Telemedicine and e-Health

Long-term cancer survivors have specific needs that are frequently neglected. Telehealth, as a new form of health care, can benefit this growing population.

To identify, analyze, and synthesize the existing evidence on the use of telehealth in the care of cancer survivors after the end of treatment.

A scoping review was conducted in the databases PubMed, CINAHL, COCHRANE, SCIELO, DIALNET, and LILACS and reference institutions in cancer.

The initial search yielded 406 publications with 59 articles meeting the eligibility criteria. There are different types of telehealth (video calls, phone calls, websites, mobile applications, and short message services) used for the care of cancer survivors. Most telehealth interventions focus on improving the physical and mental spheres of quality of life in the extended survival phase (from 1 to 3 years postdiagnosis), with only two articles (3%) on long-term cancer survivors (>5 years postdiagnosis). Survivors are satisfied with telehealth interventions, noting the importance of improving comprehensibility, personalization of the platforms, and the lack of excessive information included.

Telehealth is a feasible modality for cancer survival care. The scarcity of interventions aimed at long-term survivors stands out, as does the general neglect of the social and spiritual spheres of quality of life.

Telehealth platforms must adapt their content, format, and items to the preferences reported by the survivors.

Consumer wearable devices allow physical activity to be measured objectively, which can be useful in remote cardiovascular disease management. This review aimed to summarize the effects of using wearable devices to monitor physical activity/adherence to physical activity in adults with cardiovascular disease.

The review used The Cochrane Overview of Reviews Methodology. The databases searched were PubMed, EMBASE, CINAHL, Web of Science, and the Cochrane Database of Systematic Reviews, the date of the last search was October 12, 2021. Risk of bias was assessed using the AMSTAR-2^® tool.

Of the 767 records, we identified 6 systematic reviews (SRs) and meta-analyses (MA) that met our inclusion criteria. The individual SRs did not consistently favor the use of wearables, but the MA syntheses each found significant effects, favoring wearable devices in measures, including mean steps per day and mean time spent completing moderate-to-vigorous physical activity. The MA on adherence to cardiac rehabilitation (CR) found greater adherence to CR with the use of a mobile app than with no app support.

Within this review, there were SRs demonstrating no difference and reviews indicating a positive impact with the use of wearables for physical activity/adherence measures in individuals with cardiovascular conditions, with no studies demonstrating a negative impact. The six SR/MAs included had methodological flaws, which introduced potential biases. Additionally, the MAs included a small number of studies, which limits their generalizability. The protocol for this review was registered on PROSPERO, the international prospective register of systematic reviews (#CRD42021286699).

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to the rapid adoption of telehealth to provide HIV care and treatment. However, limited information exists about the feasibility, acceptability, and efficacy of telehealth interventions at different points of the HIV care continuum.

A systematic search was conducted of Ovid MEDLINE, PsycINFO, and CINAHL databases to synthesize evidence regarding the feasibility, acceptability, and efficacy of videoconferencing and video-based interventions for HIV testing and treatment in adult populations. Seventeen articles published through July 2021 were included in the review. We used descriptive methods to analyze data, and findings were reported using frequencies and percentages.

Findings show that videoconferencing and video-based interventions are generally feasible and acceptable. Videoconferencing is effective in improving adherence to HIV treatment and in promoting HIV testing. In addition, video-based interventions were effective in promoting HIV testing, treatment initiation, and adherence to medication. Both modalities enhanced linkage and retention in treatment for HIV-positive patients.

Video-based and videoconferencing interventions are beneficial in HIV testing and treatment. However, the scarcity of primary studies employing these telehealth modalities means that there is a need for more research in these areas. Also, reviewed studies suffered from several limitations, including reliance on subjective measures, lack of standardized ways of evaluating acceptability and feasibility, use of small sample sizes, and short follow-up durations. In addition, there was less representation of studies from resource-limited settings disproportionately affected by HIV and AIDS. Thus, future research should focus on addressing these challenges.

To assess the factors associated with offering remote patient monitoring (RPM) services.

We integrated three datasets: (1) 2019–2020 Area Health Resource Files, (2) 2019 American Community Survey, and (3) 2019 American Hospitals Association annual survey using county Federal Information Processing Standards code to evaluate associations between hospital characteristics and county-level demographic factors with provision of (1) post-discharge, (2) chronic care, (3) other RPM services, and (4) any of these three RPM service categories. These outcomes were analyzed using multi-level, mixed-effects multivariate logistic regression modeling to account for county-level clustering of hospitals.

