Quebec population and telehealth: a survey on knowledge and perceptions

Feasibility of Glaucoma Detection Programs for At-Risk Populations Using Existing Health Care Infrastructure

PRCIS

Targeted glaucoma screening strategies performed within retail care-based clinics and Federally Qualified Health Centers (FQHCs) uncover a high prevalence of glaucoma.

OBJECTIVE

To summarize the glaucoma detection and maintenance programs that utilize existing health care infrastructure to promote up-scalable programs.

METHODS

Health care infrastructure that already exists may facilitate glaucoma detection. This infrastructure includes retail-based optometry practices and FQHC. Persons who are at risk for glaucoma are disproportionately represented within the patient populations served by much of this infrastructure, thus suggesting that it could be useful for deploying glaucoma screening programs. Glaucoma screening within FQHCs reveals a very high prevalence of glaucoma and related disease in the patients seeking care at these facilities.

RESULTS

These telemetric-based care delivery programs have a high patient acceptance. A simulated telemedicine program modeled after a telemedicine program based in Walmart Vision Centers for the diagnosis of glaucoma indicated that there was moderate diagnostic agreement between an ophthalmologist's telemedicine diagnosis and an ophthalmologist's in-person diagnosis. There was also moderate agreement between an optometrist's telemedicine diagnosis and the ophthalmologist's in-person diagnosis.

CONCLUSION

Telemetric care delivery programs that capitalize on existing infrastructure within a retail-based care setting or FQHCs may provide a promising setting to cost-effectively screen for glaucoma and other eye diseases that are potentially expandable nationwide.

Factors associated with the intention of telehealth service utilization among Bangladeshi people: a cross-sectional study

Background

Telehealth is comprised of telecommunications and electronic information systems to support and maintain long-distance healthcare services. Although it has not been thoroughly explored, the intention of using the service among the general public is critical to its success. We investigated the factors associated with the intention to utilize telehealth services among the general population of Bangladesh.

Methods

This cross-sectional study was conducted between May 22, 2021 and June 15, 2021 in Bangladesh, where the total number of participants was 1038. The Pearson chi-square test and Kruskal-Wallis H tests were used to examine the unadjusted relationship between the explanatory variables and the intention to use telehealth services. A multinomial logistic regression model was fitted to determine the adjusted association. Shapiro-Wilk tests were used to check the normality of continuous data. Data were processed and analyzed by software STATA-16.

Results

The probability of utilizing the service increased significantly with increasing knowledge, perceived benefit, and predisposition levels among respondents. However, when perceived concern increased, the likelihood of utilizing the service dropped significantly. Age, marital status, educational status, profession, residence, and perceived health status were significantly associated with the participants' intention to utilize the telehealth service.

Conclusions

The influencing aspects of telehealth service utilization should be recognized by the respective authorities. Possible activities to enhance usability among people are also recommended.

Assessment of Telemedicine Usage Among Saudis During the COVID-19 Pandemic

INTRODUCTION

Telemedicine was the first line of defense during the COVID-19 pandemic. As a result, Saudi Arabia believes it is essential to emphasize telemedicine services to combat the virus as part of its early precautionary actions.

OBJECTIVES

To measure the prevalence of telemedicine usage and determine the facilitators and barriers affecting telemedicine usage.

METHODS

A cross-sectional study was conducted among Saudis from October 2020 to April 2021. Participants received an online questionnaire through multiple social media platforms.

RESULTS

The prevalence of telemedicine usage was 45.2%. The most significant facilitator that affected the participants' usage was avoiding the infection of COVID-19, at 87.3%. In-person consultation preference was the biggest barrier preventing Saudis from using telemedicine services (62.5%).

CONCLUSION

Not enough people are aware of telemedicine services, so it is recommended to multiply advertisements for the services provided to reach many users. To enhance Saudi Arabia's awareness of the risks of COVID-19, further studies are needed to assess telemedicine usage during COVID-19, since the majority of studies were conducted in advance.

