Activity analysis of telemedicine in the UK

A Solution Focused Approach of Delivering Virtual Paediatric Diabetes Consultations During the COVID-19 Pandemic

The onset of the COVID-19 global pandemic rapidly accelerated the use of virtual consultations into everyday practice. A solution focused approach (SFA) has been established in paediatric diabetes care, resulting in positive clinical outcomes and communication. The aim of this study was to assess feedback from paediatric diabetes patients and their parents or carers regarding virtual consultations, using a solution focused approach, in a hospital setting. An electronic survey was sent to patients following their virtual consultation. Of those surveyed, 86% recommended video consultations to be part of their diabetes care. Qualitative data showed reduced travel time, comfort, reduced need for parking and convenience as the highest areas improved through video consultations. Clinical care was shown to be positive and addressed patients concerns, the majority of respondents (84%) reported that the appointment was about what they wanted it to be about. Using the solution focused model helped overcome the challenges faced with virtual consultations particularly with concerns surrounding safeguarding issues, confidentiality, audio/video difficulties and also helped to support the patient journey.

Different applications of telemedicine - assessing the challenges, barriers, and opportunities- a narrative review

Telemedicine (TLM) is a technique of telecommunication used to create, promote, or accelerate health services. Because of its societal significance, the current study attempted to demonstrate its essential applications in the health sector and the challenges, obstacles, and opportunities that lie ahead. Various studies and reports were received based on the subject of the current study, first using MeSH terms related to the subject in authentic and available international databases. After that, 30-related articles were selected based on the study criteria, and then the required results were extracted from the selected studies. The study results showed that TLM has a significant role in more than 13 major areas of health and treatment, and in most of these areas, it has made the relevant affairs easier for both patients and medical staff. Although TLM has many advantages, it still has obstacles and challenges requiring further studies to manage this technology better. Given the high importance of the TLM in the health sector in most countries worldwide, efforts are needed to promote this technology and remove the obstacles in front of it. Therefore, further evaluations of TLM efficiency in terms of economics, speed of action, effectiveness, and the provision of infrastructure are necessary to overcome the obstacles highlighted based on the results of these studies and improve the efficiency of using this technology.

"Chiropractic is manual therapy, not talk therapy": a qualitative analysis exploring perceived barriers to remote consultations by chiropractors

Background

Remote consultations (RCs) enable clinicians to continue to support patients when face-to-face appointments are not possible. Restrictions to face-to-face care during the COVID-19 pandemic has accelerated a pre-existing trend for their adoption. This is true for many health professionals including some chiropractors. Whilst most chiropractors in the UK have used RCs in some form during the pandemic, others have not. This study seeks to understand the views of chiropractors not using RCs and to explore perceived potential barriers.

Methods

A national online survey was completed by 534 registered practicing UK chiropractors on the use of RCs. Respondents had the opportunity of providing open-ended responses concerning lack of engagement in RCs during the COVID-19 pandemic. Textual responses obtained from 137 respondents were coded and analysed using thematic analysis.

Results

The use of RCs provided an opportunity for chiropractors to deliver ongoing care during the COVID-19 pandemic. However, many chiropractors expressed concern that RCs misaligned with their strong professional identity of providing ‘hands-on’ care. Some chiropractors also perceived that patients expected physical interventions during chiropractic care and thus considered a lack of demand when direct contact is not possible. In the absence of a physical examination, some chiropractors had concerns about potential misdiagnosis, and perceived lack of diagnostic information with which to guide treatment. Clinic closures and change in working environment led to practical difficulties of providing remote care for a few chiropractors.

Conclusions

The COVID-19 pandemic may have accelerated changes in the way healthcare is provided with RCs becoming more commonplace in primary healthcare provision. This paper highlights perceived barriers which may lead to reduced utilisation of RCs by chiropractors, some of which appear fundamental to their perceived identity, whilst others are likely amenable to change with training and experience.

