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1.
Sensors (Basel) ; 21(3)2021 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-33525556

RESUMEN

Heart failure (HF) is a major health care issue, and the incidence of HF is only expected to grow further. Due to the frequent hospitalizations, HF places a major burden on the available hospital and healthcare resources. In the future, HF care should not only be organized solely at the clinical ward and outpatient clinics, but remote monitoring strategies are urgently needed to guide, monitor, and treat chronic HF patients remotely from their homes as well. The intuitiveness and relatively low costs of non-invasive remote monitoring tools make them an appealing and emerging concept for developing new medical apps and devices. The recent COVID-19 pandemic and the associated transition of patient care outside the hospital will boost the development of remote monitoring tools, and many strategies will be reinvented with modern tools. However, it is important to look carefully at the inconsistencies that have been reported in non-invasive remote monitoring effectiveness. With this review, we provide an up-to-date overview of the available evidence on non-invasive remote monitoring in chronic HF patients and provide future perspectives that may significantly benefit the broader group of HF patients.


Asunto(s)
Continuidad de la Atención al Paciente/tendencias , Insuficiencia Cardíaca/terapia , Monitoreo Fisiológico/métodos , Telemedicina/tendencias , Insuficiencia Cardíaca/diagnóstico , Humanos , Pandemias , Telemetría , Teleenfermería
2.
J Ovarian Res ; 14(1): 34, 2021 Feb 18.
Artículo en Inglés | MEDLINE | ID: mdl-33602259

RESUMEN

The COVID-19 pandemic has claimed the lives of over one million people worldwide, and has affected all aspects of healthcare worldwide, including the delivery of care to patients with fertility-related diagnoses. In the United States, the response of US fertility clinics to the COVID-19 pandemic was coordinated by the American Society for Reproductive Medicine (ASRM). ASRM acted quickly to develop guidelines for limiting fertility treatment and clinic consultations during the early days of the pandemic, and then safely restarting fertility treatment. A survey of patients with fertility-related diagnoses who presented for care during the first months of the pandemic revealed that a majority of patients who presented for care during the early months of the pandemic experienced delayed or cancelled treatment cycles. Patients with infertility subsequently reported a desire to resume fertility care, but emphasized the importance of their clinic having policies and procedures in place to limit the risk of infection.


Asunto(s)
/prevención & control , Fertilidad , Medicina Reproductiva/métodos , /aislamiento & purificación , /epidemiología , Femenino , Humanos , Infertilidad/terapia , Pandemias , Medicina Reproductiva/tendencias , Telemedicina/métodos , Telemedicina/tendencias , Estados Unidos
3.
CMAJ Open ; 9(1): E107-E114, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33597307

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is thought to have increased use of virtual care, but population-based studies are lacking. We aimed to assess the uptake of virtual care during the COVID-19 pandemic using comprehensive population-based data from Ontario. METHODS: This was a repeated cross-sectional study design. We used administrative data to evaluate changes in in-person and virtual visits among all residents of Ontario before (2012-2019) and during (January-August 2020) the COVID-19 pandemic. We included all patients who had an ambulatory care visit in Ontario. We excluded claims for patients who were not Ontario residents or had an invalid or missing health card number. We compared monthly or quarterly virtual care use across age groups, neighbourhood income quintiles and chronic disease subgroups. We also examined physician characteristics that may have been associated with virtual care use. RESULTS: Among all residents of Ontario (population 14.6 million), virtual care increased from 1.6% of total ambulatory visits in the second quarter of 2019 to 70.6% in the second quarter of 2020. The proportion of physicians who provided 1 or more virtual visits per year increased from 7.0% in the second quarter of 2019 to 85.9% in the second quarter of 2020. The proportion of Ontarians who had a virtual visit increased from 1.3% in 2019 to 29.2% in 2020. Older patients were the highest users of virtual care. The proportion of total virtual visits that were provided to patients residing in rural areas (v. urban areas) declined significantly between 2012 and 2020, reflecting a shift in virtual care to a service increasingly used in urban centres. The rates of virtual care use increased similarly across all conditions and across all income quintiles. INTERPRETATION: Our findings show that Ontario's approach to virtual care led to broad adoption across all provider groups, patient age, types of chronic diseases and neighborhood income. These findings have policy implications, including use of virtual care billing codes, for the ongoing use of virtual care during the second wave of the pandemic and beyond.


