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Correia GDS, Silva ACSSD, Pinto LF, Góes FGB, Goulart MDCEL, Pereira-Ávila FMV. Usability of the ROBOVID mobile app for health education about COVID-19. Rev Lat Am Enfermagem 2024; 32:e4191. [PMID: 38865557 DOI: 10.1590/1518-8345.6924.4191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/06/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVE to evaluate the usability of the ROBOVID mobile application for health education about COVID-19. METHOD methodological study with an applied quantitative approach, developed with 21 adults, using an electronic form. Usability was assessed using the System Usability Scale. The Statistical Package for the Social Sciences software was used to analyze the data. RESULTS the overall average score on the System Usability Scale questionnaire was 87.3, which classifies the usability of the ROBOVID application as the best achievable. Furthermore, the application has high scores for ease of memorization, user satisfaction and ease of getting to know the system, as well as excellent scores for absence of errors and speed in carrying out the tasks set. CONCLUSION the ROBOVID application complies with the principles of usability in terms of efficiency, effectiveness and satisfaction in the evaluation of end users, showing that the application meets consumer needs in terms of its functionalities, demonstrating its viability in terms of the initial objectives. (1) ROBOVID was considered better achievable on the SUS scale by the participants. (2) The ROBOVID app meets the user's needs in terms of its functions. (3) ROBOVID helps individuals to take care of themselves and prevent COVID-19. (4) The ROBOVID app was evaluated as a useful, didactic and functional tool.
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Affiliation(s)
- Gabrielle Dos Santos Correia
- Universidade Federal Fluminense, Campus Universitário de Rio das Ostras, Rio das Ostras, RJ, Brazil
- Scholarship holder at the Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Brazil
| | | | - Layanne Fonseca Pinto
- Universidade Federal Fluminense, Campus Universitário de Rio das Ostras, Rio das Ostras, RJ, Brazil
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Zhuang H, Yu HP, Gu YJ, Li LJ, Yao JL. The effect of telemedicine interventions on patients with diabetic foot ulcers: A systematic review and meta-analysis of randomized controlled trials. Adv Wound Care (New Rochelle) 2024. [PMID: 38618714 DOI: 10.1089/wound.2024.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
OBJECTIVE The meta-analysis was performed to evaluate the effectiveness of telemedicine interventions on patients with diabetic foot ulcers(DFU). APPROACH The authors conducted a comprehensive search across eight databases. The aim was to identify randomized controlled trials examining the effectiveness of telemedicine for patients with DFU. Methodological qualities of included studies were assessed using Cochrane Handbook for Systematic Reviews of Intervention.. Subsequently, a meta-analysis was conducted using RevMan 5.3 to synthesize the findings. RESULTS Ten studies involving 1678 patients with DFU were included in the meta-analysis. In comparison to the face-to-face intervention group, telemedicine interventions significantly reduced the amputation rate (risk ratio (RR) = 0.64, 95% confidence interval (CI) = 0.44-0.92, p = 0.02), decreased costs (mean difference (MD) = -4158.51, 95% CI = -7304.69--1012.34, p = 0.01), better controlled fasting blood glucose( FPG)(MD = -0.89, 95% CI = -1.43--0.36, p = 0.001), achieved superior glycated hemoglobin(HbA1c) control (MD = -0.71, 95% CI = -1.01--0.41, p ˂ 0.00001). No significant differences were observed between the telemedicine group and the face-to-face group in terms of healing rate, mortality, and healing time. Innovations: Our study suggests that telemedicine is a viable strategy for managing DFU. CONCLUSIONS The meta-analysis indicates that telemedicine interventions have a positive effect on DFU. Nevertheless, more well-designed and high-quality studies are needed to reach a conclusion with greater confidence.
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Affiliation(s)
- Huiren Zhuang
- Shanghai East Hospital, 66324, No. 1800 Yuntai Road, Pudong New Area, Shanghai, Shanghai, China, 200120;
| | - Hai-Ping Yu
- Shanghai East Hospital, 66324, Shanghai, Shanghai, China;
| | - Ying-Jie Gu
- Shanghai East Hospital, 66324, Shanghai, Shanghai, China;
| | - Ling-Jun Li
- Shanghai East Hospital, 66324, Shanghai, Shanghai, China;
| | - Jia-Li Yao
- Shanghai East Hospital, 66324, Shanghai, Shanghai, China;
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Lazarus J, Cioroianu I, Ehrhardt B, Gurevich D, Kreusser L, Metcalfe B, Nishtala P, Preatoni E, Sharp TH. Data-driven digital health technologies in the remote clinical care of diabetic foot ulcers: a scoping review. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1212182. [PMID: 37727285 PMCID: PMC10505804 DOI: 10.3389/fcdhc.2023.1212182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/31/2023] [Indexed: 09/21/2023]
Abstract
Background The availability and effectiveness of Digital Health Technologies (DHTs) to support clinicians, empower patients, and generate economic savings for national healthcare systems are growing rapidly. Of particular promise is the capacity of DHTs to autonomously facilitate remote monitoring and treatment. Diabetic Foot Ulcers (DFUs) are characterised by high rates of infection, amputation, mortality, and healthcare costs. With clinical outcomes contingent on activities that can be readily monitored, DFUs present a promising focus for the application of remote DHTs. Objective This scoping review has been conducted as a first step toward ascertaining fthe data-related challenges and opportunities for the development of more comprehensive, integrated, and individualised sense/act DHTs. We review the latest developments in the application of DHTs to the remote care of DFUs. We cover the types of DHTs in development and their features, technological readiness, and scope of clinical testing. Eligibility criteria Only peer-reviewed original experimental and observational studies, case series and qualitative studies were included in literature searches. All reviews and manuscripts presenting pre-trial prototype technologies were excluded. Methods An initial search of three databases (Web of Science, MEDLINE, and Scopus) generated 1,925 English-language papers for screening. 388 papers were assessed as eligible for full-text screening by the review team. 81 manuscripts were found to meet the eligibility criteria. Results Only 19% of studies incorporated multiple DHTs. We categorised 56% of studies as 'Treatment-Manual', i.e. studies involving technologies aimed at treatment requiring manual data generation, and 26% as 'Prevention-Autonomous', i.e. studies of technologies generating data autonomously through wearable sensors aimed at ulcer prevention through patient behavioural change. Only 10% of studies involved more ambitious 'Treatment-Autonomous' interventions. We found that studies generally reported high levels of patient adherence and satisfaction. Conclusions Our findings point to a major potential role for DHTs in remote personalised medical management of DFUs. However, larger studies are required to assess their impact. Here, we see opportunities for developing much larger, more comprehensive, and integrated monitoring and decision support systems with the potential to address the disease in a more complete context by capturing and integrating data from multiple sources from subjective and objective measurements.
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Affiliation(s)
- Joel Lazarus
- Department of Social and Policy Studies, University of Bath, Bath, United Kingdom
| | - Iulia Cioroianu
- Department of Politics, Languages and International Studies, Faculty of Humanities and Social Sciences, University of Bath, Bath, United Kingdom
| | - Beate Ehrhardt
- Institute for Mathematical Innovation, Languages and International Studies, Faculty of Humanities and Social Sciences, University of Bath, Bath, United Kingdom
| | - David Gurevich
- Department of Life Sciences, University of Bath, Bath, United Kingdom
| | - Lisa Kreusser
- Department of Mathematical Sciences, Faculty of Science, University of Bath, Bath, United Kingdom
| | - Benjamin Metcalfe
- Department of Electronic and Electrical Engineering, Faculty of Science, University of Bath, Bath, United Kingdom
| | - Prasad Nishtala
- Department of Life Sciences, Faculty of Engineering and Design, University of Bath, Bath, United Kingdom
| | - Ezio Preatoni
- Department for Health, Faculty of Humanities and Social Sciences, University of Bath, Bath, United Kingdom
| | - Tamsin H. Sharp
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Bath, Bath, United Kingdom
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Dardari D, Franc S, Charpentier G, Orlando L, Bobony E, Bouly M, Xhaard I, Amrous Z, Sall KL, Detournay B, Penfornis A. Hospital stays and costs of telemedical monitoring versus standard follow-up for diabetic foot ulcer: an open-label randomised controlled study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 32:100686. [PMID: 37520145 PMCID: PMC10384180 DOI: 10.1016/j.lanepe.2023.100686] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023]
Abstract
Background Two randomised controlled trials (RCTs) have previously shown that telemedical monitoring of diabetic foot ulcer (DFU) reduces the number of visits to the outpatient clinic, without losing treatment efficacy or increasing costs. Here we present the results of an open-label, randomised controlled trial designed to investigate whether telemonitoring, provided by an expert nurse (with extensive experience in DFU and trained in remote monitoring), reduces the hospital stay and the associated costs for a patient with DFU (TELEPIED trial). Methods Eligible patients (n = 180) were randomly allocated to: (i) a control group, in which they received standard care, and (ii) an intervention group, in which they received asynchronous telemedicine follow-up by the expert nurse. The primary outcome was the cumulative hospital days over 12 months. The main secondary outcomes were (i) direct healthcare costs (estimated in a collective perspective), (ii) wound healing and (iii) amputation rates. ITT (intention-to-treat) population was analysed. Findings In the ITT population, cumulative hospital days were significantly higher in the control group (13.4 days [95% CI 9.0-17.8]) than in the intervention group (7.1 days [2.8-11.5]) (p = 0.0458, ANCOVA model). Cumulative direct costs over 12 months were 7185 € (95% CI 5144-9226) in the control group and 3471 € (95% CI 1430-5512) in the intervention group (p = 0.0120). The percentage of wounds healed and amputation rate were not significantly different between groups. Similar results were found with the PP population. Interpretation The implementation of a telemedical intervention with an expert nurse could lead to a length of hospitalization and direct costs that were two times lower compared to conventional follow-up. This lower medical and economic burden was obtained without losing effectiveness on the rate of healing, nor increasing the amputation rate. Additional studies are required to confirm these findings. Funding This study was designed, funded and conducted by CERITD (Study and Research Centre for Intensification of Diabetes Treatment, Evry, France), Genopole GIP, 20 rue Henri Desbruères, 91030 EVRY Cedex and Laboratoires URGO, 15 Avenue d'Iéna, 75116 Paris Cedex, France. The findings and conclusions in this study are those of the authors and do not necessarily represent the views of the sponsor. The corresponding author (DD) certify that authors were not precluded from accessing data in the study, and they accept responsibility to submit for publication.