Digital technology, tele-medicine and artificial intelligence in ophthalmology: A global perspective

The simultaneous maturation of multiple digital and telecommunications technologies in 2020 has created an unprecedented opportunity for ophthalmology to adapt to new models of care using tele-health supported by digital innovations. These digital innovations include artificial intelligence (AI), 5th generation (5G) telecommunication networks and the Internet of Things (IoT), creating an inter-dependent ecosystem offering opportunities to develop new models of eye care addressing the challenges of COVID-19 and beyond. Ophthalmology has thrived in some of these areas partly due to its many image-based investigations. Tele-health and AI provide synchronous solutions to challenges facing ophthalmologists and healthcare providers worldwide. This article reviews how countries across the world have utilised these digital innovations to tackle diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration, glaucoma, refractive error correction, cataract and other anterior segment disorders. The review summarises the digital strategies that countries are developing and discusses technologies that may increasingly enter the clinical workflow and processes of ophthalmologists. Furthermore as countries around the world have initiated a series of escalating containment and mitigation measures during the COVID-19 pandemic, the delivery of eye care services globally has been significantly impacted. As ophthalmic services adapt and form a "new normal", the rapid adoption of some of telehealth and digital innovation during the pandemic is also discussed. Finally, challenges for validation and clinical implementation are considered, as well as recommendations on future directions.

The transition to teletherapy in marriage and family therapy training settings during COVID-19: What do the data tell us?

In the wake of the COVID-19 pandemic, little is known about how university training programs transitioned to teletherapy. This study describes the transition of two university marriage and family therapy (i.e., master's and doctoral) training clinics to teletherapy and presents preliminary analyses of the types of clients and cases that converted to teletherapy. A series of chi-square analyses, a t-test, a logistic regression model, and a multiple linear regression model were employed. Four key findings emerged: (1) most cases converted to teletherapy; (2) Hispanic ethnicity was the only demographic characteristic to significantly predict conversion to teletherapy; (3) individual cases were significantly more likely to convert to teletherapy than relational cases; and (4) the number of prior in-person sessions attended significantly predicted conversion to teletherapy. Teletherapy conversion implications are discussed across four systemic levels: client, student trainee, supervision, and larger systems.

Glaucoma Patient Knowledge, Perceptions, and Predispositions for Telemedicine

PURPOSE

The purpose was to identify factors associated with older glaucoma patients' knowledge of, perceptions of, and predispositions for telemedicine use.

MATERIALS AND METHODS

Established patients age 60 years and above with a diagnosis of primary open-angle glaucoma, glaucoma suspect, or ocular hypertension followed by a glaucoma fellowship-trained ophthalmologist were enrolled in the study at an academic, urban, tertiary referral eye clinic. Enrolled patients were administered a Life Space Questionnaire (LSQ), scored 0 to 9, and Preferences for Telemedicine Questionnaire (PTQ), a Likert scale validated tool. χ testing analyzed PTQ responses by age, race, education, employment status, LSQ score, and distance traveled from home address to clinic. A Mann-Whitney U test was used to compare PTQ responses by visual field index and visual acuity for the better and worse eye.

RESULTS

Of 110 patients enrolled, 71% of patients agreed or were neutral to receiving telediagnosis and 74% of patients agreed or were neutral to receiving teleintervention. Patients aged 60 to 69 years compared with those 70 and above had significantly greater knowledge about types of telemedicine: telediagnosis (53% vs. 31%, P=0.02), teleintervention (49% vs. 24%, P=0.006), teletriage (80% vs. 47%, P=0.0004), and telemonitoring (55% vs. 27%, P=0.003). Patients of European descent had significantly more knowledge about teletriage compared with those of non-European descent (72% vs. 53%, P=0.04). Patients with more education (>high school) compared with those with less education (≤high school) had more knowledge about telemedicine (39% vs. 16%, P=0.007) and all the uses of it: telediagnosis (61% vs. 45%, P<0.001), teleintervention (54% vs. 14%, P<0.001), teletriage (86% vs. 35%, P<0.001), and telemonitoring (59% vs. 18%, P=0.001). Patients with a LSQ score ≥6, meaning they traveled a greater distance from home in the previous 3 days, displayed significantly more knowledge about telediagnosis (49% vs. 25%, P=0.02), teleintervention (43% vs. 19%, P=0.01), and telemonitoring (47% vs. 25%, P=0.03) than those with an LSQ<6. Responses to the PTQ were not significantly different by distance traveled.

CONCLUSIONS

Knowledge of telemedicine was variable but between one third and one half of patients had favorable attitudes toward using telemedicine for glaucoma care.

