregnant women for stressors.


Asunto(s)
Adaptación Psicológica , Recursos en Salud/organización & administración , Accesibilidad a los Servicios de Salud , Responsabilidad Parental/psicología , Atención Perinatal , Educación Prenatal/métodos , /epidemiología , /psicología , Femenino , Asignación de Recursos para la Atención de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/normas , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Recién Nacido , Salud Mental/normas , Evaluación de Necesidades , Atención Perinatal/métodos , Atención Perinatal/organización & administración , Atención Perinatal/tendencias , Embarazo , Estrés Psicológico/etiología , Estrés Psicológico/prevención & control , Telemedicina/métodos , Telemedicina/organización & administración , Estados Unidos
8.
BMJ Health Care Inform ; 28(1)2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33753326

RESUMEN

INTRODUCTION: Telehealth became the most practical option for general practice consultations in Aotearoa New Zealand (NZ) as a result of the national lockdowns in response to the COVID-19 pandemic. What is the consumer experience of access to telehealth and how do consumers and providers perceive this mode of care delivery going forward? METHODS AND ANALYSIS: A national survey of general practice consumers and providers who used telehealth services since the national lockdowns in 2020 will be distributed. It is based on the Unified Theory of Acceptance and Use of Technology framework of technology acceptance and the access to care framework. The data will be statistically analysed to create a foundation for in-depth research on the use of telehealth services in NZ general practice services, with a specific focus on consumer experiences and health outcomes. ETHICS AND DISSEMINATION: Ethics approval was granted by the Auckland Health Research Ethics Committee on 13/11/2020, reference AH2539. The survey will be disseminated online.


Asunto(s)
/epidemiología , Medicina General/organización & administración , Telemedicina/organización & administración , Actitud hacia los Computadores , Humanos , Nueva Zelanda/epidemiología , Pandemias , Estudios Prospectivos , Proyectos de Investigación , Encuestas y Cuestionarios , Teléfono , Comunicación por Videocoferencia
10.
J Prim Care Community Health ; 12: 21501327211000235, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33729044

RESUMEN

BACKGROUND: To characterize the experience of converting a geriatrics clinic to telehealth visits in early stages of a pandemic. DESIGN: An organizational case study with mixed methods evaluation from the first 8 weeks of converting a geriatrics clinic from in-person visits to video and telephone visits. SETTING: Veteran's Health Administration in Northern California Participants Community-dwelling older Veterans receiving care at VA Palo Alto Geriatrics clinic. Veterans had a mean age of 85.7 (SD = 6.8) and 72.1% had cognitive impairment. INTERVENTION: Veterans with face-to-face appointments were converted to video or telephone visits to mitigate exposure to community spread of COVID-19. MEASUREMENTS: Thirty-two patient evaluations and 80 clinician feedback evaluations were completed. This provided information on satisfaction, care access during pandemic, and travel and time savings. RESULTS: Of the 62 scheduled appointments, 43 virtual visits (69.4%) were conducted. Twenty-six (60.5%) visits were conducted via video, 17 (39.5%) by telephone. Virtual visits saved patients an average of 118.6 minutes each. Patients and providers had similar, positive perceptions about telehealth to in-person visit comparison, limiting exposure, and visit satisfaction. After the telehealth appointment, patients indicated greater comfort with using virtual visits in the future. Thirty-one evaluations included comments for qualitative analysis. We identified 3 main themes of technology set-up and usability, satisfaction with visit, and clinical assessment and communication. CONCLUSION: During a pandemic that has limited the ability to safely conduct inperson services, virtual formats offer a feasible and acceptable alternative for clinically-complex older patients. Despite potential barriers and additional effort required for telehealth visits, patients expressed willingness to utilize this format. Patients and providers reported high satisfaction, particularly with the ability to access care similar to in-person while staying safe. Investing in telehealth services during a pandemic ensures that vulnerable older patients can access care while maintaining social distancing, an important safety measure.