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Affiliation(s)
- Dured Dardari
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- LBEPS, Université d’Evry, IRBA, Université de Paris-Saclay, Evry, France
| | - Sylvia Franc
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Guillaume Charpentier
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Laurent Orlando
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Elise Bobony
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Marie Bouly
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
| | - Ilham Xhaard
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Zohra Amrous
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Khadijatou Ly Sall
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Bruno Detournay
- CEMKA, 43, Boulevard du Maréchal Joffre, Bourg-La-Reine 92340, France
| | - Alfred Penfornis
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- Paris-Sud Medical School, Paris-Saclay University, Saint-Aubin, France
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Lira JAC, Rocha ÁSC, Bezerra SMG, Nogueira PC, dos Santos AMR, Nogueira LT. Effects of educational technologies on the prevention and treatment of diabetic ulcers: A systematic review and meta-analysis. Rev Lat Am Enfermagem 2023; 31:e3944. [PMID: 37341258 PMCID: PMC10306059 DOI: 10.1590/1518-8345.6628.3944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/08/2023] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE to analyze the effects of educational technologies in the prevention and treatment of diabetic ulcers. METHOD a systematic review conducted in seven databases, a bibliographic index, an electronic library and the Gray Literature. The sample consisted of 11 randomized controlled clinical trials. The synthesis of the results was descriptive and through meta-analysis. RESULTS the predominant educational technologies were training sessions and verbal guidelines, with soft-hard technologies standing out. When compared to usual care, the educational technologies presented a protective factor to prevent the incidence of diabetic ulcers (RR=0.40; 95% CI=0.18-0.90; p=0.03) and the certainty of the evidence assessment was low. The educational technologies also had a protective factor to prevent the incidence of lower limb amputations (RR=0.53; 95% CI=0.31-0.90; p=0.02) and certainty of the evidence was very low. CONCLUSION soft-hard educational technologies such as structured verbal guidelines, educational games, lectures, theoretical-practical training sessions, educational videos, folders, serial albums and playful drawings, and hard technologies such as therapeutic footwear, insoles, infrared digital thermometer, foot care kits, Telemedicine app and mobile phone use, were effective for the prevention and treatment of diabetic ulcers, although more robust studies are required.
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Affiliation(s)
| | | | | | - Paula Cristina Nogueira
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Médico-Cirúrgica, São Paulo, SP, Brasil
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Levy BE, Wilt WS, Johnson J, Wallace H, Ballert E, Newcomb M, Cavatassi W, Harris A. Procedure-Based Telehealth Utilization in General Surgery. Am J Med Qual 2023; 38:154-159. [PMID: 37125671 DOI: 10.1097/jmq.0000000000000122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The authors hypothesize that standardized telehealth (TH) scheduling processes will improve TH utilization without increasing adverse events. Fifty visits preimplementation and 67 visits postimplementation were audited from June 2021 to January 2022. Both leadership and frontline stakeholders were engaged to identify current workflows and potential interventions targeting outpatient elective procedures. Process mapping outlined current TH scheduling workflows. Outcomes related to TH completion, cost, and TH scheduling were collected after implementation. Preimplementation TH scheduling rate was 32%. The intervention required TH postoperative appointments to be scheduled in clinic at the time of surgery scheduling with TH being the default postsurgical appointment for a standardized list of eligible procedures. Following implementation, 95% of patients undergoing eligible procedures had TH follow-up. This provided improved access to surgical follow-up care, by reducing travel needs to the Veterans Affairs facility. Secondarily, this intervention increased clinic appointment availability and resulted in possible increased revenue for billable visits. Standardizing TH scheduling based on the procedure improves the utilization of TH resulting in improved clinic efficiency and increased revenue, without increasing adverse events.
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Affiliation(s)
- Brittany E Levy
- Department of General Surgery, University of Kentucky, Lexington, KY
| | - Wesley S Wilt
- Department of General Surgery, University of Kentucky, Lexington, KY
| | | | | | - Erik Ballert
- Department of General Surgery, University of Kentucky, Lexington, KY
- Lexington Veteran's Affairs Medical Center, Lexington, KY
| | - Melissa Newcomb
- Department of General Surgery, University of Kentucky, Lexington, KY
- Lexington Veteran's Affairs Medical Center, Lexington, KY
| | - William Cavatassi
- Department of General Surgery, University of Kentucky, Lexington, KY
- Lexington Veteran's Affairs Medical Center, Lexington, KY
| | - Andrew Harris
- Lexington Veteran's Affairs Medical Center, Lexington, KY
- Department of Urology, University of Kentucky, Lexington, KY
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Abou Ali AN, Abdul Malak OM, Hafeez MS, Habib S, Cherfan P, Salem KM, Hager E, Avgerinos E, Sridharan N. Improved outpatient medical visit compliance with sociodemographic discrepancies in vascular telehealth evaluations. J Vasc Surg 2023; 77:1238-1244. [PMID: 36375724 PMCID: PMC9652098 DOI: 10.1016/j.jvs.2022.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The COVID-19 (coronavirus disease 2019) pandemic has led to a rapid expansion in the use of telemedicine across all medical fields but has also exposed telehealth care disparities with differing access to technology across racial and ethnic groups. The objective of our study was to investigate the effects of telehealth on vascular visit compliance and to explore the effects of sociodemographic factors on vascular surgery outpatient telehealth usage during the COVID-19 pandemic. METHODS Consecutive patients who had undergone an outpatient vascular surgery evaluation between February 24, 2020 (the launch of our telemedicine program) and December 31, 2020, were reviewed. The baseline demographic and outcomes were obtained from the electronic medical records. Telehealth and in-person evaluations were defined according to the patient's index visit during the study period. Medical visit compliance was established on completion of the telehealth or in-person encounter. We used χ2 tests and logistic regression analyses. RESULTS A total of 23,553 outpatient visits had been scheduled for 10,587 patients during the study period. Of the outpatient visits, 1559 had been scheduled telehealth encounters compared with 21,994 scheduled in-person encounters. Of the scheduled outpatient encounters, 13,900 medical visits (59.0%) had been completed: 1183 telehealth visits and 12,717 in-person visits. The mean travel distance saved for the telehealth visits was 22.1 ± 27.1 miles, and the mean travel time saved was 46.3 ± 41.47 minutes. We noted no sociodemographic differences between the patients scheduled for telehealth vs in-person visits. We found a trend toward a lower proportion of African-American patients in the telehealth group vs the in-person group (7.8% vs 10.6%; P = .116), without statistical significance. A significantly higher rate of medical visit completion was found for the telehealth group compared with the in-person group (79.5% vs 59.4%; P < .001). Among the patients scheduled for an outpatient medical visit, a scheduled telemedicine evaluation (vs in-person) was associated with 2.3 times the odds of completing the medical visit (odds ratio, 2.31; 95% confidence interval, 2.05-2.61), adjusting for age, sex, race, ethnicity, language, and the distance between the patient's home zip code and the outpatient vascular center's zip code. Selecting for scheduled telemedicine visits, African-American race was associated with a decreased odds of telemedicine usage (odds ratio, 0.73; 95% confidence interval, 0.59-0.90) after adjusting for age, sex, ethnicity, language, and visit type. CONCLUSIONS Use of the vascular surgery outpatient telehealth evaluation appeared to improve medical visit completion in our region with apparent sociodemographic disparities. Further studies are needed to confirm whether telemedicine expansion has improved access to care in other geographic areas.