Among 3,381 hospitals, 1,354 (40.0%) provided any RPM services. Being part of a clinically integrated network (CIN) and private, non-profit (vs. public) ownership were respectively associated with 104.5% (95% confidence interval [CI]: 69.4–146.8%; p < 0.001) and 30.4% (95% CI: 2.5–66.0%; p = 0.031) higher odds of providing any RPM services. Critical access hospital (CAH) designation, for-profit (vs. public) ownership, and location in the South (vs. Northeast) were associated with significantly lowering odds of providing any RPM services by 36.2% (95% CI: 14.2–52.6%; p = 0.003), 70.1% (95% CI: 56.0–79.6%; p < 0.001), and 34.0% (95% CI: 2.8–55.1%; p = 0.035), respectively. Similar trends were found with the various RPM service categories.

The factors most associated with provision of any RPM services were hospital-level factors. Specifically, being part of a CIN and private, non-profit ownership had the highest positive associations with offering RPM services whereas location in the South and CAH designation had the strongest negative associations. Further studies are needed to understand the reasons behind these associations.

School-based health services, particularly those available to underserved and rural communities, remain in high demand. Advancements in telehealth services present clinical resources otherwise typically unavailable to students from rural communities.

Data were collected during 4 semesters on all students receiving primary care or urgent care health services from 8 school-based telehealth programs delivering care to 40 schools across the United States.

Across the 4 semesters, 2,769 students received primary care telehealth and 2,238 students received urgent care telehealth. The primary care telehealth services were delivered by a primary care provider with a registered nurse also involved in half of the encounters. In contrast, the urgent care telehealth services were delivered almost exclusively by a registered nurse. Primary care telehealth delivered a variety of services including medication management, counseling, and sports physicals in addition to assessments and evaluations. Urgent care telehealth primarily involved an assessment. Both services returned most students to the classroom without the need for further follow-up, thus reducing or eliminating the need for seeking health care outside of the school setting. Notably, 67.7% of students seeking primary care telehealth services did not have a primary care provider outside of the school, clearly demonstrating the importance of these school-based services in increasing access to basic health care services for these students in rural and underserved communities.

Telehealth provides a reliable solution and immediate access to care for students in need of health care, which, in turn, presents advantages to educators and parents.

Although studies have examined if the internet and mobile technology (IMT) can support cardiovascular health (CVH) self-management and health information-seeking efforts, limited studies have targeted African American communities. This study analyzes a possible association between CVH and IMT use and if socioeconomic status is linked to this relationship among older, African Americans in the Jackson Heart Study (JHS).

This analysis uses JHS data from three time points: Examination 1 (2000–2004), Examination 3 (2009–2013), and the Digital Connectedness Survey (2017–2019). Participants completed measures of CVH (the American Heart Association's Life Simple 7 [LS7]), IMT use, and demographic characteristics via telephone interview. Both multivariable logistic and linear regression analyses were conducted to analyze the relationship between the LS7 composite and component scores (representing CVH) and IMT use.

Fifty eight percent of participants were 60 or older; 64% were women. Overall, 2,255 (88%) of participants were IMT users. Generally, no association was found when analyzing LS7 composite scores and IMT use except for the association between LS7 composite scores and use of other smart devices (p = 0.01). However, having ideal blood pressure, body mass index, and cholesterol had positive associations with using technology to track health (p = 0.003, p = 0.004, p = 0.052, respectively), and having ideal physical activity was positively associated with using smart devices (p = 0.012).

No association was found between LS7 composite scores and IMT use. However, there were associations between individual LS7 metrics, IMT use, and IMT use characteristics. More research should be done to continue assessing the feasibility of using IMT for CVH self-management among older African Americans.

Data addressing the economic aspects of telehealth initiatives are incipient. This study aimed to evaluate the labor costs for running a COVID-19 telehealth system and its potential incremental access to health care service.

From July 2020 to July 2021, data from a Brazilian teleconsultation service were analyzed. Labor costs were estimated by time-driven activity-based costing. A Generalized Reduced Gradient solving method was coded to maximize the mean incremental access rate and two scenarios were considered to compare the teleconsultation with the in-person consultation: (1) only the length of time that patients spent with a clinician in an in-person consultation was accounted and (2) in addition to the medical consultation, nursing screening was accounted. The mean incremental access rate of the teleconsultation service was defined as a maximization objective in the model.

Mean labor costs per medical and nursing teleconsultations are Int$ 24 and Int$ 10, based on data analyses from 25,258 patients. Telemonitoring a patient with a daily call for 7 days costs, on average, Int$ 14. COVID-19 teleconsultation service represents, on average, an incremental access to medical consultation rate of 35% to 52% (min 23% max 63%) for the scenarios (1) and (2), respectively, and considering the current consumed budget for this service.

A COVID-19 telehealth service contributes to increasing access to the health care system without increasing costs. These services can be included in the bundle of care strategies offered in a national public health care system that looks for more sustainable strategies to provide care.

