Telemedicine and e-Health

This research aims to develop a theoretical service quality (SQ) model for direct-to-consumer (DTC) telemedicine consultations. Although it can change care delivery for the better, it is crucial to create the appropriate measurement tool to collect and analyze patient's perceptions of SQ to identify any service pitfall and encourage a faster adoption. To the best of the authors' knowledge, this article is one of the first to investigate and propose a SQ model for DTC telemedicine consultations. This study is therefore motivated by a clear need for such a model as it is currently inexistent.

A literature review of health and e-service quality (e-SQ) models was conducted to identify a suitable instrument for the research. A total of 60 studies were included.

The main findings are threefold: (1) DTC telemedicine SQ is interdisciplinary: it encompasses generic and context-specific dimensions from the health, e-SQ, and information system literature; (2) the existing SQ models are not adequate, they do not cover all dimensions of DTC telemedicine services; (3) although LeRouge et al.'s Telemedicine service encounter quality model was identified as a reference model, it is inadequate to simply transpose it to the context of the study. Thus, the elaboration of a more suitable instrument and creation of a new updated model by the authors.

The conceptual model captures three primary dimensions (system quality, interaction quality and use quality) that represent SQ of DTC telemedicine consultations from a patient perspective.

Infectious disease outbreaks disrupt inpatient clinical care and have an impact on staff and patients' ability to communicate with each other and with the wider community. Digital technology may offer opportunities for communication in the inpatient setting during infectious disease outbreaks.

This scoping review aimed to investigate the use of digital technology in the inpatient setting to promote communication in the early stages of an infectious disease outbreak.

There were three aspects to this scoping review: (1) a database search of Ovid MEDLINE (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Association for Computing Machinery Digital Library (ACM) and IEEE Xplore (IEEE) exploring peer-reviewed articles, (2) a gray literature search, and (3) a media search.

Results focused on the early stages of the COVID-19 pandemic. Thirty-eight peer-reviewed articles were extracted from the database search. There were three main areas of investigation: study characteristics, technology features, and benefits and barriers. Forty-four websites were searched for the gray literature search focusing on policy and guidance. Eighteen media articles were retrieved focusing on patients' use of technology and community involvement.

Results demonstrate the diverse use of digital technology in the inpatient setting to facilitate communication during the early stages of the COVID-19 pandemic. However, the articles provide limited data to allow readers to fully understand and reproduce described actions. Furthermore, there was limited guidance to support clinicians to communicate using digital technology to create trusting therapeutic relationships. Areas for future development include standard reporting process for technology hardware, software, and content; and structured reporting and evaluation of the implementation of technologies.

Use of electronic health (e-Health) technologies has increased in the past decade and inadequate e-Health literacy may lead to health-related social inequality. This is especially true for patients living with chronic diseases who are often involved in self-care. However, the measurement of e-Health literacy represents several challenges. Among available instruments, the e-Health Literacy Scale (eHEALS) is the only instrument with available psychometric properties.

To identify studies measuring e-Health literacy in adults living with chronic disease and its relationship to health-related behaviors and other perceptions such as quality of life, self-efficacy, or specific disease biomarkers, and studies analyzing the impact of educational intervention on e-Health literacy.

The authors searched MEDLINE, the Cochrane Library, and Web of Science databases to identify studies published in English language until April 2022.

Seventeen studies involving 4,877 participants were included. A majority of the studies were cross-sectional with a lack of appropriate controls. Five of the included studies were experimental, involving 758 participants. All of them reported positive effects of educational interventions on the improvements in self-reported e-Health literacy skills. However, most studies were at risk of bias.

Despite these limitations, the findings of this review indicate the positive relationship between e-Health literacy and various health care processes in adults with chronic diseases and highlights a need for prospective controlled studies. Promoting e-Health literacy might give better opportunities for the active involvement of people with chronic diseases in self-care and for the implementation of online interventions into existing system of care.

Telepharmacy is widely known as the delivery of pharmacy care offered by registered pharmacists and pharmacies using telecommunication technologies to patients at a distance. We conducted a systematic review of the reported usages, benefits, and limitations of telepharmacy models worldwide to further clarify the pros and cons of a telepharmacy model.

A total of 39 relevant articles was included after searching for articles with a fixed term on four databases, including PubMed, Virtual Health Library (VHL), Global Health Library (GHL), and Google Scholar, as of April 2021.

Our review suggested that telepharmacy has played an essential role in addressing pharmacist shortages and helping patients both safely and effectively administer medications in underserved areas. During the COVID-19 pandemic, remote dispensing and counseling are effective measures to avoid infection.