Asunto(s)
Atención Ambulatoria/tendencias , Telemedicina/tendencias , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Renta , Masculino , Persona de Mediana Edad , Ontario , Características de la Residencia , Población Rural , Población Urbana , Adulto Joven
4.
MMWR Morb Mortal Wkly Rep ; 70(7): 240-244, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33600385

RESUMEN

Telehealth can facilitate access to care, reduce risk for transmission of SARS-CoV-2 (the virus that causes coronavirus disease 2019 [COVID-19]), conserve scarce medical supplies, and reduce strain on health care capacity and facilities while supporting continuity of care. Health Resources and Services Administration (HRSA)-funded health centers* expanded telehealth† services during the COVID-19 pandemic (1). The Centers for Medicare & Medicaid Services eliminated geographic restrictions and enhanced reimbursement so that telehealth services-enabled health centers could expand telehealth services and continue providing care during the pandemic (2,3). CDC and HRSA analyzed data from 245 health centers that completed a voluntary weekly HRSA Health Center COVID-19 Survey§ for 20 consecutive weeks to describe trends in telehealth use. During the weeks ending June 26-November 6, 2020, the overall percentage of weekly health care visits conducted via telehealth (telehealth visits) decreased by 25%, from 35.8% during the week ending June 26 to 26.9% for the week ending November 6, averaging 30.2% over the study period. Weekly telehealth visits declined when COVID-19 cases were decreasing and plateaued as cases were increasing. Health centers in the South and in rural areas consistently reported the lowest average percentage of weekly telehealth visits over the 20 weeks, compared with health centers in other regions and urban areas. As the COVID-19 pandemic continues, maintaining and expanding telehealth services will be critical to ensuring access to care while limiting exposure to SARS-CoV-2.


Asunto(s)
/epidemiología , Instituciones de Salud/estadística & datos numéricos , Pandemias , Telemedicina/estadística & datos numéricos , Telemedicina/tendencias , Encuestas de Atención de la Salud , Humanos , Estados Unidos/epidemiología
6.
Intern Med J ; 51(1): 125-133, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33572014

RESUMEN

The COVID-19 pandemic has precipitated the rapid uptake of telehealth in cancer care and in other fields. Many of the changes made in routine clinical practice could be embedded beyond the duration of the pandemic. This is intended as a practical guide to cancer clinicians and others in establishing and improving the quality of consultations performed by telehealth.


Asunto(s)
Oncología Médica/tendencias , Neoplasias , Pandemias , Telemedicina/tendencias , Humanos , Neoplasias/terapia
7.
J Drugs Dermatol ; 20(2): 178-183, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33538563

RESUMEN

BACKGROUND: The COVID-19 pandemic has drastically changed the practice of dermatology as social distancing guidelines have led to a shift from in-office care to virtual telehealth (teledermatology). We aimed to determine patient satisfaction, perceived barriers, as well as indications for teledermatology appointments during the COVID-19 pandemic. METHODS: A survey was sent out via SurveyMonkey's online platform to patients of the George Washington Medical Faculty Associates' Dermatology department who attended telehealth appointments during the COVID-19 pandemic. RESULTS: Out of 894 invitations sent, 168 patients completed our survey.The most common reasons for making a telehealth appointment were for a new rash (11.6%), eczema (9.8%), and psoriasis (9.1%). The most common reasons respondents liked telehealth were because of time efficiency (81.1%), not requiring transportation (74.2%), and maintaining social distancing (73.6%). The most common reasons respondents did not like telehealth were due to lack of physical touch (26.8%) and feeling they received an inadequate assessment (15.7%). Very few patients reported that they were unlikely to undertake another telehealth visit (9.94%) or recommend a telehealth visit to others (6.92%). CONCLUSION: Dermatology patients likely perceive telehealth visits as a convenient and safe method for quality care during the COVID-19 pandemic. The lack of physical touch, inability to provide close inspection and/or procedural intervention can be frustrating for patients and therefore meaningful selection of appropriate cases for telehealth visits can optimize the patient experience. Overall, telemedicine represents an effective and safe vehicle for delivering care especially during a global pandemic. J Drugs Dermatol. 2021;20(2):178-183. doi:10.36849/JDD.2021.5714.