Asunto(s)
Instituciones de Atención Ambulatoria/organización & administración , Geriatría/organización & administración , Telemedicina/organización & administración , Servicios de Salud para Veteranos/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , California/epidemiología , Demencia/terapia , Accesibilidad a los Servicios de Salud , Humanos , Persona de Mediana Edad , Estudios de Casos Organizacionales , Atención Primaria de Salud/organización & administración , Investigación Cualitativa , Teléfono , Comunicación por Videocoferencia
11.
Inquiry ; 58: 46958021997337, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33682514

RESUMEN

The coronavirus disease pandemic has created a crisis for patients with chronic kidney disease, as far as getting treatment facilities are concerned. The crisis is more intense in developing countries where the health system is more vulnerable due to poor infrastructures and insufficient health professionals. Bangladesh, being a developing nation, is also facing similar challenges to provide sufficient services to patients with chronic kidney disease. In this short report, we have discussed the challenges and barriers non-COVID chronic kidney disease patients are facing in terms of healthcare access along with getting proper medical interventions and suggested probable strategies to minimize the suffering.


Asunto(s)
/epidemiología , Accesibilidad a los Servicios de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/organización & administración , Insuficiencia Renal Crónica/terapia , Telemedicina/organización & administración , Bangladesh , Países en Desarrollo , Humanos , Servicios Preventivos de Salud/organización & administración , Índice de Severidad de la Enfermedad
12.
Integr Cancer Ther ; 20: 1534735421999101, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33655797

RESUMEN

BACKGROUND: The COVID-19 pandemic has catalyzed the use of mobile technologies to deliver health care. This new medical model has benefited integrative oncology (IO) consultations, where cancer patients are counseled about healthy lifestyle, non-pharmacological approaches for symptom management, and addressing questions around natural products and other integrative modalities. Here we report the feasibility of conducting IO physician consultations via telehealth in 2020 and compare patient characteristics to prior in-person consultations conducted in 2019. METHODS: An integrated EHR-telemedicine platform was used for IO physician consultations. As in the prior in-person visits, patients completed pre-visit patient-reported outcome (PRO) assessments about common cancer symptoms [modified Edmonton Symptom Assessment Scale, (ESAS)], Measure Yourself Concerns and Wellbeing (MYCaW), and the PROMIS-10 to assess quality of life (QOL). Patient demographics, clinical characteristics, and PROs for new telehealth consultation in 2020 were compared to new in-person consultations in 2019 using t-tests, chi-squared tests, and -Wilcoxon rank-sum test. RESULTS: We provided telehealth IO consultations to 509 new patients from April 21, 2020, to October 21, 2020, versus 842 new patients in-person during the same period in 2019. Most were female (77 % vs 73%); median age (56 vs 58), and the most frequent cancer type was breast (48% vs 39%). More patients were seeking counseling on herbs and supplements (12.9 vs 6.8%) and lifestyle (diet 22.7 vs 16.9% and exercise 5.2 vs 1.8%) in the 2020 cohort than 2019, respectively. The 2020 telehealth cohort had lower symptom management concerns compared to the 2019 in-person cohort (19.5 vs 33.1%). CONCLUSIONS: Delivering IO consultations using telehealth is feasible and meets patients' needs. Compared to patients seen in-person during 2019, patients having telehealth IO consultations in 2020 reported lower symptom burden and more concerns about lifestyle and herbs and supplements. Additional research is warranted to explore the satisfaction and challenges among patients receiving telehealth IO care.


