Eur J Vasc Endovasc Surg. 2023 Mar 24:S1078-5884(23)00278-2. doi: 10.1016/j.ejvs.2023.02.083. Online ahead of print.

NO ABSTRACT

PMID:36967014 | DOI:10.1016/j.ejvs.2023.02.083

Am J Surg. 2023 Mar 15:S0002-9610(23)00102-2. doi: 10.1016/j.amjsurg.2023.03.007. Online ahead of print.

ABSTRACT

BACKGROUND: Due to the COVID-19 pandemic, post-discharge virtual visits transitioned from a novel intervention to standard practice. Our aim was to evaluate participation in and outcomes of virtual post-discharge visits in the early-pandemic timeframe.

METHODS: Pandemic cohort patients were compared to historical patients. Patient demographics, clinical information, and post-discharge 30-day hospital encounters were compared between groups.

RESULTS: The historical cohort included 563 patients and the pandemic cohort had 823 patients. There was no difference in 30-day hospital encounters between patients who completed a video vs. telephone visit in the pandemic cohort (3.8% vs. 7.6%, p = 0.11). There was a lower 30-day hospital encounter rate in pandemic video and telephone visits compared to similar historical sub-groups.

CONCLUSION: Expansion of virtual post-discharge visits to include all patients and telephone calls did not negatively impact rates of 30-day post-discharge hospital encounters. Offering telehealth options for post-discharge follow-up does not appear to have negative impact on healthcare utilization.

PMID:36966017 | DOI:10.1016/j.amjsurg.2023.03.007

Am J Obstet Gynecol MFM. 2023 Mar 23:100941. doi: 10.1016/j.ajogmf.2023.100941. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic started a period of rapid transition to telehealth in obstetric care delivery to maintain social distancing and curb the spread of the virus. The use of telehealth, such as telephone and video visits, remote imaging interpretation, and provider-to-provider consultations, increased in the early months of the pandemic to maintain access to prenatal and postpartum care. While there is considerable literature on the use of telehealth in obstetric care, there are limited data on wide-spread telehealth use among different practice types and patient populations during the pandemic and whether these are preferable technologies.

OBJECTIVES: The objective of this study is to describe variations in telehealth use for obstetric care among practices in North Carolina during the COVID-19 pandemic and to outline future preferences and needs for continued telehealth use. This study also aims to delineate telehealth use among rural/micropolitan and metropolitan practices to better understand if telehealth use varies by practice location.

STUDY DESIGN: A web-based survey was distributed to practice managers of obstetric practices in North Carolina from June 14, 2020 to September 14, 2020. Practice managers were contacted through the assistance of the Community Care of North Carolina Pregnancy Medical Home Program. Practice location was defined as rural, micropolitan, or metropolitan based upon the county population. The survey assessed telehealth use prior to and during the COVID-19 pandemic, types of modalities used, and preferences for future use. Descriptive statistics were performed to describe survey responses and compare them by practice location.

RESULTS: A total of 295 practice managers were sent a web-based survey and 98 practices responded. Responding practices represented 66/100 counties in NC with 50 practices from rural/micropolitan counties and 48 practices from metropolitan counties. The most common type of provider reported by practice managers were general obstetrician and gynecologists (85%) and the most common practice type was county health departments (38%). Overall, 9% of practices reported telehealth use before the pandemic and 60% reported telehealth use during the pandemic. The most common type of telehealth modality was telephone visits. There were no significant differences in the uptake of telehealth or in the modalities used by practice location. Forty percent of practices endorsed a preference to continue telehealth use beyond the COVID-19 pandemic. The most commonly reported need for continued telehealth use was assistance with patient access to telehealth technologies (54%). There were no significant differences in preferences for telehealth continuation or future needs by practice location.

CONCLUSIONS: Telehealth use increased among a variety of practice types during the pandemic with no variation observed by practice location for modalities used, future preferences, or needs. To the best of our knowledge, this is one of few studies that assesses statewide uptake of and differences in obstetric telehealth use during the early COVID-19 pandemic. With telehealth becoming an integral part of obstetric care delivery, this survey has implications for anticipating the needs of practices and designing innovative solutions for providers and pregnant people beyond the COVID-19 pandemic.