Asunto(s)
Actitud , Dermatología/tendencias , Pandemias , Satisfacción del Paciente , Telemedicina/tendencias , Adolescente , Adulto , Factores de Edad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Piel/terapia , Encuestas y Cuestionarios , Estados Unidos , Adulto Joven
8.
Heart ; 107(5): 366-372, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33431425

RESUMEN

The incidence of heart failure (HF) remains high and patients with HF are at risk for frequent hospitalisations. Remote monitoring technologies may provide early indications of HF decompensation and potentially allow for optimisation of therapy to prevent HF hospitalisations. The need for reliable remote monitoring technology has never been greater as the COVID-19 pandemic has led to the rapid expansion of a new mode of healthcare delivery: the virtual visit. With the convergence of remote monitoring technologies and reliable method of remote healthcare delivery, an understanding of the role of both in the management of patients with HF is critical. In this review, we outline the evidence on current remote monitoring technologies in patients with HF and highlight how these advances may benefit patients in the context of the current pandemic.


Asunto(s)
Insuficiencia Cardíaca , Tecnología de Sensores Remotos , Telemedicina , /epidemiología , Control de Enfermedades Transmisibles , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/terapia , Humanos , Telemedicina/instrumentación , Telemedicina/métodos , Telemedicina/tendencias
9.
Curr Oncol ; 28(1): 671-677, 2021 01 22.
Artículo en Inglés | MEDLINE | ID: mdl-33499380

RESUMEN

There has been rapid implementation of virtual oncology appointments in response to the COVID-19 pandemic, particularly in its first wave. Our objective was to assess patterns and perspectives towards virtual oncology appointments during the pandemic among patients with cancer undergoing active treatment. We conducted an international Internet-based cross-sectional survey. Participants were eligible if they (1) were ≥18 years of age; (2) had been diagnosed with cancer (3) were currently undergoing cancer treatment, and (4) spoke English or French. Between 23 April 2020 and 9 June 2020, 381 individuals accessed the survey, with 212 actively undergoing treatment for cancer, including 27% with colorectal, 21% with breast, 7% with prostate and 7% with lung cancer. A total of 52% of respondents were from Canada and 35% were from the United States. Many participants (129, 62%) indicated having had a virtual oncology appointment during the COVID-19 pandemic and most were satisfied with their experience (83%). We found older participants (≥50 years; adjusted OR 0.22, 95% CI 0.06 to 0.85 compared to <50 years) and those with shortest duration of treatment (≤3 months; adjusted OR 0.06; 95% CI 0 to 0.69 compared to >12 months) were less likely to be satisfied with virtual oncology appointments. Virtual health platforms used differed across countries with higher telephone use in Canada (87%) and other countries (86%) as compared to the United States (54%; p-value < 0.05), where there was higher use of video conferencing. Altogether, our findings demonstrate favorable patient perspectives towards virtual oncology appointments experienced during the first wave of the COVID-19 pandemic.


Asunto(s)
/epidemiología , Oncología Médica/organización & administración , Neoplasias/terapia , Telemedicina/tendencias , Adulto , Anciano , Canadá/epidemiología , Estudios Transversales , Femenino , Conductas Relacionadas con la Salud , Accesibilidad a los Servicios de Salud , Humanos , Cooperación Internacional , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Comunicación por Videocoferencia
10.
JMIR Public Health Surveill ; 7(1): e21327, 2021 01 08.
Artículo en Inglés | MEDLINE | ID: mdl-33400680