Changes in instrumental activities of daily living functioning associated with concurrent common mental disorders and physical multimorbidity in older adults

Introduction: Instrumental activities of daily living (IADL) are key indicators of general functional status that are frequently used to assess the autonomy of older adults living in the community.Aims: To evaluate the changes in IADL in community-living older adults and the role of common mental disorders and physical multimorbidity in predicting these changes.Method: A secondary analysis including participants from the Longitudinal Survey on Senior's Health and Health Services. Self-reported sociodemographic and clinical information on chronic conditions were obtained at baseline interview (n = 1615). Measures of IADL were obtained at two time points, 3 years apart. Administrative data on physician diagnoses of chronic diseases were linked to self-reported information. Logistic and multinomial regression models were used to study the outcomes of interest.Results: More than one-third of participants reported disability. Significant increase in global and specific IADL tasks disability were observed over time. Concurrent mental and physical chronic conditions predicted persistent and future incidence of disability.Conclusions: We draw attention to the synergistic effect of mental and physical co-morbidities on IADL functioning and to the importance of the simultaneous management of these conditions in order to prevent disability, future decline and the associated health and societal burden.Implications for RehabilitationBy establishing the prevalence of global and specific IADL disability, we can better recognize the needs of older adults and inform health and social care planning.Influenced by the morbidity profile, older adults may experience decline, improvement or maintenance of autonomy in IADL over time.The presence of synergistic effect of physical and mental chronic conditions on functioning suggests that their simultaneous management is crucial in delaying or preventing disability.Reports of significant impairment in tasks such as taking medication calls attention to the need for increased accessibility to programs on medication management.The progressive loss of ability to take medication among multimorbid patients emphasize the need for therapeutic plans that circumvent polypharmacy.

The beliefs of Senegal's physicians toward the use of telemedicine

INTRODUCTION

Telemedicine is seen as a potential solution to improve access to specialist services in underserved areas, but using telemedicine depends on physicians' beliefs regarding its use. Applying the theory of planned behaviour, there are three kinds of beliefs of relevance: behavioural, normative and control beliefs. This study aimed to determine the behavioural, normative and control beliefs of Senegal's physicians regarding the use of telemedicine.

METHODS

A qualitative descriptive study involving individual interviews with physicians was conducted between January and June 2014. It included 32 physicians working in public hospitals and 37 physicians working in district health centres. Interviews were taped, transcribed and their content coded thematically using the NVivo 10 software.

RESULTS

The most significant positive behavioural belief was that telemedicine makes experts' opinions accessible despite distance; the most important negative behavioural belief was that telemedicine can lead to medical errors. The positive normative belief mentioned most was that patients approve the use of telemedicine, but the negative normative belief mentioned most was that the patients would not approve it. The prevailing positive control belief was that physicians will use telemedicine if it is easy to use and the most cited negative control belief was that physicians will not use telemedicine if they have insufficient time.

CONCLUSION

The results of this study provide a better understanding of the beliefs of Senegal's physicians regarding telemedicine, which can help in designing interventions to promote its use. Such interventions may help improve access to healthcare in rural areas.

Public knowledge and perceptions of connected health

RATIONALE, AIMS AND OBJECTIVES

This study aims to examine the public's knowledge and perceptions of connected health (CH).

METHODS

A structured questionnaire was administered by face-to-face interview to an opportunistic sample of 1003 members of the public in 11 shopping centres across Northern Ireland (NI). Topics included public knowledge of CH, opinions about who should provide CH and views about the use of computers in health care. Multivariable analyses were conducted to assess respondents' willingness to use CH in the future.

RESULTS

Sixty-seven per cent of respondents were female, 31% were less than 30 years old and 22% were over 60 years. Most respondents had never heard of CH (92%). Following a standard definition, the majority felt CH was a good idea (≈90%) and that general practitioners were in the best position to provide CH; however, respondents were equivocal about reductions in health care professionals' workload and had some concerns about the ease of device use. Factors positively influencing willingness to use CH in the future included knowledge of someone who has a chronic disease, residence in NI since birth and less concern about the use of information technology (IT) in health care. Those over 60 years old or who felt threatened by the use of IT to store personal health information were less willing to use CH in the future.

CONCLUSION

Increased public awareness and education about CH is required to alleviate concerns and increase the acceptability of this type of care.