Asunto(s)
/epidemiología , Oncología Integrativa/estadística & datos numéricos , Neoplasias/terapia , Relaciones Profesional-Paciente , Telemedicina/organización & administración , Actitud del Personal de Salud , Femenino , Humanos , Persona de Mediana Edad , Satisfacción Personal , Calidad de Vida , Consulta Remota/organización & administración , Encuestas y Cuestionarios , Comunicación por Videocoferencia
13.
J Med Internet Res ; 23(3): e19473, 2021 03 10.
Artículo en Inglés | MEDLINE | ID: mdl-33600344

RESUMEN

BACKGROUND: COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, has become a global pandemic, affecting most countries worldwide. Digital health information technologies can be applied in three aspects, namely digital patients, digital devices, and digital clinics, and could be useful in fighting the COVID-19 pandemic. OBJECTIVE: Recent reviews have examined the role of digital health in controlling COVID-19 to identify the potential of digital health interventions to fight the disease. However, this study aims to review and analyze the digital technology that is being applied to control the COVID-19 pandemic in the 10 countries with the highest prevalence of the disease. METHODS: For this review, the Google Scholar, PubMed, Web of Science, and Scopus databases were searched in August 2020 to retrieve publications from December 2019 to March 15, 2020. Furthermore, the Google search engine was used to identify additional applications of digital health for COVID-19 pandemic control. RESULTS: We included 32 papers in this review that reported 37 digital health applications for COVID-19 control. The most common digital health projects to address COVID-19 were telemedicine visits (11/37, 30%). Digital learning packages for informing people about the disease, geographic information systems and quick response code applications for real-time case tracking, and cloud- or mobile-based systems for self-care and patient tracking were in the second rank of digital tool applications (all 7/37, 19%). The projects were deployed in various European countries and in the United States, Australia, and China. CONCLUSIONS: Considering the potential of available information technologies worldwide in the 21st century, particularly in developed countries, it appears that more digital health products with a higher level of intelligence capability remain to be applied for the management of pandemics and health-related crises.


Asunto(s)
/epidemiología , Prestación de Atención de Salud/métodos , Control de Infecciones/métodos , Tecnología de la Información/normas , Telemedicina/organización & administración , Humanos , Pandemias , Prevalencia , /aislamiento & purificación
14.
Value Health ; 24(2): 291-302, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33518036

RESUMEN

OBJECTIVES: Asthma is one of the most common major noncommunicable diseases in the world and affects individuals of all ages. Medication is used to achieve and maintain quality of life (QOL) for people with asthma. Telehealth interventions offer optimized and personalized symptom monitoring with timely treatment adjustment and the potential to increase medication adherence for individuals with asthma. This study examines and synthesizes the available data on the change in the QOL for patients with asthma who use interactive telehealth interventions, and identifies the most effective telehealth modalities used for intervention in this area. METHODS: Literature searches were conducted in 5 databases in November 2018 for studies measuring a change in QOL for patients with asthma. Study QOL outcomes, where possible, were pooled in a meta-analysis. RESULTS: Seventeen publications (describing 16 studies) comprising 2015 patients were included. Based on a meta-analysis, interactive telehealth interventions can improve QOL outcomes for people living with asthma, although the improved effects may be small: web portals (0.51, 95% confidence interval [CI] -0.00 to 1.03), interactive smartphone apps (0.30, 95% CI -0.16 to 0.76) and remote monitoring (standardized mean difference 0.20, 95% CI -0.11 to 0.52). Intervention delivery modalities identified include interactive web portals, smartphone apps, and remote monitoring programs. CONCLUSIONS: The findings provide a comprehensive overview of the available literature on interactive telehealth interventions, including interactive web portals, smartphone apps, and remote monitoring programs. These findings demonstrated that a positive change in QOL can be attributed to these interventions and provide evidence for the implementation of telehealth interventions for individuals with asthma.