RESUMEN

BACKGROUND: The COVID-19 pandemic, caused by SARS-CoV-2, has forced the health care delivery structure to change rapidly. The pandemic has further widened the disparities in health care and exposed vulnerable populations. Health care services caring for such populations must not only continue to operate but create innovative methods of care delivery without compromising safety. We present our experience of incorporating telemedicine in our university hospital-based outpatient clinic in one of the worst-hit areas in the world. OBJECTIVE: Our goal is to assess the adoption of a telemedicine service in the first month of its implementation in outpatient practice during the COVID-19 pandemic. We also want to assess the need for transitioning to telemedicine, the benefits and challenges in doing so, and ongoing solutions during the initial phase of the implementation of telemedicine services for our patients. METHODS: We conducted a prospective review of clinic operations data from the first month of a telemedicine rollout in the outpatient adult ambulatory clinic from April 1, 2020, to April 30, 2020. A telemedicine visit was defined as synchronous audio-video communication between the provider and patient for clinical care longer than 5 minutes or if the video visit converted to a telephone visit after 5 minutes due to technical problems. We recorded the number of telemedicine visits scheduled, visits completed, and the time for each visit. We also noted the most frequent billing codes used based on the time spent in the patient care and the number of clinical tasks (eg, activity suggested through diagnosis or procedural code) that were addressed remotely by the physicians. RESULTS: During the study period, we had 110 telemedicine visits scheduled, of which 94 (85.4%) visits were completed. The average duration of the video visit was 35 minutes, with the most prolonged visit lasting 120 minutes. Of 94 patients, 24 (25.54%) patients were recently discharged from the hospital, and 70 (74.46%) patients were seen for urgent care needs. There was a 50% increase from the baseline in the number of clinical tasks that were addressed by the physicians during the pandemic. CONCLUSIONS: There was a high acceptance of telemedicine services by the patients, which was evident by a high show rate during the COVID-19 pandemic in Detroit. With limited staffing, restricted outpatient work hours, a shortage of providers, and increased outpatient needs, telemedicine was successfully implemented in our practice.


Asunto(s)
Pandemias/prevención & control , Telemedicina/métodos , Atención Ambulatoria/métodos , /transmisión , Humanos , Michigan , Pandemias/estadística & datos numéricos , Satisfacción del Paciente , Estudios Prospectivos , Estudios Retrospectivos , Telemedicina/tendencias , Centros de Atención Terciaria/organización & administración , Centros de Atención Terciaria/tendencias
11.
Nutr Diabetes ; 11(1): 1, 2021 01 05.
Artículo en Inglés | MEDLINE | ID: mdl-33414391

RESUMEN

BACKGROUND: Starting March 2020 the Italian Government imposed a lockdown to limit the spread of SARS-CoV-2. During lockdown outpatient visits were limited and telemedicine (TM) was encouraged. METHODS: We retrospectively analyzed data from continuous or flash glucose monitoring systems shared through different cloud systems during the lockdown by subjects with type 1 diabetes and compared data obtained 4 weeks before and 4 weeks after structured telephonic visit. Variables considered were mean glucose, time spent in target (70-180 mg/dl), hypoglycemia (<70 mg/dl) and hyperglycemia (>180 mg/dl), coefficient of variation, and length of sensor use. RESULTS: During the 4 weeks following the telephonic visit there was an improvement of glycemic control, with a significant reduction of mean glucose values (161.1 before vs 156.3 mg/dl after, p = 0.001), an increase of the time spent in target (63.6 vs 66.3, p = 0.0009) and a reduction of time spent in hyperglycemia (33.4 vs 30.5, p = 0.002). No changes were observed regarding glucose variability, time spent in hypoglycemia, and length of sensor use. Similar results were observed in subjects treated with multiple daily injections or continuous subcutaneous insulin infusion. CONCLUSIONS: A structured telephonic visit appears to be an effective way to replace or integrate routine visits in particular conditions.


Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Pandemias , Cuarentena , Telemedicina/tendencias , Adulto , Anciano , Glucemia/análisis , Automonitorización de la Glucosa Sanguínea , Femenino , Humanos , Hiperglucemia/epidemiología , Hipoglucemia/epidemiología , Hipoglucemiantes/administración & dosificación , Sistemas de Infusión de Insulina , Italia/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
12.
Ann Fam Med ; 19(1): 75-78, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33431398

RESUMEN

As I begin my 4th year of medical school amidst the coronavirus disease 2019 (COVID-19) pandemic, telehealth has allowed me to connect with many patients who previously struggled to access consistent primary care. In this essay, I describe 2 of my most formative experiences with telehealth: participating in my medical school's new "tele-hotspotting" elective, and providing virtual gender-affirming care through our student-run free clinic. These experiences demonstrate not only telehealth's utility during a viral pandemic, but also its potential as a powerful tool for expanding access to care and promoting health equity over the coming years. With this said, telehealth is not without limitations. Patients and clinicians alike have expressed concerns regarding the challenge of performing a physical exam and maintaining emotional connection across physical distance. A sustained expansion of telehealth is further challenged by inconsistent availability of broadband Internet, as well as a lack of standardized reimbursement procedures for telehealth visits. Strategies are available to help meet these challenges while maximizing health equity.