PMID:36965697 | DOI:10.1016/j.ajogmf.2023.100941

Prof Inferm. 2022 Jul 1;75(2):115-122. doi: 10.7429/pi.2022.752115.

ABSTRACT

INTRODUCTION: Heart failure has an enormous impact in terms of mortality, morbidity, and costs for healthcare organizations. Indications for implanted heart devices, such as pacemakers or implantable cardioverter defibrillators (ICDs) are constantly increasing. With the arrival of the telemedicine, nurses play an important role in the remote management of chronic heart diseases. The purpose of this study was to describe the experiences of nurses who remotely monitor patients with an implanted heart device in Italy.

METHODS: A qualitative study with a phenomenological approach was conducted. The sample consisted of 7 nurses dedicated to remote monitoring (RM), from three cardiology clinics in Northern Italy. We conducted semi-structured interviews to understand the experience and training nurses received to conduct RM.

RESULTS: From the analysis of the interviews, six themes were identified: 'Specialized knowledge and skills', 'Learn through practice', 'Organization of work', 'Decision making', 'Trust', and 'Need for information'. The majority of our sample developed their competencies directly on the field, in absence of a certified recognized pathway, on RM in patients with heart failure implanted with cardiac devices. Therefore, nurses performing RM activities do not receive the same type of education and training.

CONCLUSION: Currently, in Italy, there is no standardised training for nurses who perform RM activities for heart failure patients with implanted heart device, and yet it is instrumental to have appropriate knowledge and training to effectively perform this type of activity and care.

PMID:36964922 | DOI:10.7429/pi.2022.752115

J Gen Intern Med. 2023 Mar 24. doi: 10.1007/s11606-023-08165-9. Online ahead of print.

ABSTRACT

BACKGROUND: During the pandemic, there was a dramatic shift to telemedicine for opioid use disorder (OUD) treatment. Little is known about how clinician attitudes about telemedicine use for OUD treatment are evolving or their preferences for future use.

OBJECTIVE: To understand OUD clinician views of and preferences regarding telemedicine.

DESIGN: Longitudinal survey (wave 1, December 2020; wave 2, March 2022).

SUBJECTS: National sample of 425 clinicians who treat OUD.

MAIN MEASURES: Self-reported proportion of OUD visits delivered via telemedicine (actual vs. preferred), comfort in using video visits for OUD, impact of telemedicine on work-related well-being.

KEY RESULTS: The mean reported percentage of OUD visits delivered via telemedicine (vs. in person) dropped from 56.9% in December 2020 to 41.5% in March 2022; the mean preferred post-pandemic percentage of OUD visits delivered via telemedicine was 34.8%. Responses about comfort in using video visits for different types of OUD patients remained similar over time despite clinicians having substantially more experience with telemedicine by spring 2022 (e.g., 35.8% vs. 36.0% report being comfortable using video visits for new patients). Almost three-quarters (70.9%) reported that most of their patients preferred to have the majority of their visits via telemedicine, and 76.7% agreed that the option to do video visits helped their patients remain in treatment longer. The majority (58.7%) reported that telemedicine had a positive impact on their work-related well-being, with higher rates of a positive impact among those who completed training more recently (68.5% of those with < 10 years, 62.1% with 10-19 years, and 45.8% with 20 + years, p < 0.001).

CONCLUSIONS: While many surveyed OUD clinicians were not comfortable using telemedicine for all types of patients, most wanted telemedicine to account for a substantial fraction of OUD visits, and most believed telemedicine has had positive impacts for themselves and their patients.

PMID:36964424 | DOI:10.1007/s11606-023-08165-9

Int J Med Inform. 2023 Mar 20;174:105048. doi: 10.1016/j.ijmedinf.2023.105048. Online ahead of print.

ABSTRACT

OBJECTIVES: The role of startups has been growing in healthcare delivery, particularly in telehealth and telemedicine. Yet, little has been published about their role in evolving digital healthcare ecosystem. This study aimed to review the literature on telehealth startups to understand their roles, challenges, business models, and directions for sustainable innovation and commercialization.