Telepharmacy could potentially replace or complement pharmaceutical-related activities, facilitating future innovation in the health care industry.

To investigate factors influencing delayed or forgone care due to the coronavirus pandemic and examine patterns in overall virtual care use and virtual care related to the coronavirus pandemic.

The cross-sectional study used the 2020 National Center for Health Statistics, National Health Interview Survey. Individuals (17,586) who responded to delayed or forgone care questions were included. A generalized linear model estimated prevalence ratios (PRs) for delayed care, forgone care, and virtual care.

Approximately 26.5% of participants reported either having delayed (23.6%) or forgone care (15.7%). Females showed 1.29 (95% confidence interval [CI] 1.20–1.38; p ≤ 0.000) and 1.29 (95% CI 1.17–1.48; p ≤ 0.000) times greater risk of delayed and forgone care than males, respectively. Being insured and having chronic conditions were associated with more delayed and forgone care. About 32.5% of adults reported 1 year of virtual care, and of these, 83.6% were related to the coronavirus pandemic. Patterns of virtual care use of 1 year and the one related to the coronavirus pandemic varied. In the coronavirus pandemic-related virtual care, adults of 85 years old or above had a lower likelihood (PR 0.87, 95% CI 0.77–1.00; p = 0.043) of receiving virtual care. Low education attainment and nonmetro areas showed less virtual care usage.

The coronavirus pandemic greatly affected health care. While virtual care significantly increased, historically underserved populations, such as older adults, rural residents, and those with low education attainment, experienced disparities in virtual care use. The findings provide important implications for sustained health care in a rapidly changing public health landscape.

Telemedicine was implemented at our institution in response to the COVID-19 pandemic. Data do not currently exist about the use of telemedicine in providing comprehensive postpartum care.

This project aimed to evaluate the impact of telemedicine on postpartum care at an urban Federally Qualified Health Center (FQHC).

This was a retrospective cohort study of patients who delivered at an urban hospital in New York between September and November 2019 (pre-COVID), February through April 2020 (peak-COVID) and June through August 2020 (ongoing-COVID). The primary outcome was postpartum visit attendance. Secondary outcomes included contraception use, breastfeeding, depression screening, hospital readmission, and emergency department visit rates. Log-binomial regression models were used to estimate relative risk.

Telemedicine accounted for 1% of postpartum visits in the pre-COVID cohort, 60% in the peak-COVID cohort, and 48% in the ongoing-COVID cohort. Postpartum visit attendance rates were 52% in the pre-COVID cohort, 43% in the peak-COVID cohort, and 56% in the ongoing-COVID cohort (p > 0.05). There was a nonsignificant increase in postpartum visit show rate for telemedicine visits compared to in-person visits in the peak-COVID cohort (76% vs. 65%; relative risk [RR] 1.17 [0.87–1.57]) and ongoing-COVID cohort (85% vs. 74%; RR 1.16 [0.90–1.50]). Patients were significantly less likely to have a Patient Health Questionnaire-2 Depression screen in the peak-COVID and ongoing-COVID cohorts (22% and 33%) than in the pre-COVID cohort (74%) (p < 0.01). There were no significant differences in hospital readmissions, contraceptive use or breastfeeding rates across cohorts (p > 0.05).

At our urban FQHC, telemedicine was comparable to in-person postpartum care in terms of attendance rates during the COVID-19 pandemic, without an increase in rates of hospital visits or readmissions. However, postpartum depression screening needs to be better integrated into the telemedicine visit type.

With the coronavirus disease 2019 (COVID-19) pandemic causing the need for social distancing, telemedicine saw a significant increase in use to provide routine medical care. As a field, physiatry had already been implementing telemedicine prior to the pandemic. In this study, we characterized the use of telemedicine among physiatrists during the early phase of the COVID-19 pandemic to understand the barriers and facilitators to implementing telemedicine use in the field of physiatry in the future.

Online survey of a cross-sectional sample of physiatrists. Analysis was conducted using logistic regression.

One hundred seventy one (n = 171) participants completed the survey. Before the pandemic, only 17.5% of respondents used telemedicine. In the logistic regression, physicians who used a hospital-provided platform were more likely to use telemedicine in the future compared with those who used their own secure platform, conducted a phone visit, and used a non-secure platform or other platforms. The three most popular barriers identified were “inability to complete the physical examination,” “patients lack of access to technology,” and “patients lack of familiarity with the technology.”

Focus on education on telemedicine functional examination strategies and technology strategies for patients and providers (including addressing the digital divide and hospital-provided secure platforms) are potential targets of implementation strategies for greater telemedicine uptake for physiatrists in the future.