Asunto(s)
Predicción , Accesibilidad a los Servicios de Salud/tendencias , Atención Primaria de Salud/tendencias , Telemedicina/tendencias , Humanos , Atención Primaria de Salud/métodos
13.
Ann Fam Med ; 19(1): 44-47, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33431391

RESUMEN

We studied the changes in presented health problems and demand for primary care since the outbreak of coronavirus disease 2019 (COVID-19) in the Netherlands. We analyzed prominent symptom features of COVID-19, and COVID-19 itself as the reason for encounter. Also, we analyzed the number and type of encounters for common important health problems. Respiratory tract symptoms related to COVID-19 were presented more often in 2020 than in 2019. We observed a dramatic increase of telephone/e-mail/Internet consultations in the months after the outbreak. Contacts for other health problems such as prevention and acute and chronic conditions plummeted substantially (P <0.001); mental health problems stabilized.


Asunto(s)
/terapia , Medicina Familiar y Comunitaria/tendencias , Necesidades y Demandas de Servicios de Salud/tendencias , Pautas de la Práctica en Medicina/tendencias , Atención Primaria de Salud/tendencias , Humanos , Países Bajos/epidemiología , Derivación y Consulta/tendencias , Telemedicina/tendencias
15.
J Med Internet Res ; 23(1): e26165, 2021 01 22.
Artículo en Inglés | MEDLINE | ID: mdl-33444153

RESUMEN

BACKGROUND: To minimize the spread and risk of a COVID-19 outbreak, societal norms have been challenged with respect to how essential services are delivered. With pressures to reduce the number of in-person ambulatory visits, innovative models of telemonitoring have been used during the pandemic as a necessary alternative to support access to care for patients with chronic conditions. The pandemic has led health care organizations to consider the adoption of telemonitoring interventions for the first time, while others have seen existing programs rapidly expand. OBJECTIVE: At the Toronto General Hospital in Ontario, Canada, the rapid expansion of a telemonitoring program began on March 9, 2020, in response to COVID-19. The objective of this study was to understand the experiences related to the expanded role of a telemonitoring program under the changing conditions of the pandemic. METHODS: A single-case qualitative study was conducted with 3 embedded units of analysis. Semistructured interviews probed the experiences of patients, clinicians, and program staff from the Medly telemonitoring program at a heart function clinic in Toronto, Canada. Data were analyzed using inductive thematic analysis as well as Eakin and Gladstone's value-adding approach to enhance the analytic interpretation of the study findings. RESULTS: A total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and operational staff (n=4). Four themes were identified: (1) providing care continuity through telemonitoring; (2) adapting telemonitoring operations for a more virtual health care system; (3) confronting virtual workflow challenges; and (4) fostering a meaningful patient-provider relationship. Beyond supporting virtual visits, the program's ability to provide a more comprehensive picture of the patient's health was valued. However, issues relating to the lack of system integration and alert-driven interactions jeopardized the perceived sustainability of the program. CONCLUSIONS: With the reduction of in-person visits during the pandemic, virtual services such as telemonitoring have demonstrated significant value. Based on our study findings, we offer recommendations to proactively adapt and scale telemonitoring programs under the changing conditions of an increasingly virtual health care system. These include revisiting the scope and expectations of telemedicine interventions, streamlining virtual patient onboarding processes, and personalizing the collection of patient information to build a stronger virtual relationship and a more holistic assessment of patient well-being.