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Affiliation(s)
- Adham N Abou Ali
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Othman M Abdul Malak
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Muhammad Saad Hafeez
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Salim Habib
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Patrick Cherfan
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Karim M Salem
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Eric Hager
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Efthymios Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Natalie Sridharan
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
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Parise AC, Coria HE, López V, Santini Araujo MG. Pie diabético y pandemia de la COVID-19: adaptación al uso de la Telemedicina por los especialistas de pie y tobillo de los Servicios de Traumatología de la Argentina. REVISTA DE LA ASOCIACIÓN ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGÍA 2023. [DOI: 10.15417/issn.1852-7434.2023.88.1.1623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Introducción: La telemedicina fue la recomendación internacional durante la pandemia de COVID-19 para las consultas médicas de los pacientes con pie diabético. El objetivo de este estudio fue analizar el empleo de la telemedicina como herramienta en pacientes con pie diabético, por parte de especialistas en pie y tobillo de la Argentina. Como objetivos secundarios se planteó valorar la satisfacción percibida por los profesionales con el uso de esta herramienta, evaluar qué estrategias se usaron para realizar la consulta médica remota y determinar la permanencia al retornar a la actividad asistencial habitual.
Materiales y Métodos: Se enviaron tres encuestas a los socios de la Sociedad Argentina de Medicina y Cirugía de la Pierna y Pie, entre mayo 2020 y abril de 2022.
Resultados: La función más valiosa de la consulta remota fue la prevención (75% de los encuestados), el seguimiento clínico (54,1%), el seguimiento posoperatorio (41,6%) y el diagnóstico (29,1%). El recurso más utilizado fue la conversación telefónica, seguida del envío de imágenes por mensajería instantánea. Solo el 37,5% utilizó las plataformas de historia clínica virtual.
Conclusiones: Los recursos más utilizados para la consulta remota fueron la conversación telefónica, seguida del envío de imágenes por mensajería instantánea. El 33,4% estaba conforme con la consulta por telemedicina en mayo de 2020, mientras que, en julio, la conformidad ascendió al 46,7%. En abril de 2022, solo el 13% continuaba con las consultas remotas.
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Takahashi EA, Schwamm LH, Adeoye OM, Alabi O, Jahangir E, Misra S, Still CH. An Overview of Telehealth in the Management of Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e558-e568. [PMID: 36373541 DOI: 10.1161/cir.0000000000001107] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Telehealth enables the remote delivery of health care through telecommunication technologies and has substantially affected the evolving medical landscape. The COVID-19 pandemic accelerated the utilization of telehealth as health care professionals were forced to limit face-to-face in-person visits. It has been shown that information delivery, diagnosis, disease monitoring, and follow-up care can be conducted remotely, resulting in considerable changes specific to cardiovascular disease management. Despite increasing telehealth utilization, several factors such as technological infrastructure, reimbursement, and limited patient digital literacy can hinder the adoption of remote care. This scientific statement reviews definitions pertinent to telehealth discussions, summarizes the effect of telehealth utilization on cardiovascular and peripheral vascular disease care, and identifies obstacles to the adoption of telehealth that need to be addressed to improve health care accessibility and equity.
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Søndergaard SF, Vestergaard EG, Andersen AB, Kolbæk R, Dahl M, Høgh A. How patients with diabetic foot ulcers experience telemedicine solutions: A scoping review. Int Wound J 2022; 20:1796-1810. [PMID: 36453130 PMCID: PMC10088844 DOI: 10.1111/iwj.14026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Diabetic foot ulcer (DFU) is a common, complex and severe complication of diabetes that is associated with severely decreased health-related quality of life. Treatment of DFUs calls for a multi-sectoral approach, incorporating interdisciplinary care pathways. Telemedicine (TM) may be used as a communication tool between caregivers across healthcare sectors to obligate the need for close follow-up, including early intervention in preventing the recurrence of DFU. The objective of this review was to identify, examine and conceptually map the available literature on patients' experiences and views regarding the use of TM solutions among patients with DFUs. We identified the Population, Concept and Context to pinpoint the focus of this review, word the research question and title as well as facilitate the literature search strategy. The literature examined stems from 13 sources. We imposed no restrictions on the methodological approach of the included studies, neither on the format. During the review process, four main maps emerged: "A whole human not merely a hole in a human," "Less of a burden on the family, the community and the environment," "Competences and continuity of care are essential for high-quality care" and "The quality and modality of the technology." Further investigation from both the patients' and the multi-sectoral caregivers' perspective is needed, focusing on whatever modifications of the TM intervention may fit the DFU care pathway better.
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Affiliation(s)
- Susanne Friis Søndergaard
- Centre for Research in Clinical Nursing Regional Hospital Viborg Viborg Denmark
- VIA University College and Aarhus University, Health Aarhus Denmark
| | - Else Godsk Vestergaard
- Wound Nurse, Vascular Research Unit, Department of Surgery Viborg Regional Hospital Viborg Denmark
| | - Anne Bendix Andersen
- Centre for Research in Clinical Nursing Regional Hospital Viborg Viborg Denmark
- VIA University College and Aarhus University, Health Aarhus Denmark
| | | | - Marie Dahl
- Vascular Research Unit, Department of Surgery Viborg Regional Hospital Viborg Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
- Department of Clinical Research University of Southern Denmark and Odense University Hospital Odense Denmark
| | - Annette Høgh
- Vascular Research Unit and Wound Centre. Department of Surgery Regional Hospital Viborg, Region Central Jutland Viborg Denmark
- Institute for Clinical Medicine Aarhus University Aarhus Denmark
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Barakat‐Johnson M, Kita B, Jones A, Burger M, Airey D, Stephenson J, Leong T, Pinkova J, Frank G, Ko N, Kirk A, Frotjold A, White K, Coyer F. The viability and acceptability of a Virtual Wound Care Command Centre in Australia. Int Wound J 2022; 19:1769-1785. [PMID: 35607997 PMCID: PMC9615290 DOI: 10.1111/iwj.13782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to assess the viability and acceptability of an innovative Virtual Wound Care Command Centre where patients in the community, and their treating clinicians, have access to an expert wound specialist service that comprises a digitally enabled application for wound analysis, decision-making, remote consultation, and monitoring. Fifty-one patients with chronic wounds from 9 centres, encompassing hospital services, outpatient clinics, and community nurses in one metropolitan and rural state in Australia, were enrolled and a total of 61 wounds were analysed over 7 months. Patients received, on average, an occasion of service every 4.4 days, with direct queries responded to in a median time of 1.5 hours. During the study period, 26 (42.6%) wounds were healed, with a median time to healing of 66 (95% CI: 56-88) days. All patients reported high satisfaction with their wound care, 86.4% of patients recommended the Virtual Wound Care Command Centre with 84.1% of patients reporting the digital wound application as easy to use. Potential mean travel savings of $99.65 for rural patients per visit were recognised. The data revealed that the Virtual Wound Care Command Centre was a viable and acceptable patient-centred expert wound consultation service for chronic wound patients in the community.
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Affiliation(s)
- Michelle Barakat‐Johnson
- Department of Nursing and Midwifery Executive ServicesSydney Local Health DistrictSydneyNew South WalesAustralia
- Susan Wakil School of Nursing and MidwiferyFaculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
- School of NursingQueensland University of TechnologyBrisbaneQueenslandAustralia
- Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Badia Kita
- Department of Nursing and Midwifery Executive ServicesSydney Local Health DistrictSydneyNew South WalesAustralia
- Susan Wakil School of Nursing and MidwiferyFaculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
| | - Aaron Jones
- Department of Nursing and Midwifery Executive ServicesSydney Local Health DistrictSydneyNew South WalesAustralia
- Health Informatics UnitSydney Local Health DistrictSydneyNew South WalesAustralia
- Discipline of Biomedical Informatics and Digital Health, University of SydneySydneyNew South WalesAustralia
| | - Mitchell Burger
- Health Informatics UnitSydney Local Health DistrictSydneyNew South WalesAustralia
- Discipline of Biomedical Informatics and Digital Health, University of SydneySydneyNew South WalesAustralia
- Information Communication Technology, Strategy Architecture and Innovation, Sydney Local Health DistrictSydneyNew South WalesAustralia
- School of Population HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - David Airey
- Riverina EndovascularWagga WaggaNew South WalesAustralia
| | - John Stephenson
- Biomedical StatisticsSchool of Human and Health Services, University of HuddersfieldHuddersfieldUnited Kingdom
- Institute of Skin Integrity and Infection PreventionUniversity of HuddersfieldHuddersfieldUnited Kingdom
| | - Thomas Leong
- Nursing and Midwifery ServicesRoyal Prince Alfred Hospital, Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Jana Pinkova
- Nursing and Midwifery ServicesRoyal Prince Alfred Hospital, Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Georgina Frank
- Podiatry DepartmentSydney Local Health DistrictSydneyNew South WalesAustralia
| | - Natalie Ko
- Department of Nursing and MidwiferyConcord HospitalSydneyNew South WalesAustralia
| | - Andrea Kirk
- Nursing and Midwifery ServicesWestern Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Astrid Frotjold
- Susan Wakil School of Nursing and MidwiferyFaculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
| | - Kate White
- Department of Nursing and Midwifery Executive ServicesSydney Local Health DistrictSydneyNew South WalesAustralia
- Susan Wakil School of Nursing and MidwiferyFaculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
- The Daffodil Centre, University of Sydney, A Joint Venture With Cancer Council NSWSydneyNew South WalesAustralia
| | - Fiona Coyer
- School of NursingQueensland University of TechnologyBrisbaneQueenslandAustralia
- Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Institute of Skin Integrity and Infection PreventionUniversity of HuddersfieldHuddersfieldUnited Kingdom
- Intensive Care ServicesRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
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Description and Utilization of Telewound Monitoring Services in Primary Care Patients with Acute Wounds in Singapore: A Retrospective Study. Adv Skin Wound Care 2022; 35:544-549. [PMID: 36125454 PMCID: PMC9508980 DOI: 10.1097/01.asw.0000855740.66588.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe an inaugural telewound monitoring service (TMS) designed for the remote monitoring of acute wounds to empower primary care patients, and identify factors associated with the utilization of the TMS. METHODS Retrospective data were collected from 204 patients who participated in the TMS between June 19, 2016 and August 31, 2017 and analyzed using both descriptive and multiple regression analysis. RESULTS The mean patient age was 27.9 years (SD, 12.4); wound area was 7.8 cm2 (SD, 21.2); and duration of healing was 11.7 days (SD, 6.9). A multiple regression model based on patients' demographics and wound factors predicted which patients were likely to have more telewound sessions than face-to-face sessions. The model was statistically significant (F = 2.093 (11, 124), P = .025) with 15.7% of variance explained by the variables. An increase in age (P = .043) and increased days to healing (P = .043) were associated with a reduction in the number of telewound sessions. CONCLUSIONS The TMS is a valuable alternative to face-to-face wound care that enables patients with acute wounds to assume the roles of both patient and carer simultaneously. Age and healing duration are predictors for utilization of this service. Prompt attention to these predictors may improve service allocation and utilization.