The widespread use of telemedicine systems and medical information networks has made telemedicine one of the current trends in health care. The purpose of this article is to propose a community health intervention with remote monitoring and teleconsultation during COVID-19 for the prevention and control of COVID-19 at the rural level.

In this intervention study, a randomized group of 1,500 community residents was selected. A questionnaire with acceptable validity and reliability was used to collect data. The study was conducted with the test group itself as a control, and the questionnaire was completed again 6 months after the health intervention through remote monitoring. The extent of the effect of the remote monitoring intervention on community health during COVID-19 was measured. The data were entered into SPSS 26, and the data were analyzed using the K–S normality test, t-test, and chi-square test.

After 6 months of the intervention, the differences in mean scores of the test group were statistically significant (p < 0.05) in cognition, perceived benefits, self-efficacy, and behavioral outcomes, with a substantial increase in mean scores for all variables.

The application of remote monitoring during COVID-19 in rural communities can influence the health perception, benefit perception, self-efficacy, and behavior of community residents, thus effectively preventing and controlling the spread of COVID-19 in rural communities. It reduces medical barriers for rural areas while meeting.

We present an innovative care model for telehealth by creating a video conference group telemedicine program for patients with chronic disease and discuss findings from a post-program survey that was instrumental in understanding the response to telemedicine in a group setting.

All patients who attended the group telemedicine program had a diagnosis of Hypermobile Ehlers-Danlos Syndrome or Hypermobility Spectrum Disorder and were requested to complete survey responses at the close of the program. Surveys were completed anonymously and electronically by REDCap. Elements of the Press Ganey, Consumer Assessment of Healthcare Providers and Systems, and Utah Telehealth Network patient satisfaction surveys were modified to construct the survey.

A total of 102 patients completed the post-telehealth program survey between August 20, 2021, and February 11, 2022. Around 93.1% stated that they gained a better understanding of the chronic condition, 88.3% stated that the program gave them the tools to improve, and 76.5% indicated the program addressed their specific needs. Approximately 92.1% found it easy to interact with the program facilitator and 79.4% found it easy to interact with program members. Around 93.1% said they would recommend the program to others.

We created a group telemedicine program for a complex chronic medical condition. The foundation of knowledge provided by the telemedicine program allowed more time during face-to-face encounters for individual assessment of the patient, and increased access to care. Overall, the program has improved the treatment process by reducing treatment burden and empowering patients with self-management skills to help reach our fundamental treatment goal of improving quality of life.

The utilization of telemedicine has been steadily rising and became more available during the coronavirus disease 2019 (COVID-19) pandemic to ensure the continuity of care and minimize the risk of exposure to the infection. The aim of this study was to evaluate patients' and caregivers' satisfaction to newly developed teleconsultation services at the internal medical outpatient clinics at a tertiary university hospital during the COVID-19 pandemic.

A cross-sectional satisfaction evaluation was conducted between April 2020 and June 2020. Participants included patients or caregivers who were randomly selected to answer a multi-item questionnaire to measure satisfaction with the quality, effectiveness, and convenience of the service.

A total of 901 participants completed the satisfaction survey. Most of the patients were in the age group 45–64 years (43.7%). The main teleconsultation method was telephone call (99.2%) and 798 participants (88.6%) were satisfied with the quality of teleconsultation. There was no difference in satisfaction levels across the various specialty clinics or age groups. The service was viewed as convenient by 636 participants (70.5%) and 481 (56.6%) preferred to continue using telemedicine after the COVID-19 pandemic.

The study revealed high level of satisfaction among patients and caregivers with the recently introduced teleconsultation services at internal medicine outpatient clinics during the COVID-19 pandemic, which is a relatively new concept in many countries. This opens the door to further utilize telemedicine as an integrated part to improve patient care beyond the pandemic.

The emergence or persistence of symptoms after acute SARS-CoV-2 infection has made it necessary to develop tools to detect them and assess their impact on patients' quality of life. One of these tools is the COVID-19 Yorkshire Rehabilitation Screening (C19-YRS) scale. We present the results of this tool in a cohort of first pandemic wave patients.

A cross-sectional study of patients with confirmed SARS-CoV-2 infection from March to May 2020 in Lugo (northwestern Spain). C19-YRS was administered via phone 10 months after the acute infection to both former inpatients and outpatients. Electronic medical records were reviewed and relevant data from the acute episode were collected. The main outcome was the presence of impairment in different areas measured by the C19-YRS scale.