: Adherence to dermatological treatment is described as poor. Empathy and open communication in the physician–patient relationship has been proven to improve adherence. As direct-to-consumer teledermatology enables patients to access dermatological consultations without in-person interactions, we hypothesized treatment adherence in teledermatology to be low.

: The objective of the study was to examine treatment adherence in teledermatology. This retrospective cross-sectional study used data from patients treated through a German direct-to-consumer teledermatology platform between July 2021 and April 2022. Additional information was collected through voluntary follow-up questionnaires provided to patients to assess individual treatment success, treatment-related adverse events, and treatment adherence.

: Data collection included 771 patients; 61.6% (475/771) were women (mean age 35 years). In 46% (355/771), skin disease had been present for <3 months before teleconsultation. Of all patients who answered the follow-up questionnaire (n = 228), 28.5% (65/228) reported treatment-related adverse events, with skin dryness being the most common (56.9%, 37/65). Adverse events resulting in treatment discontinuation were reported in 1.3% (3/228) of all cases. Improvement in skin condition on therapy was described by 75.4% (172/228). In 85.5% (195/228), full treatment adherence was reported.

: This is the first study worldwide to examine data on treatment adherence in direct-to-consumer-teledermatology. Despite the lack of doctor–patient interaction, the results of our study demonstrate that most patients show high treatment adherence. Possible drivers contributing to high compliance rates could be the high proportion of new-onset skin diseases, the high treatment success of the prescribed therapies, and the low rate of serious adverse events.

Limited range of motion (ROM) of the shoulder occurs commonly after breast cancer surgery, resulting in reduced quality of life and difficulty with activities of daily living. Physical exercise is effective in postoperative breast cancer patients, but no study has assessed the effects of augmented reality (AR)-based telerehabilitation. Therefore, this study aimed to investigate the effect of hospital-home linked rehabilitation therapy using an AR-based digital health care system (UINCARE Home+) in postoperative patients with breast cancer.

This study was a prospective, multicenter, assessor-blinded, randomized controlled trial. Patients who underwent breast cancer surgery were assigned to either the UINCARE Home+ (intervention) group or the brochure-based home rehabilitation (control) group for an 8-week intervention. The study outcomes were the change in ROM of the affected shoulder, pain in the affected shoulder (Numerical Rating Scale [NRS]), functional outcomes (Disabilities of the Arm, Shoulder, and Hand questionnaire [QuickDASH] score), and quality of life (Functional Assessment of Cancer Therapy-Breast [FACT-B] and EuroQoL 5-Dimension 5-Level [EQ-5D-5L] scores), all of which were measured at enrollment and at 4, 8, and 12 weeks thereafter.

A total of 100 participants were enrolled in the study (n = 50 in each groups). In both groups, active and passive ROM, NRS, and the QuickDASH, FACT-B, and EQ-5D-5L scores showed significant improvements from baseline to 12 weeks (p < 0.001), but no group differences were detected.

A home-based exercise program with an AR system improved shoulder dysfunction in breast cancer patients and could be used in conjunction with a traditional hospital-based rehabilitation program.

ClinicalTrials.gov ID: NCT04316156.

The COVID-19 pandemic necessitated a rapid transition to telemedicine, providing a critical opportunity to study telemedicine satisfaction and usability in patients with sickle cell disease (SCD).

A cross-sectional survey was completed by 99 adult SCD patients who participated in at least one telemedicine visit between March and July 2020. Telemedicine satisfaction and usability were assessed with the Telemedicine Satisfaction Questionnaire (TSQ) and System Usability Scale (SUS), respectively. Preference for video visits was assessed with a 1–10 rating scale, with 10 indicating the highest preference. Measures of anxiety, depression, and patient activation were also assessed. Linear and logistic regressions were performed to evaluate for socioeconomic and psychosocial correlates of telemedicine satisfaction, usability, and preference.

Participants were 72% women, with a mean age of 39 years. The median (interquartile range [IQR]) TSQ was 56 (52–64) out of 70, indicating high satisfaction. The median (IQR) SUS was 72.5 (62.5–82.5) out of 100, indicating above average usability. Participants tended to prefer video visits for regular care (median [IQR] rating of 7 [5–9]) but not for management of acute pain (median [IQR] rating of 4 [2–8]). Neither satisfaction nor usability was associated with age or mental health. Telemedicine usability was positively associated with having private insurance compared with public insurance. Higher scores on both satisfaction and usability were associated with higher patient activation.

Adults with SCD report good usability and high satisfaction with telemedicine, across multiple demographic groups. Therefore, telemedicine has valuable potential to improve access to high-quality care for these patients.

: Telemedicine holds the promise of increasing access-to-care at a lower cost. Yet, for years, the evidence of telemedicine's cost-effectiveness was scarce. Faced with a rapidly expanding literature, we conduct both manual and systematic selection of the literature, and analyzed the data to determine: (1) the characteristics of economic evaluations of telemedicine, and (2) the determinants of economically efficient telemedicine interventions.

