The utility of telemedicine in managing patients after COVID-19

Implementing a Patient Portal for the Remote Follow-Up of Self-Isolating Patients With COVID-19 Infection Through Patient and Stakeholder Engagement (the Opal-COVID Study): Mixed Methods Pilot Study

BACKGROUND

The COVID-19 pandemic was an unprecedent challenge to public health systems, with 95% of cases in Quebec sent home for self-isolation. To ensure continuous care, we implemented an intervention supported by a patient portal (Opal) to remotely monitor at-home patients with COVID-19 via daily self-reports of symptoms, vital signs, and mental health that were reviewed by health care professionals.

OBJECTIVE

We describe the intervention's implementation, focusing on the (1) process; (2) outcomes, including feasibility, fidelity, acceptability, usability, and perceived response burden; and (3) barriers and facilitators encountered by stakeholders.

METHODS

The implementation followed a co-design approach operationalized through patient and stakeholder engagement. The intervention included a 14-day follow-up for each patient. In the mixed methods study at the McGill University Health Centre in Montreal, Quebec, participants completed questionnaires on implementation outcomes on days 1, 7, and 14. All scores were examined against predefined success thresholds. Linear mixed models and generalized estimating equations were used to assess changes in scores over time and whether they differed by sex, age, and race. Semistructured interviews were conducted with expert patients, health care professionals, and coordinators for the qualitative analysis and submitted to thematic analysis guided by the Consolidated Framework for Implementation Research.

RESULTS

In total, 51 participants were enrolled between December 2020 and March 2021; 49 (96%) were included in the quantitative analysis. Observed recruitment and retention rates (51/52, 98% and 49/51, 96%) met the 75% feasibility success threshold. Over 80% of the participants found it "quite easy/very easy" to complete the daily self-report, with a completion rate (fidelity) of >75% and a nonsignificant decreasing trend over time (from 100%, 49/49 to 82%, 40/49; P=.21). Mean acceptability and usability scores at all time points exceeded the threshold of 4 out of 5. Acceptability scores increased significantly between at least 2 time points (days 1, 7, and 14: mean 4.06, SD 0.57; mean 4.26, SD 0.59; and mean 4.25, SD 0.57; P=.04). Participants aged >50 years reported significantly lower mean ease of use (usability) scores than younger participants (days 1, 7, and 14: mean 4.29, SD 0.91 vs mean 4.67, SD 0.45; mean 4.13, SD 0.89 vs mean 4.77, SD 0.35; and mean 4.24, SD 0.71 vs mean 4.72, SD 0.71; P=.004). In total, 28 stakeholders were interviewed between June and September 2021. Facilitators included a structured implementation process, a focus on stakeholders' recommendations, the adjustability of the intervention, and the team's emphasis on safety. However, Opal's thorough privacy protection measures and limited acute follow-up capacities were identified as barriers, along with implementation delays due to data security-related institutional barriers.

CONCLUSIONS

The intervention attained targets across all studied implementation outcomes. Qualitative findings highlighted the importance of stakeholder engagement. Telehealth tools have potential for the remote follow-up of acute health conditions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/35760.

Exploring the determinants of online health service usage intentions under the threat of air pollution

Introduction

The rapid evolution of online health services (OHS) has significantly improved healthcare accessibility. However, the impact of air pollution on individuals' willingness to engage with OHS remains underexplored in the existing literature. This study addresses this gap by investigating how air pollution threats influence the intention to use OHS, grounded in Protection Motivation Theory (PMT) and Rational Choice Theory (RCT).

Methods

Using cross-sectional survey data, a theoretical model was developed and tested to examine the relationships between threat appraisal, coping appraisal, perceived benefits, perceived costs, and OHS usage intentions.

Results

The findings indicate that threat appraisal, coping appraisal, and perceived benefits positively affect the intention to use OHS, while perceived costs negatively impact usage intention. Additionally, age significantly moderates the relationship between coping appraisal and the intention to use OHS.

Discussion

This study extends the application of PMT and RCT in the context of OHS. It provides valuable insights into the factors influencing users' intentions to utilize these services, with implications for improving OHS adoption in environments affected by air pollution.

Digital approaches in post-COVID healthcare: a systematic review of technological innovations in disease management

Post-COVID conditions (PCC) emerged during the pandemic, prompting a rise in the use of Digital Health Technologies (DHTs) to manage lockdowns and hospital overcrowding. Real-time tracking and information analyses were crucial to strengthening the global research response. This study aims to map the use of modern digital approaches in estimating the prevalence, predicting, diagnosing, treating, monitoring, and prognosis of PCC. This review was conducted by searching PubMed and Scopus databases for keywords and synonyms related to DHTs, Smart Healthcare Systems, and PCC based on the World Health Organization definition. Articles published from 1 January 2020 to 21 May 2024 were screened for eligibility based on predefined inclusion criteria, and the PRISMA framework was used to report the findings from the retained studies. Our search identified 377 studies, but we retained 23 studies that used DHTs, artificial intelligence (AI), and infodemiology to diagnose, estimate prevalence, predict, treat, and monitor PCC. Notably, a few interventions used infodemics to identify the clinical presentations of the disease, while most utilized Electronic Health Records and AI tools to estimate diagnosis and prevalence. However, we found that AI tools were scarcely used for monitoring symptoms, and studies involving SHS were non-existent in low- and middle-income countries (LMICs). These findings show several DHTs used in healthcare, but there is an urgent need for further research in SHS for complex health conditions, particularly in LMICs. Enhancing DHTs and integrating AI and infodemiology provide promising avenues for managing epidemics and related complications, such as PCC.