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Muacevic A, Adler JR. Effectiveness of Telemedicine for the Management of Foot Ulcers in People With Diabetes: A Meta-Analysis. Cureus 2022; 14:e30634. [PMID: 36439575 PMCID: PMC9683114 DOI: 10.7759/cureus.30634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2022] [Indexed: 01/25/2023] Open
Abstract
Treatment of diabetes-related foot ulcers presents great pressure on the healthcare system in terms of management strategy and allocation of resources. Telemedicine can be used to treat diabetic foot ulcers more effectively. This meta-analysis aims to evaluate the impacts of telemedicine on the treatment of diabetic foot ulcers. The current meta-analysis was conducted as per the reported guidelines of the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Two reviewers independently searched for relevant articles using PubMed, EMBASE, and the Cochrane Database of Systematic Reviews from inception to 31 August 2022, assessing the impacts of telemedicine on the treatment of diabetic foot ulcers. The primary outcomes assessed in the current meta-analysis included the percentage of foot ulcers healed and the time of healing foot ulcers within 12 months. Secondary outcomes included the percentage of amputation (minor and major) and all-cause mortality. A total of six studies were included in the current meta-analysis enrolling 1876 patients with diabetic foot ulcers. No difference was there between the two groups in terms of the number of patients whose ulcer healed (risk ratio (RR): 1.01, 95% confidence interval (CI): 0.93-1.09), time to healing of wound within 12 months (mean difference: -0.07, 95% CI: -0.31-0.17), the incidence of amputation (RR: 0.73, 95% CI: 0.54-1.00), and all-cause mortality (RR: 0.99, 95% CI: 0.42-2.37). In conclusion, the study found that telemedicine is non-inferior to standard care in terms of reducing healing time and the number of patients with ulcer healing within 12 months. The study also found that the incidence of amputation is also lower in patients assigned to the telemedicine group compared to patients in the control group and no significant differences were reported in terms of mortality.
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14
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Kamaratos-Sevdalis N, Kamaratos A, Papadakis M, Tsagkaris C. Telehealth has comparable outcomes to in-person diabetic foot care during the COVID-19 pandemic. World J Methodol 2022; 12:285-292. [PMID: 36159092 PMCID: PMC9350733 DOI: 10.5662/wjm.v12.i4.285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/19/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has posed obstacles to the delivery of diabetic foot care. In response to this remote healthcare services have been deployed offering monitoring, follow-up, and referral services to patients with diabetic foot ulcers and related conditions. Although, remote diabetic foot care has been studied before the COVID-19 pandemic as an alternative to in-person care, the peculiar situation of the pandemic, which dictates that remote care would be the sole available option for healthcare practitioners and patients, necessitates an evaluation of the relevant knowledge obtained since the beginning of the severe acute respiratory syndrome coronavirus 2 outbreak.
AIM To perform a thorough search in PubMed/Medline and Cochrane to identify original records on the topic.
METHODS To identify relevant peer-reviewed publications and gray literature, the authors searched PubMed-MEDLINE and Cochrane Library-Cochrane Central Register of Controlled Trials starting September 27 till October 31, 2021. The reference lists of the selected sources and relevant systematic reviews were also hand–searched to identify potentially relevant resources. Otherwise, the authors searched Reference Citation Analysis (https://www.referencecitationanalysis.com/).
RESULTS A number of randomized prospective studies, case series, and case reports have shown that the effectiveness of remote care is comparable to in-person care in terms of hospitalizations, amputations, and mortality. The level of satisfaction of patients’ receiving this type of care was high. The cost of remote healthcare was not significantly lower than in - person care though.
CONCLUSION It is noteworthy that remote care during the COVID-19 pandemic appeared to be more effective and well - received than remote care in the past. Nevertheless, larger studies spanning over longer time intervals are necessary in order to validate these results and provide additional insights.
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Affiliation(s)
- Nikolaos Kamaratos-Sevdalis
- Diabetic Foot Clinic, Diabetes Center and 1st Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Piraeus 18536, Greece
| | - Alexandros Kamaratos
- Diabetic Foot Clinic, Diabetes Center and 1st Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Piraeus 18536, Greece
| | - Marios Papadakis
- Surgery II, University of Witten-Herdecke, Wuppertal 42283, Germany
| | - Christos Tsagkaris
- Diabetic Foot Clinic, Diabetes Center and 1st Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Piraeus 18536, Greece
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Kostovich CT, Etingen B, Wirth M, Patrianakos J, Kartje R, Baharestani M, Weaver FM. Outcomes of Telehealth for Wound Care: A Scoping Review. Adv Skin Wound Care 2022; 35:394-403. [PMID: 35170501 DOI: 10.1097/01.asw.0000821916.26355.fa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To synthesize the literature on delivering wound care via telehealth and compare clinical, healthcare utilization, and cost outcomes when wound care is provided via telehealth (telewound) modalities compared with in-person care. DATA SOURCES An electronic search of PubMed, CINAHL, and Cochrane Clinical Trials databases for articles published from 1999 to 2019 was conducted using the following MeSH search terms: telewound, wound, wound care, remote care, telehealth, telemedicine, eHealth, mobile health, pressure injury, and ulcer. STUDY SELECTION Articles were included if they were a scientific report of a single study; evaluated a telehealth method; identified the type of wound of focus; and provided data on clinical, healthcare utilization, or cost outcomes of telewound care. In total, 26 articles met these criteria. DATA EXTRACTION Data were extracted and grouped into 13 categories, including study design, wound type, telehealth modality, treatment intervention, and outcomes measured, among others. DATA SYNTHESIS Of the 26 studies, 19 reported on clinical outcomes including overall healing and healing time; 17 studies reported on healthcare utilization including hospitalizations and length of stay; and 12 studies reported costs. CONCLUSIONS Evidence regarding the use of telewound care is weak, and findings related to the impact of telewound care on outcomes are inconsistent but indicate that it is not inferior to in-person care. Greater use of telehealth as a result of the COVID-19 pandemic points to further development of navigation and education models of telehealth for wound care. However, additional studies using rigorous research design and leveraging robust sample sizes are needed to demonstrate value.
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Affiliation(s)
- Carol T Kostovich
- Carol T. Kostovich, PhD, RN, CHSE, is Research Health Scientist, Edward Hines, Jr. VA Hospital, Hines, IL; and Associate Professor, Assistant Dean of Innovative Educational Strategies, Marcella Niehoff School of Nursing, Loyola University, Chicago, IL. At the Hines VA Hospital, Bella Etingen, PhD, is Research Health Scientist, Center of Innovation for Complex Chronic Healthcare; Marissa Wirth, MPH, is Research Health Science Specialist; Jamie Patrianakos, MA, is Research Health Science Specialist; and Rebecca Kartje, MD, MS, is Analyst. Mona Baharestani, PhD, APN, CWON, FACCWS, is Associate Chief, Wound Care & Research, James H. Quillen VAMC, Johnson City (Mountain Home), Johnson City, TN. Frances M. Weaver, PhD, is Research Health Scientist, Hines VA Hospital, and Professor, Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, IL. Acknowledgment: This work was supported by the US Department of Veterans Affairs, Diffusion of Excellence Office, and Office of Research and Development, Health Services Research and Development Service, Quality Enhancement Research Initiative Program (PEC 19-310). Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views, position, or policy of the Department of Veterans Affairs or the US Government. The authors have disclosed no other financial relationships related to this article. Submitted June 8, 2021; accepted in revised form July 23, 2021; published online ahead of print February 14, 2022
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16
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Yammine K, Estephan M. Telemedicine and diabetic foot ulcer outcomes. A meta-analysis of controlled trials. Foot (Edinb) 2022; 50:101872. [PMID: 35219129 DOI: 10.1016/j.foot.2021.101872] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/05/2021] [Accepted: 10/18/2021] [Indexed: 02/04/2023]
Abstract
Telemedicine (TM) has been advanced as an effective approach to wound care management. In this era of COVID-19 pandemic, it is paramount to assess the evidence behind the use of TM in treating diabetic foot ulcers (DFU). This meta-analysis aims at evaluating the efficacy of TM versus face-to-face attendance in managing DFU. In total, four controlled studies were included in the meta-analysis comprising 3 randomized trials. The total pooled sample comprised 816 patients (816 ulcers): 337 in TM group and 479 in the control group. The results were as follows: (a) healing rate OR was 1.35, in favor of TM (p = 0.4), (b) time to heal with means of 73 ± 24.1 days and 83.5 ± 28.4 days, for the TM and control group, respectively (p = 0.35), c) the amputation rate OR was 0.48 (p = 0.007) in favor of the TM group, d) the mortality rate OR was 1.66 (p = 0.2), and e) a trend for lesser cost than face-to-face group (p = 0.4). While future research using large-sampled controlled studies is warranted, the present meta-analysis demonstrated that treating DFU via TM could be at least as effective as to face-to-face attendance. In times where clinic visits are reduced or not possible such as during this COVID-19 pandemic and the likely-to-happen future outbreaks, TM could be a valuable alternative.