: We reviewed all published economic evaluations of telemedicine in Cochrane, Embase, and Pubmed from 2008 to 2018. Articles were screened by two researchers first on title and abstract (Stage 1), then on full article (Stage 2), (protocol available on PROSPERO, ref. CRD42019143032). We proposed an alternative method for screening articles using machine learning based on textual classification and compared these two approaches. We constructed an exclusive dataset on the characteristics of the selected articles and enriched it using OECD data at the country level. We identified the determinants of efficient telemedicine interventions using multiple logit models.

: We included 156 articles out of 2,639. Most economic studies of our sample regard telemonitoring. A majority (73.7%) of studies found that telemedicine intervention is efficient, regardless of the medical domain. Articles with higher standards of economic evaluation (cost-effectiveness analysis, randomized trials with high sample size) were less likely to report an efficient intervention. We found no effect of the publication year, signifying that the nature of the evidence has not changed over time.

The COVID-19 pandemic accelerated the adoption of telemedicine services for the delivery of outpatient neurological care. We sought to understand perceptions and the acceptance of this technology by neurology specialists during the proliferation of telemedicine services into their outpatient practices.

We adapted the Telehealth Usability Questionnaire for neurological care via telemedicine. Our 29-item questionnaire evaluated the telemedicine system in three domains: quality of the telemedicine platform, ability to conduct a sufficient neurological examination, and overall system confidence. The survey was distributed to 88 clinical neurology faculty in the Johns Hopkins Health System. Responses were collapsed into “Favorable,” “Neutral,” and “Unfavorable.” Within each domain, responses to individual questions were analyzed by neurology subspecialty using descriptive statistics.

We received completed surveys from 46 of the 88 (52%) neurology faculty. Of those, most reported favorable comfort with the current platform (98%), ease of use (73%), and quality (80%). However, responses indicated only average ability to troubleshoot telemedicine platform issues when they occurred (55%) and to complete an entire neurological examination (52%). Subspecialty comparisons revealed differences in diagnostic confidence; 30% of neuromuscular faculty indicated that they could make accurate neurological diagnoses through a tele-examination as opposed to ≥84% for other specialties.

The use of telemedicine services for the delivery of outpatient neurological care is feasible and acceptable to most neurologists, although diagnostic confidence compared with in-person visits may be reduced and differs by subspecialty. Improvements in technological infrastructure and care models are needed to advance telemedicine neurological care delivery. Our data also suggest that a larger multicenter investigation of telemedicine use post-pandemic would be useful.

Publications on the integration of telehealth in the care of patients with movement disorders are increasing, but little has been presented regarding its use in tardive dyskinesia (TD), a drug-induced movement disorder associated with prolonged exposure to dopamine receptor blocking agents. This study was conducted to address that knowledge gap, based on insights from a panel of TD experts.

In 2020, six neurologists, three psychiatrists, and three psychiatric nurse practitioners participated in individual semistructured interviews about in-person and virtual TD assessment and management in their practices. Two virtual roundtables were then conducted to consolidate findings from these interviews.

The panel agreed that despite the challenges of virtual TD assessment (e.g., technology issues, difficulty observing entire body, inability to conduct thorough neurological examinations), telehealth can offer benefits (e.g., fewer missed appointments, reduced time/cost, easier access to family/caregiver feedback). The panel also agreed that telehealth should be combined with periodic in-person visits, and they recommended an in-person TD assessment within 6 months before the first virtual visit and at least one in-person assessment every 6 months thereafter. Additional best practices for TD telehealth included implementing video, involving family/caregivers, and providing preappointment instructions to help patients prepare their technology and environment.

Telehealth is not a substitute for in-person visits but can be a helpful complement to in-person clinical care. Clinicians can optimize virtual visits in patients at risk of TD by using targeted questions to identify TD and evaluate its impact and by providing education about approved TD treatments.

We investigated telehealth usage for individuals with chronic conditions by neighborhood-level socioeconomic status (SES) during the first year of the COVID-19 pandemic.

We split the population of 2.3 million commercially insured adults in the United States with at least one chronic condition in claims into four quartiles of SES using address of residence. After balancing groups on baseline characteristics, we examined telehealth and total outpatient evaluation and management (E&M) visits from March 2020 to February 2021.

Quartile 4 (highest SES) had more telehealth visits per person (0.054–0.100 more visits over each 3-month period) and a higher percentage of visits that were telehealth (1.8–5.9 percentage points higher) than other quartiles. Quartile 4 had higher levels of total outpatient E&M use throughout the year. Differences in telehealth between Quartiles 1 and 3 were small.

Commercially insured individuals in the highest SES quartile had higher use of telehealth and total E&M visits than other quartiles.