METHODS: Ten databases were screened: PubMed, Scopus, Web of Science, IEEE Xplore, ACM digital library, EBSCOhost, Embase, Medline, Cochrane review, and PsycINFO. The articles were shortlisted based on pre-determined screening criteria, and qualitative synthesis was performed. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. Cohen's K was calculated to ensure the reliability of the authors scoring on the quality appraisal test and qualitative synthesis.

RESULTS: 26 articles were included in the review. Findings are clubbed under five themes: remote and on-demand healthcare; healthcare data management; digital therapeutics; high-tech driven personalized care; and information integration and exchange. Technical infrastructure, regulation, and revenue generation were identified as major challenges for telehealth start-ups. Osterwalder business canvas was the predominantly used model. Value perspectives were recognized for a sustainable telehealth innovation and its commercialization.

CONCLUSION: Telehealth startups are evolving to meet digital healthcare needs and playing a significant role in teleconsultations, telemonitoring, and electronic health record solutions. Recently, their focus has shifted towards smartphone-enabled AI-driven personalized care, including digital therapeutics and wearable device innovation. They have significant technical and operational challenges in innovation and commercialization to optimize their role. The review also provides researchers with a new understanding of telehealth startups' sustainable innovation and commercialization through the systematic direction of value proposition, creation, and capture.

PMID:36963322 | DOI:10.1016/j.ijmedinf.2023.105048

Prof Inferm. 2022 Apr 1;75(1):44-50. doi: 10.7429/pi.2022.751044.

ABSTRACT

INTRODUCTION: In recent years, and even more following the need for social distancing generated by the global COVID-19 pandemic, e-health has become an increasingly widespread reality in clinical practice, especially for those clinicians operating in the front-line, like nurses. Its growing importance has been followed by increasing attention both by the literature as well as in the generation of specific rules aimed at regulating the phenomenon.

METHODS: A regulatory review of the literature aims to outline the current regulatory framework relating to telemedicine. Telemedicine, especially in a pandemic context, calls for regulation that runs parallel to the rapid evolution of the phenomenon itself. The paper traces the European, Italian, and Regional legislation, focusing then on a practical experience of telemedicine, called Doctor @ Home, active at the IRCCS National Cancer Center in Aviano (Italy).

DISCUSSION: First, the need for regulatory harmonization emerges. Secondly, the potential of co-production and co-learning processes for healthcare professionals and patients arises to adapt to the outpatient needs of patients in a post-pandemic "new normal," exploiting the new technological tools made available by the National Health Service.

PMID:36962913 | DOI:10.7429/pi.2022.751044

PLOS Glob Public Health. 2023 Jan 6;3(1):e0001233. doi: 10.1371/journal.pgph.0001233. eCollection 2023.

ABSTRACT

INTRODUCTION: Evidence has shown a trend towards rising mortality from surgical abdominal conditions with increasing distance from hospitals in Eastern India. It has been claimed that imaging modalities such as portable ultrasound are ideal for use in rural areas of developing countries for diagnosis and management of a variety of acute abdominal conditions. This mixed-methods study aimed to explore the need for increased access to POCUS in rural, hard-to-reach populations within India, and to identify barriers that may exist to increasing this access.

METHODS: This mixed-methods study utilized a health needs assessment framework. Quantitative data was extracted from medical records within two outreach camp organisations supporting hard-to-reach populations in Uttarakhand and Jharkhand to provide contextual background statistics. Qualitative data was collected using semi-structured interviews taken from employees of each outreach camp. A framework analysis was employed to analyse the qualitative data. Both datasets were analysed in parallel.

RESULTS: Twelve semi-structured interviews were undertaken, and 3 months of medical records were reviewed. Themes that presented themselves from the data included the use of camps for case-finding of conditions amenable to routine surgery, a need for POCUS to help with this diagnostic process, a perceived high disease burden from renal calculi, and complex cultural and legislative barriers to POCUS specific to this setting.

DISCUSSION: POCUS was considered a useful tool in expanding access to surgery for these settings and finding ways of overcoming cultural and legislative barriers to its use should be of high priority. POCUS should be highly portable, robust, easily repairable, and battery operated. For telemedicine to be fully utilised, signal quality will have to be proven to be reliable.