Teleophthalmology and COVID-19: the patient perspective

Oculoplastic services at a UK district general hospital underwent reconfiguration to incorporate teleconsultations during the COVID-19 pandemic, and patient satisfaction was assessed. Methods All oculoplastic patients at Maidstone Hospital underwent telephone or video consultations in place of face-to-face reviews. Patient feedback surveys were conducted. Results 80 telephone and 40 video consultation responses were analysed. The majority of teleconsultations lasted 6-10 minutes. 55% of telephone and 82.5% of video consultation patients felt face-to-face reviews would not have changed the appointment outcome. Satisfaction scores of 10/10 were given by 71.3% of telephone and 72.5% of video consultation patients. Correlation between age and preference of consultation type was observed, with 62.5% of patients aged >65 years requesting regular face-to-face reviews compared to only 18.8% of 25-64-year-olds. Conclusion Patients highly support teleconsultation adaptations. This is an opportunity to incorporate and enhance teleconsultation facilities to meet current and future demand, especially with ongoing social distancing guidelines.

How COVID-19 Is Testing and Evolving Our Communication Skills

The COVID-19 pandemic forced us, as health care professionals and members of the general public, to adapt. Simple things we take for granted have become more difficult. As pressures increased for health care professionals, conversations and decisions have become tougher. This brought the need to adapt working practices and find ways to continue providing compassionate patient-centred care remotely. In UK radiotherapy departments, radiation therapist (review radiographer)–led clinics moved to telephone-based clinics to reduce the time spent by patients in a hospital environment. This required setting up a “virtual” clinic room with patients by removing distractions and setting boundaries for the conversation. We have had to adapt our communication skills quickly as picking up on nonverbal cues is not possible through the phone. It can be challenging to understand feelings through the tone of a patient's voice and empathise accordingly. The pandemic has forced patients to slow down and really focus on themselves which has led to picking up physical and mental health changes earlier. This is one of the many positive outcomes that can be drawn from the pandemic. Although we have changed how we work, ultimately we are still here to help our patients.

Mapping telemedicine efforts: surveying regional initiatives in Denmark

OBJECTIVES

The aim of this study is to survey telemedicine services currently in operation across Denmark. The study specifically seeks to answer the following questions: What initiatives are deployed within the different regions? What are the motivations behind the projects? What technologies are being utilized? What medical disciplines are being supported using telemedicine systems?

MATERIALS AND METHODS

All data were surveyed from the Telemedicinsk Landkort, a newly created database designed to provide a comprehensive and systematic overview of all telemedicine technologies in Denmark.

RESULTS

The results of this study suggest that a growing numbers of telemedicine initiatives are currently in operation across Denmark but that considerable variations exist in terms of regional efforts as the number of operational telemedicine projects varied from region to region.

CONCLUSIONS

The results of this study provide a timely picture of the factors that are shaping the telemedicine landscape of Denmark and suggest potential strategies to help policymakers increase and improve national telemedicine deployment.

The effectiveness of video-telemedicine for screening of patients requesting emergency air medical transport (EAMT)

BACKGROUND

Demand for emergency air medical transport (EAMT) services have increased in recent years. However, the high costs of these services have raised questions on the benefit to patient outcomes. In this study, we evaluate the effectiveness of video-telemedicine for the preflight screening of patients for air medical transports.

METHOD

A prospective cohort study. Medical records of patients transported from the Penghu Islands to Taiwan were retrospectively collected from November 1999 to October 2002 (stage 1). In addition, we collected medical records of patients who were preflight-screened by physicians using video Web cameras from November 1, 2002 through August 30, 2003 (stage 2). The intervention in stage 2 included a set of protocols and screening criteria for EAMT implemented by the National Aeromedical Consultation Center (NACC). In stage 1, there were no standardized protocols or screening guidelines for EAMT. The EAMT system before implementing preflight screening and telemedicine was mostly based on patient's requests and their health condition determined by the treating medical officers (TMO).

RESULTS

A total of 822 transfers were included in this study. Patient demographic backgrounds in the two groups were similar on gender, age, disease classification, and types of illnesses. Patients in stage 2 were significantly older than those in stage 1. In a comparison of flight frequencies between the two stages, the results revealed a 36.2% reduction of EAMT applications in stage 2. The flight approval rate was 91.2%. The intervention in stage 2 also presented a significant reduction in cross-zone transport (16.1% to 0.1% to the northern Taiwan region). Within-zone transfers increased from 74.9% to 88.3%. Cost analysis showed that physician triage in stage 2 resulted in a total annual savings on EAMTs of US 448,986 dollars.

CONCLUSIONS

This study demonstrates the physician-assisted preflight screening using video-telemedicine significantly reduced the frequency of unnecessary air medical transports and consequently led to reduced costs. Video-telemedicine can be an essential tool to support physicians in decision-making for patient screening.