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Affiliation(s)
- Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon; Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon; Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Lebanon.
| | - Michel Estephan
- Department of Emergency Medicine, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
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Mota ANB, Turrini RNT. Evaluación de la usabilidad de una aplicación móvil para pacientes con catéter central de inserción periférica. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.5817.3665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Resumen Objetivo: evaluar la usabilidad de la aplicación Meu PICC para el seguimiento extrahospitalario de pacientes que usan catéter central de inserción periférica por medio del instrumento validado System Usability Scale. Método: estudio transversal que aplicó el System Usability Scale a 30 pacientes que usan catéter central de inserción periférica, diez enfermeros y ocho profesionales en tecnología de la información para evaluar la usabilidad de la aplicación. Resultados: hubo diferencia estadística entre la edad y la usabilidad (p=0,006), así como una correlación negativa entre el tiempo de uso de la aplicación y la usabilidad (p=0,002). Según la escala de clasificación de adjetivos del System Usability Scale, el 40,0% de los pacientes consideró que la aplicación era mejor imaginable y el 33,3% excelente. En cuanto a las enfermeras, el 70,0% consideró que la aplicación era mejor imaginable y el 20,0% excelente; de los profesionales en tecnologías de la información, el 50,0% consideró que la aplicación era mejor imaginable y el 50,0% excelente. Conclusión: la evaluación de usabilidad determinó que los pacientes, enfermeros y profesionales en TIC consideraron que la aplicación era útil para el seguimiento de pacientes que utilizan PICC y la calificaron como adecuada, otorgándole la calificación de mejor imaginable o excelente. Estos resultados confirman el uso de la aplicación Meu PICC en el seguimiento de pacientes que usan PICC fuera del hospital.
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Mota ANB, Turrini RNT. Usability assessment of a mobile app for patients with peripherally inserted central catheters. Rev Lat Am Enfermagem 2022; 30:e3666. [PMID: 36629724 PMCID: PMC9818306 DOI: 10.1590/1518-8345.5817.3666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 02/22/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE to evaluate usability of the Meu PICC (My PICC) app for follow-up of outpatients using peripherally inserted central catheters through the validated System Usability Scale instrument. METHOD a cross-sectional study that applied the System Usability Scale to 30 patients using peripherally inserted central catheters, ten nurses and eight Information and Communication Technology professionals to assess usability of the app. RESULTS a statistical difference was observed between age and usability (p=0.006), as well as a negative correlation between app use time and usability (p=0.002). As per the System Usability Scale adjectival classification, 40.0% and 33.3% of the patients considered the app as the best possible to be imagined and as excellent, respectively. In relation to the nurses, 70.0% considered the app as the best possible to be imagined and 20.0% as excellent; of the Information and Communication Technology professionals, 50.0% considered the app as the best possible to be imagined and the other 50.0%, as excellent. CONCLUSION the usability assessment showed that patients, nurses and ICT professionals considered the app useful for monitoring patients using PICCs and evaluated it as appropriate, evaluating it as the best possible to be imagined or as excellent. These results corroborate use of the Meu PICC app in the monitoring of outpatient use of PICCs.
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Mota ANB, Turrini RNT. Avaliação de usabilidade de aplicativo móvel para pacientes com cateter central de inserção periférica. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.5817.3667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Resumo Objetivo: avaliar a usabilidade do aplicativo Meu PICC para o acompanhamento extra-hospitalar de pacientes em uso de cateter central de inserção periférica por meio do instrumento validado System Usability Scale. Método: estudo transversal que aplicou o System Usability Scale a 30 pacientes em uso de cateter central de inserção periférica, dez enfermeiros e oito profissionais de tecnologia da informação para avaliar a usabilidade do aplicativo. Resultados: observou-se diferença estatística entre idade e usabilidade (p=0,006), bem como correlação negativa entre o tempo de utilização do aplicativo e usabilidade (p=0,002). Pela classificação adjetiva do System Usability Scale, 40,0% dos pacientes consideraram o aplicativo como o melhor imaginável e 33,3% como excelente. Com relação aos enfermeiros, 70,0% consideraram o aplicativo como o melhor imaginável e 20,0% como excelente; dos profissionais de tecnologia da informação, 50,0% consideraram o aplicativo como o melhor imaginável e 50,0% excelente. Conclusão: a avaliação de usabilidade mostrou que pacientes, enfermeiros e profissionais de TIC consideraram o aplicativo útil para o acompanhamento de pacientes em uso de PICC e o avaliaram como adequado, atribuindo-lhe a qualificação de melhor imaginável ou excelente. Estes resultados corroboram para o uso do aplicativo Meu PICC no acompanhamento de pacientes em uso extra-hospitalar de PICC.
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Desimone ME, Sherwood J, Soltman SC, Moran A. Telemedicine in cystic fibrosis. J Clin Transl Endocrinol 2021; 26:100270. [PMID: 34765457 PMCID: PMC8571077 DOI: 10.1016/j.jcte.2021.100270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/30/2021] [Accepted: 10/21/2021] [Indexed: 02/08/2023] Open
Abstract
Cystic Fibrosis (CF) requires lifetime multidisciplinary care to manage both pulmonary and extra pulmonary manifestations. The median age of survival for people with CF is rising and the number of adults with CF is expected to increase dramatically over the coming years. People with CF have better outcomes when managed in specialty centers, however access can be limited. Telemedicine and technology-based care solutions may help to overcome barriers to availability and improve access. This review outlines the use of telehealth for CF management. Telehealth has been utilized for CF across a broad variety of indications, even prior to the COVID-19 pandemic, and in general has been well accepted by patients and providers. There are a paucity of data, however, related to health outcomes, and the healthcare utilization specific to CF and its related comorbidities. Future studies are needed to address the questions of health outcomes, cost, burdens of telehealth and barriers to implementation.
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Affiliation(s)
- Marisa E. Desimone
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Upstate Medical University 750 East Adams Street, Syracuse, NY 13210, USA
| | - Jordan Sherwood
- Division of Pediatric Endocrinology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Sarah C. Soltman
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University, 3270 SW Pavilion Loop, Portland, OR 97239, USA
| | - Antoinette Moran
- Division of Pediatric Endocrinology, University of Minnesota, 2512 S 7th Street, Minneapolis, MN 55454, USA
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21
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Telemedicine for the treatment of foot ulcers in people with diabetes. Hippokratia 2021. [DOI: 10.1002/14651858.cd014652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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22
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Zoppo G, Marrone F, Pittarello M, Farina M, Uberti A, Demarchi D, Secco J, Corinto F, Ricci E. AI technology for remote clinical assessment and monitoring. J Wound Care 2021; 29:692-706. [PMID: 33320742 DOI: 10.12968/jowc.2020.29.12.692] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To report the clinical validation of an innovative, artificial intelligence (AI)-powered, portable and non-invasive medical device called Wound Viewer. The AI medical device uses dedicated sensors and AI algorithms to remotely collect objective and precise clinical data, including three-dimensional (3D) wound measurements, tissue composition and wound classification through the internationally recognised Wound Bed Preparation (WBP) protocol; this data can then be shared through a secure General Data Protection Regulation (GDPR)- and Health Insurance Portability and Accountability Act (HIPAA)-compliant data transfer system. This trial aims to test the reliability and precision of the AI medical device and its ability to aid health professionals in clinically evaluating wounds as efficiently remotely as at the bedside. METHOD This non-randomised comparative clinical trial was conducted in the Clinica San Luca (Turin, Italy). Patients were divided into three groups: (i) patients with venous and arterial ulcers in the lower limbs; (ii) patients with diabetes and presenting with diabetic foot syndrome; and (iii) patients with pressure ulcers. Each wound was evaluated for area, depth, volume and WBP wound classification. Each patient was examined once and the results, analysed by the AI medical device, were compared against data obtained following visual evaluation by the physician and research team. The area and depth were compared with a Kruskal-Wallis one-way analysis of variations in the obtained distribution (expected p-value>0.1 for both tests). The WBP classification and tissue segmentation were analysed by directly comparing the classification obtained by the AI medical device against that of the testing physician. RESULTS A total of 150 patients took part in the trial. The results demonstrated that the AI medical device's AI algorithm could acquire objective clinical parameters in a completely automated manner. The AI medical device reached 97% accuracy against the WBP classification and tissue segmentation analysis compared with that performed in person by the physician. Moreover, data regarding the measurements of the wounds, as analysed through the Kruskal-Wallis technique, showed that the data distribution proved comparable with the other methods of measurement previously clinically validated in the literature (p=0.9). CONCLUSION These findings indicate that remote wound assessment undertaken by physicians is as effective through the AI medical device as bedside examination, and that the device was able to assess wounds and provide a precise WBP wound classification. Furthermore, there was no need for manual data entry, thereby reducing the risk of human error while preserving high-quality clinical diagnostic data.