Specific health status has an impact on the willingness to use telemonitoring: data from a 2009 health survey in north rhine-westphalia, Germany

OBJECTIVE

Demographic changes in Germany are expected to cause a rising need for medical care and therapy while capacities are declining. Telemedicine offers the option of minimizing some aspects of these problems, but so far, many telemedicine projects in Germany (including telemonitoring projects) are not applied to the clinical routine. This study was done to assess the influence of health factors on potential willingness to use telemonitoring devices at home.

MATERIALS AND METHODS

Health status and other health-relevant factors were determined using individual and medical factors (e.g., reported diseases). Principal-component analysis was used to identify groups with a specific response behavior. This study was based on a representative telephone survey conducted in the German state of North Rhine-Westphalia in 2009.

RESULTS

Willingness to use telemonitoring was high in North Rhine-Westphalia but decreased with age. Men showed a significantly greater willingness to use telemonitoring than did women. Also, there was an effect associated with the subjects' health status (e.g., cardiovascular diseases caused a decrease of 9.7% in the level of acceptance, whereas musculoskeletal disorders caused a decrease of 5.1%).

CONCLUSIONS

The target groups for telemonitoring consisted mainly of elderly persons and those with certain diseases. This study showed that being diseased lowered the willingness to use telemonitoring. People need to understand better how telemonitoring can help to improve controlling their health status and coping with the disease. It is necessary to reflect on these specific needs if telemonitoring is to become routine in the German healthcare system.

Legal Bases for Medical Supervision via Mobile Telecommunications in Japan

This paper discusses the legal basis for mobile telecommunications-based medical supervision in Japan and bulletin from the Ministry of Health, Labour and Welfare. According to Article 44 of the Emergency Life-Saving Technician’s Act, an emergency technician shall not perform certain emergency medical procedures unless specifically authorized to do so by a medical practitioner. Actual conditions make these requirements unwieldy to put into practice. When requested to provide medical control in response to an ambulance call, a licensed physician has no choice but to allow the emergency technician to administer medical care. These circumstances expose medical practitioners to significant legal risks and societal ramifications. Is a mobile telecommunications environment characterized by insufficient information satisfactory for the medical care needed in ambulances? This paper discusses such medical care and its legal ramifications, including: how to implement such medical care under Article 21 of the Basic Act on Establishing a Networked Society Based on Advanced Information and Telecommunications. The Japanese government is obligated to provide citizens with broadband telecommunication lines in the near future to enable the smooth implementation of medical control over medical supervision provided in ambulances.

Cross-Border Medical Care and Telemedicine

Globalization is making cross-border medical care a reality. Cross-border medical care has three aspects: information, patients, and practitioners. The outsourcing of diagnostic imaging via communication lines has begun, and information on treatment poised to cross borders. However, the latter possibility raises issues concerning legal medical qualifications. Japanese legislation bans medical practice by persons not licensed by the Minister of Health, Labour and Welfare. The Ministry of Health, Labour and Welfare recently issued a bulletin regarding the medical activities of foreign licensed physicians and an interpretation of Article 17 of the Medical Practitioner’s Act, permitting foreign licensed physicians to provide medical care in the event of disasters. European countries have established a system for mutual recognition of national medical licenses, and cross-border medical care has achieved a solid foothold there. Based on these societal factors, Japan must revise its legal systems or conclude bilateral medical license recognition agreements. This paper describes the various difficulties and obstacles confronting Japan as it modifies its legal systems to achieve cross-border remote medical care and medical tourism and proposes some concrete solutions.

A comparison of rural speech-language pathologists' and residents' access to and attitudes towards the use of technology for speech-language pathology service delivery

This paper reports results and implications of two related studies which investigated (a) access of residents and speech-language pathologists (SLPs) of rural Australia to information and communication technologies (ICT) and (b) their attitudes towards the use of ICT for delivery of speech-language pathology services. Both studies used mail out questionnaires, followed by interviews with a subset of those who completed the questionnaires. Data were obtained from 43 questionnaires from rural residents and 10 interviews with a subset of those residents, and from questionnaires returned by 49 SLPs and 4 interviews with a subset of those SLPs. Results show a mismatch between rural residents' and SLPs' access to and attitudes towards use of ICT for speech-language pathology service delivery. Rural residents had better access and more positive attitudes to the use of ICT for speech-language pathology service delivery than expected by SLPs. The results of this study have important implications for education and professional development of SLPs and for research into the use of ICT for telespeech-language pathology.