Asunto(s)
Asma/psicología , Asma/terapia , Calidad de Vida , Telemedicina/organización & administración , Progresión de la Enfermedad , Antígeno HLA-A1 , Humanos , Aplicaciones Móviles , Monitoreo Ambulatorio/métodos
15.
Soc Work Health Care ; 60(1): 106-116, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33555991

RESUMEN

The issue of dating and sexual violence (DSV) on college campuses has received increased attention nationwide as a criminal justice and public health issue. College and university employed social workers play a critical role in preventing and responding to campus DSV through direct clinical services to students as well as prevention through educational programming and training. COVID-19 has negative implications for DSV student victims, as well as service delivery and accessibility. This paper examines the innovative methods used by university employed social work clinicians and educators to meet evolving mental health care needs and continue violence prevention services during COVID-19.


Asunto(s)
/epidemiología , Violencia de Pareja/psicología , Servicios de Salud Mental/organización & administración , Delitos Sexuales/psicología , Servicio Social/organización & administración , Universidades/organización & administración , Consejo/organización & administración , Educación en Salud/organización & administración , Humanos , Violencia de Pareja/prevención & control , Delitos Sexuales/prevención & control , Telemedicina/organización & administración
16.
Soc Work Health Care ; 60(1): 49-61, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33557718

RESUMEN

The COVID-19 pandemic has exposed the systemic inequities in our health care system and society has called for actions to meet the clinical, psychosocial and educational needs in health care settings and communities. In this paper we describe how an organized Department of Health Social Work in a medical school played a unique role in responding to the challenges of a pandemic with community, clinical, and educational initiatives that were integral to our community's health.


Asunto(s)
/epidemiología , Liderazgo , Facultades de Medicina/organización & administración , Servicio Social/organización & administración , Desgaste por Empatía/epidemiología , Abastecimiento de Alimentos/métodos , Estado de Salud , Líneas Directas/organización & administración , Humanos , Capacitación en Servicio/organización & administración , Salud Mental , Cuidados Paliativos/organización & administración , Pandemias , Telemedicina/organización & administración , Estados Unidos/epidemiología
17.
Soc Work Health Care ; 60(1): 78-92, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33563143

RESUMEN

The COVID-19 pandemic necessitated an immediate response and rapid transition from traditional face-to-face behavioral health services to behavioral telehealth at an organization serving sexual and gender diverse (SGD) individuals in Chicago. In this practice innovations article, we explore the unfolding public health crisis and the impact on service delivery for SGD individuals. Using a large multi-service organization as a case study, this paper describes how key members of the staff and leadership team shifted services online as a means of responding to isolation, loneliness, and disparities in access to healthcare for Chicago SGD communities. Lessons learned and practice recommendations are presented.


Asunto(s)
/epidemiología , Disparidades en Atención de Salud/organización & administración , Servicios de Salud Mental/organización & administración , Minorías Sexuales y de Género , Telemedicina/organización & administración , Chicago/epidemiología , Humanos , Pandemias
18.
ESC Heart Fail ; 8(2): 1150-1155, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33560597

RESUMEN

AIMS: Chronic heart failure (HF) is a major comorbidity accounting for an increased severity and mortality related to coronavirus disease 2019 (COVID-19). To reduce the risk of COVID-19 in HF patients, telemedicine has been encouraged. METHODS AND RESULTS: During the COVID-19 pandemic, telemedical management with mainly over-the-phone appointments became a major strategy of follow-up of our HF clinic patients. Previously, the large majority of patients have been seen in the hospital with direct patient-provider contact. We compared both strategies of follow-up, in pre-pandemic (PPP) and pandemic (PP) periods, regarding total mortality and hospitalizations/emergency department (ED) visits due to HF exacerbation. We prospectively studied a cohort of 196 patients. The mean follow-up time in PPP was 1.4 years. In this period, 20 patients died. In PP (follow-up of 71 days), there was one additional death. Total mortality in the first year of follow-up was 12.0%, matching the mortality predicted by the Meta-Analysis Global Group in Chronic Heart Failure score. Considering hospitalizations/ED visits due to decompensated HF, there was no statistically significant difference between PPP and PP. Only one patient was diagnosed with COVID-19. CONCLUSIONS: In the light of an increase in telemedical management of this cohort of HF patients, we were able to maintain a low rate of admissions due to HF decompensation, without an increment in mortality. Regarding these results, we encourage the incremental use of telemedicine in HF patients in the context of this or future pandemics and also in situations in which physical consultation might not be possible due to logistic issues.