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Affiliation(s)
- Gianluca Zoppo
- Department of Electronic Engineering and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Torino, Italy
| | - Francesco Marrone
- Department of Electronic Engineering and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Torino, Italy
| | - Monica Pittarello
- Department of Surgery 2, Clinica San Luca, Strada della Vetta 3, 10020, Torino, Italy
| | - Marco Farina
- Department of Electronic Engineering and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Torino, Italy
| | - Alberto Uberti
- Department of Management Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Torino, Italy
| | - Danilo Demarchi
- Department of Electronic Engineering and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Torino, Italy
| | - Jacopo Secco
- Department of Electronic Engineering and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Torino, Italy
| | - Fernando Corinto
- Department of Electronic Engineering and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Torino, Italy
| | - Elia Ricci
- Department of Electronic Engineering and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Torino, Italy
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Development of a Smartphone-Based Optical Device to Measure Hemoglobin Concentration Changes for Remote Monitoring of Wounds. BIOSENSORS-BASEL 2021; 11:bios11060165. [PMID: 34063972 PMCID: PMC8223975 DOI: 10.3390/bios11060165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/18/2021] [Accepted: 05/18/2021] [Indexed: 01/13/2023]
Abstract
Telemedicine (TM) can revolutionize the impact of diabetic wound care management, along with tools for remote patient monitoring (RPM). There are no low-cost mobile RPM devices for TM technology to provide comprehensive (visual and physiological) clinical assessments. Here, a novel low-cost smartphone-based optical imaging device has been developed to provide physiological measurements of tissues in terms of hemoglobin concentration maps. The device (SmartPhone Oxygenation Tool—SPOT) constitutes an add-on optical module, a smartphone, and a custom app to automate data acquisition while syncing a multi-wavelength near-infrared light-emitting diode (LED) light source (690, 810, 830 nm). The optimal imaging conditions of the SPOT device were determined from signal-to-noise maps. A standard vascular occlusion test was performed in three control subjects to observe changes in hemoglobin concentration maps between rest, occlusion, and release time points on the dorsal of the hand. Hemoglobin concentration maps were compared with and without applying an image de-noising algorithm, single value decomposition. Statistical analysis demonstrated that the hemoglobin concentrations changed significantly across the three-time stamps. Ongoing efforts are in imaging diabetic foot ulcers using the SPOT device to assess its potential as a smart health device for physiological monitoring of wounds remotely.
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Aberer F, Hochfellner DA, Mader JK. Application of Telemedicine in Diabetes Care: The Time is Now. Diabetes Ther 2021; 12:629-639. [PMID: 33474646 PMCID: PMC7816834 DOI: 10.1007/s13300-020-00996-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/24/2020] [Indexed: 11/16/2022] Open
Abstract
The utilization of telemedicine solutions to reduce outpatient clinic visits and visits to physicians' offices, thus saving financial and personal resources as well as time, has gained substantial importance in recent years. The COVID19 pandemic has made it necessary to abruptly adjust outpatient care methods in various medical settings that needlessly require consultations in person to monitor and change the disease management of patients in specific risk groups. People with diabetes represent a vulnerable population who need to be protected from avoidable outpatient clinic visits, particularly in times of influenza or other pandemic outbreaks. However, the treatment and care of patients with diabetes and its comorbidities require careful and regular monitoring and therapy adjustments by medical staff. Advanced age or cognitive impairment and insufficient access to the health care system due to low socioeconomic status can complicate the use of possible alternatives to in-person consultations in outpatient clinics or physicians' offices. Telemedicine solutions may offer suitable alternatives to standard face-to-face consultations in outpatient settings and provide sufficient access to appropriate diabetes care. Nevertheless, telemedicine methods for monitoring diabetes issues are yet to find widespread use due to numerous barriers, such as a lack of acceptance and doubt about its time- and cost-effectiveness, availability, and potential technical and regulatory issues. This article offers an overview of existing applications that provide telemedicine diabetes care. Furthermore, it discusses potential ways to restructure and revolutionize diabetes outpatient care.
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Affiliation(s)
- Felix Aberer
- Department of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
| | - Daniel A Hochfellner
- Department of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Julia K Mader
- Department of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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Huang Z, Wu S, Yu T, Hu A. Efficacy of Telemedicine for Patients with Chronic Wounds: A Meta-Analysis of Randomized Controlled Trials. Adv Wound Care (New Rochelle) 2021; 10:103-112. [PMID: 32320355 DOI: 10.1089/wound.2020.1169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective: The meta-analysis was performed to summarize the available evidence and assess the efficacy of telemedicine for patients with chronic wounds. Approach: PubMed, Embase, Web of Science, The Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), WanFang, and VIP databases were electronically searched to identify eligible studies updated to February 2020 to collect randomized controlled trials regarding the efficacy of telemedicine for patients with chronic wounds. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of included studies with the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis was performed using RevMan 5.3 and StataSE. Results: Fourteen studies involving 1,926 patients were included in the meta-analysis. Compared with usual care, telemedicine intervention significantly improved wound healing rate (risk ratio [RR] = 1.44, confidence interval [95% CI] = 1.16-1.80, p = 0.001) and reduced adverse events (RR = 0.52, 95% CI = 0.34-0.80, p = 0.003). No significant differences were found between patients allocated to the telemedicine group or usual care group, in terms of the outcomes of healing time, change in wound size, or mortality. Innovations: Telemedicine is an effective approach to promote chronic wound healing and reduce adverse events. Conclusion: The meta-analysis demonstrates that telemedicine may improve the healing rate and reduce adverse events for patients with chronic wounds. Because of the limited quality and quantity of the included studies, rigorous studies with adequate sample sizes are required to conclude with more confidence.
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Affiliation(s)
- Zehao Huang
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Siyu Wu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ting Yu
- Nursing Department, Lingnan Branch of the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ailing Hu
- Nursing Department, Lingnan Branch of the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Kavitha KV, Deshpande SR, Pandit AP, Unnikrishnan AG. Application of tele-podiatry in diabetic foot management: A series of illustrative cases. Diabetes Metab Syndr 2020; 14:1991-1995. [PMID: 33080541 PMCID: PMC7548063 DOI: 10.1016/j.dsx.2020.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/09/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Telemedicine had been proposed as a tool to manage diabetes, but its role in management of diabetic foot ulcer is still evolving. The COVID-19 pandemic and related social restrictions have necessitated the use of telemedicine in the management of diabetic foot disease (tele-podiatry), particularly of patients classified as low-risk. MATERIALS AND METHODS We present a report of three cases of varied diabetic foot problems assessed during the present pandemic using different forms of telemedicine for triaging, management of low-risk cases and for follow-up. RESULTS Tele-podiatry was effective in the management of low-risk subjects with diabetic foot ulcer, and also useful in referral of high-risk subjects for hospital/clinic visit, facilitating proper management. It also helped in the follow-up of the cases. CONCLUSION Telemedicine is a good screening tool for diagnosing and managing low-risk subjects with diabetic foot problems, and also enables a triaging system for deciding on hospital visits and hospitalization. Telemedicine offers several benefits in the management of diabetic foot disease, although it also has some limitations. Based on our experience during the pandemic, we recommend its judicious use in the triaging of patients of diabetic foot disease and management of low-risk cases. Future innovation in technology and artificial intelligence may help in better tele-podiatry care in the time to come.