Asunto(s)
/epidemiología , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/tendencias , Telemedicina/métodos , Telemedicina/tendencias , Adulto , Anciano , Continuidad de la Atención al Paciente/tendencias , Brotes de Enfermedades , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Pandemias , Adulto Joven
16.
Epilepsy Behav ; 115: 107404, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33323339

RESUMEN

The diagnosis of childhood absence epilepsy (CAE) is typically based on history and description of spells, supported by an office-based positive hyperventilation test and confirmed by routine electroencephalography (EEG). In the current coronavirus disease 2019 (COVID-19) pandemic, many pediatric neurologists have switched to telemedicine visits for nonemergent outpatient evaluations. We present a series of children diagnosed as having CAE on the basis of a positive hyperventilation test performed during remote televisits. Several of these children were begun on treatment for CAE prior to obtaining an EEG, with significant seizure reduction. Our series documents the feasibility of CAE diagnosis and management by telemedicine.


Asunto(s)
Anticonvulsivantes/uso terapéutico , Manejo de la Enfermedad , Epilepsia Tipo Ausencia/diagnóstico , Epilepsia Tipo Ausencia/tratamiento farmacológico , Telemedicina/métodos , /epidemiología , Niño , Preescolar , Electroencefalografía/métodos , Electroencefalografía/tendencias , Epilepsia Tipo Ausencia/epidemiología , Femenino , Humanos , Hiperventilación/diagnóstico , Hiperventilación/epidemiología , Masculino , Neurólogos/tendencias , Pediatras/tendencias , Telemedicina/tendencias , Ácido Valproico/uso terapéutico
17.
Z Orthop Unfall ; 159(1): 39-46, 2021 02.
Artículo en Inglés, Alemán | MEDLINE | ID: mdl-33327028

RESUMEN

INTRODUCTION: Due to the current COVID-19 pandemic, the German Health Ministry has issued restrictions applying to the field of orthopaedics and trauma surgery. Besides postponement of elective surgeries, outpatient consultations have been drastically reduced. Parallel to these developments, an increase in telemedical consultations has reflected efforts to provide sufficient patient care. This study aims to evaluate the feasibility of a clinical examination of the hip joint and pelvis by way of a telemedical consultation. MATERIALS AND METHODS: Twenty-nine patients of a German university clinic were recruited and assessed in both telemedical and conventional examinations. Agreement between the two examinations was then assessed, and connections between the observed agreement and patient-specific factors such as age, BMI and ASA classification were investigated. RESULTS: The inspections agreed closely with a mean Cohen's kappa of 0.76 ± 0.37. Palpation showed adequate agreement with a mean Cohen's kappa of 0.38 ± 0.19. Function showed good agreement with a mean Cohen's kappa of 0.61 ± 0.26 and range of motion showed adequate agreement with a mean Cohen's kappa of 0.36 ± 0.19. A significant positive correlation was observed between the number of deviations in the different examinations and age (p = 0.05), and a significant positive correlation was shown between the number of non-feasible examinations and age (p < 0.01), BMI (p < 0.01) and ASA classification score (p < 0.01). DISCUSSION: Inspection and function can be reliably evaluated, whereas the significance of palpation, provocation and measurement of range of motion is limited. The small sample size puts limitations on the significance of a statistically relevant correlation between patient-specific factors such as age, BMI and ASA classification score and valid and successful implementation of a telemedical examination. The authors recommend targeted patient selection. If, however, patients are being evaluated who are very old (> 75 years), obese (BMI > 30) or with multiple comorbidities (ASA 3 and above), caution is advised. Large, prospective studies are needed in the future to fully validate telemedical consultations in the fields of orthopaedics and trauma surgery. CONCLUSION: A telemedical examination of the hip joint and pelvis can be performed with certain limitations. Patient-specific factors such as age, BMI, and extent of comorbidities appear to have a relevant impact on validity and execution of the examination. Patients with multiple comorbidities (ASA 3 and above), advanced age (> 75 years) or obesity (BMI > 30) should, whenever possible, be examined in a conventional outpatient setting.


Asunto(s)
Articulación de la Cadera , Pandemias , Pelvis , Examen Físico/métodos , Telemedicina/tendencias , Anciano , Estudios de Factibilidad , Humanos , Estudios Prospectivos
18.
J Ambul Care Manage ; 44(1): 78-84, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33234870

RESUMEN

COVID-19 restructured the health care delivery process, catapulting telemedicine to the mainstream. The Johns Hopkins After Care Clinic (JHACC) continued transprofessional health care delivery in the telemedicine space by shifting to remote, asynchronous collaboration and a triage system. In 1 month after starting telemedicine, the JHACC had 907 encounters for 376 unique patients. Most patients reported satisfaction with their visits. Telemedicine lengthened visit completion times. Providers encountered many failed call attempts and limited access to videoconferencing. Barriers to sustainable interprofessional telemedicine include poor social determinants of health, limited reimbursement for nonphysician health professionals, and increased clinical and administrative time.