Asunto(s)
/epidemiología , Control de Enfermedades Transmisibles/organización & administración , Insuficiencia Cardíaca/terapia , Telemedicina/organización & administración , Anciano , /transmisión , Estudios de Cohortes , Servicio de Urgencia en Hospital , Femenino , Insuficiencia Cardíaca/mortalidad , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Portugal , Volumen Sistólico , Tasa de Supervivencia
19.
Artículo en Inglés | MEDLINE | ID: mdl-33547004

RESUMEN

Telehealth in the broadest sense has been used by pediatric clinicians for over a century, as telephone triage has been and continues to be an essential part of pediatric practice. Utilizing more advanced technology including video communication, although available, was generally underutilized until the onset of the COVID-19 pandemic. Telehealth presents the opportunity to bridge many divides including geographical and logistical challenges. Many acute pediatric conditions can be managed safely and effectively through telehealth especially when remote physical exam equipment is used. Telehealth can also be especially useful in medical care of children with medical complexity. Traveling with medical equipment to multiple subspecialists can be incredibly challenging and often a similar quality visit can be conducted through telehealth in the comfort of a child's home environment. Well child care presents a unique problem while trying to maintain social distancing. Integrating a hybrid model using both an in-person exam and history through video conferencing can help balance limited face to face time with the need to ensure a full and appropriate physical exam. Integration of telehealth into the pediatric patient centered medical home can enable families to gain convenience while maintaining the essential relationship with their primary care office.


Asunto(s)
/epidemiología , Servicios de Salud del Niño/organización & administración , Pediatría/organización & administración , Atención Primaria de Salud/organización & administración , Telemedicina/organización & administración , Enfermedad Aguda , Niño , Enfermedad Crónica , Humanos , Pandemias
20.
Am J Ther ; 28(2): e217-e223, 2021 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-33590991

RESUMEN

BACKGROUND: The current coronavirus disease 2019 (COVID-19) pandemic has caused a significant strain on medical resources throughout the world. A major shift to telemedicine and mobile health technologies has now taken on an immediate urgency. Newly developed devices designed for home use have facilitated remote monitoring of various physiologic parameters relevant to pulmonary diseases. These devices have also enabled home-based pulmonary rehabilitation programs. In addition, telemedicine and home care services have been leveraged to rapidly develop acute care hospital-at-home programs for the treatment of mild-to-moderate COVID-19 illness. AREAS OF UNCERTAINTY: The benefit of remote monitoring technologies on patient outcomes has not been established in robust trials. Furthermore, the use of these devices, which can increase the burden of care, has not been integrated into current clinical workflows and electronic medical records. Finally, reimbursement for these telemedicine and remote monitoring services is variable. DATA SOURCES: Literature review. THERAPEUTIC ADVANCES: Advances in digital technology have improved remote monitoring of physiologic parameters relevant to pulmonary medicine. In addition, telemedicine services for the provision of pulmonary rehabilitation and novel hospital-at-home programs have been developed. These new home-based programs have been adapted for COVID-19 and may also be relevant for the management of acute and chronic pulmonary diseases after the pandemic. CONCLUSION: Digital remote monitoring of physiologic parameters relevant to pulmonary medicine and novel hospital-at-home programs are feasible and may improve care for patients with acute and chronic respiratory-related disorders.


Asunto(s)
Enfermedades Pulmonares , Telemedicina , Tecnología Biomédica/tendencias , /terapia , Humanos , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/rehabilitación , Enfermedades Pulmonares/terapia , Neumología/tendencias , Telemedicina/métodos , Telemedicina/organización & administración
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