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Affiliation(s)
| | | | - Anil P Pandit
- Department of Hospital Administration, Chellaram Diabetes Institute, Pune, India
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Iversen MM, Igland J, Smith-Strøm H, Østbye T, Tell GS, Skeie S, Cooper JG, Peyrot M, Graue M. Effect of a telemedicine intervention for diabetes-related foot ulcers on health, well-being and quality of life: secondary outcomes from a cluster randomized controlled trial (DiaFOTo). BMC Endocr Disord 2020; 20:157. [PMID: 33087074 PMCID: PMC7580005 DOI: 10.1186/s12902-020-00637-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/13/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Follow-up care provided via telemedicine (TM) is intended to be a more integrated care pathway to manage diabetes-related foot ulcers (DFU) than traditionally-delivered healthcare. However, knowledge of the effect of TM follow-up on PROMs including self-reported health, well-being and QOL in patients with DFUs is lacking and often neglected in RCT reports in general. Therefore, in this study of secondary outcomes from the DiaFOTo trial, the aim was to compare changes in self-reported health, well-being and QOL between patients with DFUs receiving telemedicine follow-up care in primary healthcare in collaboration with specialist healthcare, and patients receiving standard outpatient care. METHODS The current study reports secondary endpoints from a cluster randomized controlled trial whose primary endpoint was ulcer healing time. The trial included 182 adults with diabetes-related foot ulcers (94/88 in the telemedicine/standard care groups) in 42 municipalities/districts, recruited from three clinical sites in Western Norway. Mean (SD) diabetes duration for the study population was 20.8 (15.0). The intervention group received care in the community in collaboration with specialist healthcare using an asynchronous telemedicine intervention. The intervention included an interactive web-based ulcer record and a mobile phone enabling counseling and communication between the community nurses and specialist healthcare; the control group received standard outpatient care. In total 156 participants (78/78) reported on secondary endpoints: self-reported health, well-being and quality of life evaluated by generic and disease-specific patient-reported outcome measures (e.g. Euro-QOL, the Hospital Anxiety and Depression Scale (HADS), Problem Areas in Diabetes (PAID), Neuropathy and Foot Ulcer-Specific Quality of Life Instrument (NeuroQOL)). Linear mixed-effects regression was used to investigate possible differences in changes in the scores between the intervention and control group at the end of follow-up. RESULTS In intention to treat analyses, differences between treatment groups were small and non-significant for the health and well-being scale scores, as well as for diabetes-related distress and foot ulcer-specific quality of life. CONCLUSIONS There were no significant differences in changes in scores for the patient reported outcomes between the intervention and control group, indicating that the intervention did not affect the participants' health, well-being and quality of life. TRIAL REGISTRATION Clinicaltrials.gov , NCT01710774 . Registered October 19th, 2012.
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Affiliation(s)
- Marjolein M Iversen
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway.
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway.
| | - Jannicke Igland
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Hilde Smith-Strøm
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Truls Østbye
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Svein Skeie
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - John G Cooper
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Mark Peyrot
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
- Department of Sociology, Loyola University Maryland, Baltimore, MD, USA
| | - Marit Graue
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
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Petersen BJ, Bus SA, Rothenberg GM, Linders DR, Lavery LA, Armstrong DG. Recurrence rates suggest delayed identification of plantar ulceration for patients in diabetic foot remission. BMJ Open Diabetes Res Care 2020; 8:8/1/e001697. [PMID: 32998870 PMCID: PMC7528350 DOI: 10.1136/bmjdrc-2020-001697] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/01/2020] [Accepted: 09/05/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Foot ulcers are a common and costly complication of diabetes, and delays in treatment can result in impaired healing, infection, hospitalization, and lower extremity amputation. RESEARCH DESIGN AND METHODS We aimed to determine whether patterns in plantar diabetic foot ulcer (DFU) recurrence coincided with typical intervals between routine preventive care appointments, which would suggest that delays exist between ulcer development and identification. We completed an analysis of existing data from two multicenter studies in 300 total participants. We analyzed unadjusted counts of DFU binned in weekly intervals and defined 'exam periods' as intervals from 2 to 4 weeks, from 6 to 8 weeks, within 1 week of 3 months and within 1 week of 6 months. We tested whether recurrence rates during exam periods were equivalent to rates outside exam periods. We estimated the delay between DFU development and DFU identification such that the rate of development would have been constant. RESULTS During exam periods, a total of 43 DFUs were identified (43/86=50%) despite the fact that these periods represent only 23.5% of follow-up in aggregate. Accounting for censoring, the annualized incidence during exam periods was 0.68 DFU/year (CI 0.48 to 0.89) in contrast to 0.25 DFU/year (CI 0.18 to 0.32) outside exam periods (incidence ratio=2.8, CI 1.8 to 4.3). We estimated delays between DFU occurrence and identification to average 15.3 days (IQR 7.4-23.7 days). CONCLUSIONS These findings have potential implications for practice, particularly related to the value of telehealth and in-home monitoring of patients in diabetic foot remission. Additionally, there are implications for study design, which should consider the impact of interval censoring and attempt to control for confounders related to frequency and timing of exams.
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Affiliation(s)
| | - Sicco A Bus
- Department of Rehabilitation Medicine, University of Amsterdam, Amsterdam, Noord-Holland, Netherlands
| | - Gary M Rothenberg
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - David G Armstrong
- Department of Surgery, USC Keck School of Medicine, Los Angeles, California, USA
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Golledge J, Fernando M, Lazzarini P, Najafi B, G. Armstrong D. The Potential Role of Sensors, Wearables and Telehealth in the Remote Management of Diabetes-Related Foot Disease. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4527. [PMID: 32823514 PMCID: PMC7491197 DOI: 10.3390/s20164527] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/29/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022]
Abstract
Diabetes-related foot disease (DFD), which includes foot ulcers, infection and gangrene, is a leading cause of the global disability burden. About half of people who develop DFD experience a recurrence within one year. Long-term medical management to reduce the risk of recurrence is therefore important to reduce the global DFD burden. This review describes research assessing the value of sensors, wearables and telehealth in preventing DFD. Sensors and wearables have been developed to monitor foot temperature, plantar pressures, glucose, blood pressure and lipids. The monitoring of these risk factors along with telehealth consultations has promise as a method for remotely managing people who are at risk of DFD. This approach can potentially avoid or reduce the need for face-to-face consultations. Home foot temperature monitoring, continuous glucose monitoring and telehealth consultations are the approaches for which the most highly developed and user-friendly technology has been developed. A number of clinical studies in people at risk of DFD have demonstrated benefits when using one of these remote monitoring methods. Further development and evidence are needed for some of the other approaches, such as home plantar pressure and footwear adherence monitoring. As yet, no composite remote management program incorporating remote monitoring and the management of all the key risk factors for DFD has been developed and implemented. Further research assessing the feasibility and value of combining these remote monitoring approaches as a holistic way of preventing DFD is needed.
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Affiliation(s)
- Jonathan Golledge
- Ulcer and wound Healing consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia;
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland 4814, Australia
| | - Malindu Fernando
- Ulcer and wound Healing consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia;
| | - Peter Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland 4000, Australia;
- Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Queensland 4006, Australia
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA;
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90089, USA;
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30
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Alromaihi D, Alamuddin N, George S. Sustainable diabetes care services during COVID-19 pandemic. Diabetes Res Clin Pract 2020; 166:108298. [PMID: 32623031 PMCID: PMC7332426 DOI: 10.1016/j.diabres.2020.108298] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 05/26/2020] [Accepted: 06/29/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The COVID-19 pandemic creates a challenge in the provision of care for patients with diabetes. Furthermore, those with uncontrolled diabetes are at a higher risk for complications due to COVID-19. The purpose of this study is to find an innovative method to sustain effective diabetes care services amidst the COVID-19 pandemic. METHODS Outpatient diabetes care was successfully transformed from traditional face-to-face encounters in the clinic to an online telemedicine service. RESULTS 1,972 patients were encountered over a 4-week study period during which we had a low proportion of unreached patients (4%). Some patients were still seen in person because they came as walk-in visits or insisted to be seen in person. CONCLUSION Telemedicine has become an essential healthcare service and could be augmented by the use of technology like web-based applications and communication via transfer of data from patients' glucometer, insulin pumps, or sensors. Diabetes care can be transitioned to telemedicine effectively and would be successful in reaching more patients than by traditional face-to-face visits. This model of care is time consuming and unfortunately does not reduce the need for medical staff.
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Affiliation(s)
- Dalal Alromaihi
- King Hamad University Hospital, Bahrain; Royal College of Surgeons in Ireland - Medical University of Bahrain, Bahrain; Bahrain Diabetes Society, Bahrain.
| | - Naji Alamuddin
- King Hamad University Hospital, Bahrain; Royal College of Surgeons in Ireland - Medical University of Bahrain, Bahrain; Bahrain Diabetes Society, Bahrain
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31
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Etingen B, Patrianakos J, Wirth M, Hogan TP, Smith BM, Tarlov E, Stroupe KT, Kartje R, Weaver FM. TeleWound Practice Within the Veterans Health Administration: Protocol for a Mixed Methods Program Evaluation. JMIR Res Protoc 2020; 9:e20139. [PMID: 32706742 PMCID: PMC7399961 DOI: 10.2196/20139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic wounds, such as pressure injuries and diabetic foot ulcers, are a significant predictor of mortality. Veterans who reside in rural areas often have difficulty accessing care for their wounds. TeleWound Practice (TWP), a coordinated effort to incorporate telehealth into the provision of specialty care for patients with skin wounds, has the potential to increase access to wound care by allowing veterans to receive this care at nearby outpatient clinics or in their homes. The Veterans Health Administration (VA) is championing the rollout of the TWP, starting with regional implementation. OBJECTIVE This paper aims to describe the protocol for a mixed-methods program evaluation to assess the implementation and outcomes of TWP in VA. METHODS We are conducting a mixed-methods evaluation of 4 VA medical centers and their community-based outpatient clinics that are participating in the initial implementation of the TWP. Data will be collected from veterans, VA health care team members, and other key stakeholders (eg, clinical leadership). We will use qualitative methods (ie, semistructured interviews), site visits, and quantitative methods (ie, surveys, national VA administrative databases) to assess the process and reach of TWP implementation and its impact on veterans' clinical outcomes and travel burdens and costs. RESULTS This program evaluation was funded in October 2019 as a Partnered Evaluation Initiative by the US Department of Veterans Affairs, Diffusion of Excellence Office, and Office of Research and Development, Health Services Research and Development Service, Quality Enhancement Research Initiative Program (PEC 19-310). CONCLUSIONS Evaluation of the TWP will identify barriers and solutions to TeleWound implementation in a small number of sites that can be used to inform successful rollout of the TWP nationally. Our evaluation work will inform future efforts to scale up the TWP across VA and optimize reach of the program to veterans across the nation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/20139.