A Comparative Analysis of Telerehabilitation and Telemedicine Utilization During the COVID-19 Pandemic in Poland: Trends, Patterns, and Implications

The study aimed to examine the influence of COVID-19 on the adoption of teleservices in Poland, with a focus on contrasting patterns between rehabilitation and ambulatory care settings. We conducted a retrospective analysis of a national dataset to assess trends in telehealth use from 2020 to 2022. The use of teleservices peaked in April 2020 in both sectors. The share of the teleservices in the period of October 2020-December 2022 was much higher in the ambulatory (average 7,8%) than the rehabilitation sector (average 0,16%). Although, the analysis showed a moderate relationship between COVID-19 incidence and telehealth utilization (Spearman's rho from 0.39 and 0.52). Our findings demonstrate no statistically significant difference in Spearman's rho values between ambulatory care and rehabilitation, indicating a similar strength of response to the pandemic waves. Our findings underscore the importance of telehealth services in ensuring healthcare accessibility during times of crisis, emphasizing their role in facilitating continuity of care amidst pandemic-related disruptions. This study contributes to the understanding of telehealth utilization trends during the COVID-19 pandemic, offering insights into the adaptive responses of healthcare systems to unprecedented challenges. Further research is warranted to explore the long-term implications of telehealth use and to inform strategies for optimizing healthcare delivery in post-pandemic contexts.

A 12-Month Randomized Controlled Trial to Assess the Impact of Telemedicine on Patient Experience and Care Continuity

BACKGROUND

Telemedicine is the use of electronic information to communicate technologies to provide and support healthcare when distance separates the participants. Satisfaction and engagement of patients are key resource indicators for any healthcare setup and healthcare provider for evolving the care continuum (a system that provides a comprehensive range of health services so that care can evolve with the patient over time) and ensuring continuous quality improvement in the systems. As the latest remarkable strategy to connect with patients for consultations and follow-up, telemedicine has been of pivotal importance, especially during the coronavirus disease 2019 (COVID-19), where medicinal services utilize digital sound, video, and information interchanges to remotely access and provide care.

MATERIALS AND METHODS

A cross-sectional study was planned during the second wave of the COVID-19 pandemic from April 2021 to April 2022 to assess the impact of telemedicine in essential healthcare delivery by super specialty tertiary care healthcare setup, which is also a medical college, by three consultants and a physiotherapist.

RESULTS

There was a significant improvement in satisfaction scores and an improvement in the approach of patients towards telemedicine was observed. Various other parameters, like readmission compliance with medications and a reduction in ED times, were also observed. Finally, clinical endpoints were captured, and the correlation between readmission and medicine adherence was found to be strongly correlated (r = 0.9). A p-value of the reduction in utilization times of ED (emergency department), readmission, and medicine adherence was found to be highly significant Conclusions: Telemedicine is the need of the hour and is now an essential part of healthcare. Its acceptance post-COVID-19 pandemic and adaptability into existing healthcare setups would deliver fruitful results.

Is Pulmonary Involvement a Distinct Phenotype of Post-COVID-19?

(1) Background: COVID-19 infection often provokes symptoms lasting many months: most commonly fatigue, dyspnea, myalgia and mental distress symptoms. In this study, we searched for clinical features of post-COVID-19 condition (PCC) and differences between patients with and without pulmonary involvement. (2) Methods: A total of 282 patients with a mean age of 57 years (SD +/- 12 years) underwent assessment up to 12 weeks after COVID-19 recovery. The course of acute disease, past medical history and clinical symptoms were gathered; pulmonary function tests were performed; radiographic studies were assessed and follow-up examinations were conducted. Patients with and without detectable pulmonary lesions were divided into separate groups. (3) Results: Patients within the pulmonary group were more often older (59 vs. 51 y.o.; p < 0.001) males (p = 0.002) that underwent COVID-19-related hospitalization (p < 0.001) and were either ex- or active smokers with the median of 20 pack-years. We also managed to find correlations with hypertension (p = 0.01), liver failure (p = 0.03), clinical symptoms such as dyspnea (p < 0.001), myalgia (p = 0.04), headache (p = 0.009), sleeplessness (p = 0.046), pulmonary function tests (such as FVC, TLCO, RV and TLC; p < 0.001) and several basic laboratory tests (D-dimer, cardiac troponin, WBC, creatinine and others). (4) Conclusions: Our results indicate that initial pulmonary involvement alters the PCC, and it can be used to individualize clinical approaches.