The answer rate was 63.2%. The mean age was 54 ± 16 years, 38.4% were male and 190 (42.9%) had some comorbidity. Eighty-seven patients (19.6%) required hospitalization and 10 (2.3%) required intensive care unit admission. Ten (3.5%) patients lost their job due to the pandemic. Two hundred seventy-six patients (62.3%) related any symptoms; fatigue (37.2%) and exertional dyspnea (33.4%) were the most common with significant worsening in both cases compared with the situation before the infection. Subgroup analysis showed that more symptom domains were impaired in women than men. Older patients, those with comorbidity and those who needed hospital admission, demanded more health resources after the acute infection.

C19-YRS is useful for the detection and quantification of symptoms after COVID-19 and provides relevant social, health, and occupational information.

Recent technological advances have paved the way for a new modality of medical practice known as teleconsultation. Positive perceptions about the benefits of teleconsultation and its acceptance by clinicians are key predictors of its uptake. The aim of this study was to assess knowledge, perceptions, and acceptability of teleconsultation among Moroccan physicians.

This is a descriptive cross-sectional study conducted at the Cheikh Khalifa International University Hospital (HCK) of Casablanca, Morocco. Study participants answered an anonymous self-administered questionnaire designed based on similar studies. The questionnaire contained four sections related to demographic characteristics, knowledge about telemedicine and teleconsultation, perceptions about teleconsultation, and its acceptability by the study participants.

Of 486 eligible participants, a total of 212 completed the questionnaire. Approximately 96.7% had prior knowledge of teleconsultation. Most participants identified internet access (95.3%), data security (93.4%), and confidentiality (92.9%) as the main facilitators to the use of teleconsultation. The main barriers to the use of teleconsultation were internet access issues (98.6%), poor audio quality (96.2%), poor video quality (94.3%), and difficulty encountered by patients in expressing themselves and communicating with their physician (79.7%). The majority of participants (91.5%) believed that teleconsultation will be an integral part of future medical practice and about 70.8% thought that they would be able to allot time to teleconsultation in their current schedules.

The findings of this study should be used by policy makers to remove barriers and promote enablers of teleconsultation use by physicians to bring health care closer to the Moroccan population.

The rapid onset of the COVID-19 pandemic increased hospital admissions and shortages for personal protective equipment (PPE) used to slow the spread of infections. In addition, nurses treating COVID-19 patients have time-consuming guidelines to properly don and doff PPE to prevent the spread.

To address these issues, the Medical University of South Carolina repurposed continuous virtual monitoring (CVM) systems to reduce the need for staff to enter patient rooms. The objective of this study was to identify the economic implications associated with using the CVM program for COVID-19 patients. We employed a time-driven activity-based costing approach to determine time and costs saved by implementing CVM.

Over the first 52 days of the pandemic, the use of the CVM system helped providers attend to patients needs virtually while averting 19,086 unnecessary in-person interactions. The estimated cost savings for the CVM program for COVID-19 patients in 2020 were $419,319, not including potential savings from avoided COVID-19 transmissions to health care workers. A total of 19,086 PPE changes were avoided, with savings of $186,661. After accounting for cost of the CVM system, the net savings provided an outstanding return on investment of 20.6 for the CVM program for COVID-19 patient care.

The successful and cost saving repurposing of CVM systems could be expanded to other infectious disease applications, and be applied to high-risk groups, such as bone marrow and organ transplant patients.

Remote patient monitoring (RPM) can be deployed as part of a tiered approach to open up hospital bed availability by allowing earlier discharge of patients with continued virtual monitoring. We describe the impact of RPM on length of stay (LOS) for patients with COVID-19.

We deployed RPM during two COVID-19 surges at a tertiary academic hospital from March to June 2020 as a feasibility pilot to establish the infrastructure for RPM including electronic health record changes and virtual health center (VHC) protocols, and October 2020 to February 2021, during the second surge of COVID-19. Discharging patients received a wearable vital sign monitoring device, allowing real-time data transmission to the VHC using a smart phone application. The data, monitored 24 h a day for 8 days by a technician, had built-in escalation protocols to nurses and/or attending physicians.

We compared patients discharged with RPM with those discharged without RPM during both phases using a two-to-one–matched case–control design including age, sex, Charlson comorbidity index, and limited English proficiency. After including discharge with home oxygen therapy as an effect modifier, there was a significant association between shorter LOS and RPM for patients discharging without home oxygen (p = 0.0075) compared with patients not discharging on RPM.

Our study shows a strong association between a reduction in LOS for patients discharging with RPM but without home oxygen therapy, which can assist with hospital capacity.

Home telemonitoring after discharge for patients with COVID-19 may reduce LOS.