Asunto(s)
Instituciones de Atención Ambulatoria/organización & administración , Prestación de Atención de Salud/organización & administración , Telemedicina/tendencias , Humanos , Innovación Organizacional , Pandemias , Estados Unidos
19.
Work ; 68(1): 13-20, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33337401

RESUMEN

BACKGROUND: An analysis of data from an international survey was undertaken to determine the impact of the COVID-19 pandemic on telehealth practice in occupational therapy worldwide, in addition to facilitators and barriers in utilising this form of service delivery. METHOD: The global online survey was circulated in the occupational therapy community by the World Federation of Occupational Therapists (WFOT) between April and July 2020, collecting responses to closed-ended questions, in addition to free-text comments. Descriptive statistics and bivariate analyses were used to assess relationships between respondent characteristics and the utilisation of telehealth. Thematic statement analysis provided further insight regarding factors impacting telehealth use. RESULTS: Findings revealed a significant increase in the use of telehealth strategies with the onset of the pandemic among survey respondents, with many reported benefits. Bivariate analyses indicated telehealth users were more likely to score higher feelings of safety and positive work morale, as well as perceive employer expectations to be reasonable. Restricted access to technology, limitations of remote practice, funding issues and slow pace of change were identified as barriers for some respondents to utilising telehealth. Facilitators included availability of supportive policy, guidelines and strategies, in addition to education and training. CONCLUSION: This study advances the understanding of the current scope of occupational therapy telehealth practice in the context of the ongoing COVID-19 pandemic. Although results suggest long-term potential for telehealth use as an adjunct to traditional service provision, important considerations were identified regarding factors influencing integration of such strategies.


Asunto(s)
Salud Global/tendencias , Terapia Ocupacional/instrumentación , Pandemias/prevención & control , Telemedicina/tendencias , Humanos , Terapia Ocupacional/métodos , Telemedicina/métodos
20.
Jt Comm J Qual Patient Saf ; 47(2): 86-98, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33358323

RESUMEN

BACKGROUND: Telemedicine use rapidly increased during the COVID-19 pandemic. This study assessed quality aspects of rapid expansion of a virtual urgent care (VUC) telehealth system and the effects of a secondary telephonic screening initiative during the pandemic. METHODS: A retrospective cohort analysis was performed in a single health care network of VUC patients from March 1, 2020, through April 20, 2020. Researchers abstracted demographic data, comorbidities, VUC return visits, emergency department (ED) referrals and ED visits, dispositions, intubations, and deaths. The team also reviewed incomplete visits. For comparison, the study evaluated outcomes of non-admission dispositions from the ED: return visits with and without admission and deaths. We separately analyzed the effects of enhanced callback system targeting higher-risk patients with COVID-like illness during the last two weeks of the study period. RESULTS: A total of 18,278 unique adult patients completed 22,413 VUC visits. Separately, 718 patient-scheduled visits were incomplete; the majority were no-shows. The study found that 50.9% of all patients and 74.1% of patients aged 60 years or older had comorbidities. Of VUC visits, 6.8% had a subsequent VUC encounter within 72 hours; 1.8% had a subsequent ED visit. Of patients with enhanced follow-up, 4.3% were referred for ED evaluation. Mortality was 0.20% overall; 0.21% initially and 0.16% with enhanced follow-up (p = 0.59). Males and black patients were significantly overrepresented in decedents. CONCLUSION: Appropriately deployed VUC services can provide a pragmatic strategy to care for large numbers of patients. Ongoing surveillance of operational, technical, and clinical factors is critical for patient quality and safety with this modality.


Asunto(s)
Atención Ambulatoria/normas , Atención Ambulatoria/tendencias , Seguridad del Paciente , Calidad de la Atención de Salud , Telemedicina/normas , Telemedicina/tendencias , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , New York/epidemiología , Pandemias , Estudios Retrospectivos
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