PMID:36962842 | PMC:PMC10021911 | DOI:10.1371/journal.pgph.0001233

PLOS Glob Public Health. 2022 Feb 9;2(2):e0000189. doi: 10.1371/journal.pgph.0000189. eCollection 2022.

ABSTRACT

The urgency to curtail the devastating effects of the ongoing COVID-19 Pandemic has led to the implementation of several measures to limit its spread, including movement restrictions and social distancing. As most developing countries rely solely on hospital visitations for their medical needs, this impediment to assessing healthcare services compounded by low uptake of telehealth services could result in dire consequences. This is a cross-sectional study among Healthcare providers (HCP) and Healthcare consumers (HCC) in Nigeria. We administered a pre-validated self-administered online questionnaire comprising questions to assess the knowledge, use, perceptions, and benefits of telemedicine among study participants. Descriptive statistics were used to examine participants' perceptions on telemedicine use and to summarize participants' characteristics. A total of 158 healthcare providers and 1381 healthcare consumers completed the online survey. Ninety percent of HCP reported that they used some form of telemedicine to deliver health care, and 63% of HCC had received healthcare through telemedicine. A significant proportion of HCP (62%) and HCC (69%) agreed that telemedicine would improve healthcare consultation experience and satisfaction. However, fewer (21%) HCP agreed that they liked that there would be no physical contact with patients using telemedicine. In contrast, 52% of HCC agreed that they liked that there would be no physical contact with healthcare providers while using telemedicine. The majority of the participants believed that benefits of telemedicine would include: being a safe way for healthcare delivery during pandemics (HCP = 62%, HCC = 83%), affordability (HCP = 62%, HCC = 82%), and time-saving (HCP = 54%, HCC = 82%,). Teleconsultation services have been shown to aptly complement face-to-face hospital visits in ensuring effective triaging in hospitals and providing adequate healthcare delivery to patients regardless of geographical and physical barriers. These results support telemedicine use for the provision of healthcare services during the COVID-19 pandemic.

PMID:36962178 | DOI:10.1371/journal.pgph.0000189

PLOS Glob Public Health. 2022 Apr 28;2(4):e0000214. doi: 10.1371/journal.pgph.0000214. eCollection 2022.

ABSTRACT

Routine postnatal care (PNC) allows monitoring, early detection and management of complications, and counselling to ensure immediate and long-term wellbeing of mothers and newborns; yet effective coverage is sub-optimal globally. The COVID-19 pandemic disrupted availability and quality of maternal and newborn care despite established guidelines promoting continuity of essential services. We conducted a cross-sectional global online survey of 424 maternal and newborn healthcare providers from 61 countries, to explore PNC provision, availability, content and quality following the early phase of the COVID-19 pandemic. The questionnaire (11 languages), included four multiple-choice and four open-text questions on changes to PNC during the pandemic. Quantitative and qualitative responses received between July and December 2020 were analysed separately and integrated during reporting. Tightened rules for visiting postpartum women were reported in health facilities, ranging from shorter visiting hours to banning supportive companions and visitors. A quarter (26%) of respondents reported that mothers suspected/confirmed with COVID-19 were routinely separated from their newborns. Early initiation of breastfeeding was delayed due to waiting for maternal SARS-CoV-2 test results. Reduced provision of breastfeeding support was reported by 40% of respondents in high-income countries and 7% in low-income countries. Almost 60% reported that women were discharged earlier than usual and 27% perceived a reduction in attendance to outpatient PNC. Telemedicine and home visits were mostly reported in high-income countries to ensure safe care provision. Beyond the early phase of the COVID-19 pandemic, severe disruptions to content and quality of PNC continued to exist, whereas disruptions in availability and use were less commonly reported. Depriving women of support, reducing availability of PNC services, and mother-newborn separation could lead to negative long-term outcomes for women, newborns and families, and deny their rights to respectful care. Protecting these essential services is imperative to promoting quality woman-centred PNC during and beyond the pandemic.

PMID:36962168 | DOI:10.1371/journal.pgph.0000214