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Affiliation(s)
- Bella Etingen
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | - Jamie Patrianakos
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | - Marissa Wirth
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Bridget M Smith
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States.,Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Elizabeth Tarlov
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States.,College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
| | - Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States.,Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States
| | - Rebecca Kartje
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Administration Hospital, Hines, IL, United States.,Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States
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32
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Schulz T, Long K, Kanhutu K, Bayrak I, Johnson D, Fazio T. Telehealth during the coronavirus disease 2019 pandemic: Rapid expansion of telehealth outpatient use during a pandemic is possible if the programme is previously established. J Telemed Telecare 2020; 28:445-451. [PMID: 32686556 PMCID: PMC9124640 DOI: 10.1177/1357633x20942045] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the health-care system both in Australia and internationally, and has rapidly transformed the delivery of health care in hospitals and the community. Implementation of social isolation and distancing measures to stop the spread of the disease and to reduce potential harm to patients has necessitated the use of alternate models of health-care delivery. Changes that would normally take months or years have occurred within days to weeks. Methods We conducted analysis of outpatient clinic data during the period of the pandemic and compared this to previous telehealth use. We also present the results of clinician and patient telehealth experience surveys. Results We describe a 2255% increase in the use of telehealth at a tertiary hospital within a period of six weeks, and a significant simultaneous reduction in the outpatient clinic failure-to-attend rate. The vast majority of patients and clinicians agreed that the standard of care provided by telehealth was the same as that provided by on-site appointments. Discussion Telehealth that previously had only limited utilisation has now become a main method for the delivery of outpatient care. Clinicians and patients agreed that consultations provided by telehealth were of the same standard as those provided on site. Health care in the post-pandemic period should embed the use of telehealth for outpatient care and consider the range of other clinical contexts where this can be utilised.
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Affiliation(s)
- Thomas Schulz
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Australia.,University of Melbourne, Department of Medicine, Australia.,Royal Melbourne Hospital, Australia
| | | | - Kudzai Kanhutu
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Australia.,University of Melbourne, Department of Medicine, Australia.,Royal Melbourne Hospital, Australia
| | | | - Douglas Johnson
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Australia.,University of Melbourne, Department of Medicine, Australia.,Royal Melbourne Hospital, Australia
| | - Timothy Fazio
- University of Melbourne, Department of Medicine, Australia.,Royal Melbourne Hospital, Australia
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Chen L, Cheng L, Gao W, Chen D, Wang C, Ran X. Telemedicine in Chronic Wound Management: Systematic Review And Meta-Analysis. JMIR Mhealth Uhealth 2020; 8:e15574. [PMID: 32584259 PMCID: PMC7381084 DOI: 10.2196/15574] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/28/2019] [Accepted: 05/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Chronic wounds have been a great burden to patients and the health care system. The popularity of the internet and smart devices, such as mobile phones and tablets, has made it possible to adopt telemedicine (TM) to improve the management of chronic wounds. However, studies conducted by different researchers have reported contradictory results on the effect of TM on chronic wound management. OBJECTIVE The aim of this work was to evaluate the efficacy and safety of TM in chronic wound management. METHODS We systematically searched multiple electronic databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]) to identify eligible studies published from inception to June 12, 2019. Inclusion criteria were randomized controlled trials (RCTs) and interventional cohort studies that investigated the use of TM in chronic wound management. RCT and observational data were analyzed separately. A meta-analysis and qualitative analysis were conducted to estimate endpoints. RESULTS A total of 6 RCTs and 6 cohort studies including 3913 patients were included. Of these, 4 studies used tablets or mobile phones programmed with apps, such as Skype and specialized interactive systems, whereas the remaining 8 studies used email, telephone, and videoconferencing to facilitate the implementation of TM using a specialized system. Efficacy outcomes in RCTs showed no significant differences in wound healing (hazard ratio [HR] 1.16, 95% CI 0.96-1.39; P=.13), and wound healing around 1 year (risk ratio [RR] 1.05, 95% CI 0.89-1.23; P=.15). Noninferiority criteria of TM were met. A decreased risk of amputation in patients receiving TM was revealed (RR 0.45, 95% CI 0.29-0.71; P=.001). The result of cohort studies showed that TM was more effective than standard care (HR 1.74, 95% CI 1.43-2.12; P<.001), whereas the outcome efficacy RR of wound healing around 1 year (RR 1.21, 95% CI 0.96-1.53; P=.56) and 3 months (RR 1.24, 95% CI 0.47-3.3; P=.67) was not significantly different between TM and standard care. Noninferiority criteria of TM were met for wound healing around 1 year in cohort studies. CONCLUSIONS Currently available evidence suggests that TM seems to have similar efficacy and safety, and met noninferiority criteria with conventional standard care of chronic wounds. Large-scale, well-designed RCTs are warranted.
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Affiliation(s)
- Lihong Chen
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Lihui Cheng
- Department of Clinical Laboratory, Nuclear Industry 416 Hospital, the 2nd Affiliated Hospital of Chengdu Medical College, Chengdu, China.,School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Wei Gao
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Dawei Chen
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Chun Wang
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Xingwu Ran
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
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Scientific and Clinical Abstracts From WOCNext 2020 Reimagined. J Wound Ostomy Continence Nurs 2020. [DOI: 10.1097/won.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hazenberg CEVB, aan de Stegge WB, Van Baal SG, Moll FL, Bus SA. Telehealth and telemedicine applications for the diabetic foot: A systematic review. Diabetes Metab Res Rev 2020; 36:e3247. [PMID: 31808288 PMCID: PMC7079242 DOI: 10.1002/dmrr.3247] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/13/2019] [Accepted: 11/17/2019] [Indexed: 01/15/2023]
Abstract
The aim of this systematic review is to assess the peer-reviewed literature on the psychometric properties, feasibility, effectiveness, costs, and current limitations of using telehealth and telemedicine approaches for prevention and management of diabetic foot disease. MEDLINE/PubMed was searched for peer-reviewed studies on telehealth and telemedicine approaches for assessing, monitoring, preventing, or treating diabetic foot disease. Four modalities were formulated: dermal thermography, hyperspectral imaging, digital photographic imaging, and audio/video/online communication. Outcome measures were: validity, reliability, feasibility, effectiveness, and costs. Sixty-one studies were eligible for analysis. Three randomized controlled trials showed that handheld infrared dermal thermography as home-monitoring tool is effective in reducing ulcer recurrence risk, while one small trial showed no effect. Hyperspectral imaging has been tested in clinical settings to assess and monitor foot disease and conflicting results on its diagnostic use show that this method is still in an experimental stage. Digital photography is used to assess and monitor foot ulcers and pre-ulcerative lesions and was found to be a valid, reliable, and feasible method for telehealth purposes. Audio/video/online communication is mainly used for foot ulcer monitoring. Two randomized controlled trials show similar healing efficacy compared with regular outpatient clinic visits, but no benefit in costs. In conclusion, several technologies with good psychometric properties are available that may be of benefit in helping to assess, monitor, prevent, or treat diabetic foot disease, but in most cases, feasibility, effectiveness, and cost savings still need to be demonstrated to become accepted and used modalities in diabetic foot care.
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Affiliation(s)
| | - Wouter B. aan de Stegge
- Department of SurgeryHospital Group TwenteAlmelo/HengeloThe Netherlands
- Department of Rehabilitation MedicineAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Sjef G. Van Baal
- ZGT AcademyHospital Group TwenteAlmelo/HengeloThe Netherlands
- Cardiff UniversityCardiffWalesUK
| | - Frans L. Moll
- Department of Vascular SurgeryUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Sicco A. Bus
- Department of SurgeryHospital Group TwenteAlmelo/HengeloThe Netherlands
- Department of Rehabilitation MedicineAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
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Liu Z, Ng M, Gunasekeran DV, Li H, Ponampalam K, Ponampalam R. Mobile technology: Usage and perspective of patients and caregivers presenting to a tertiary care emergency department. World J Emerg Med 2020; 11:5-11. [PMID: 31892997 DOI: 10.5847/wjem.j.1920-8642.2020.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Developments in information technology (IT) have driven a push in healthcare innovation in the emergency department (ED). Many of these applications rely on mobile technology (MT) such as smartphones but not everyone is comfortable with MT usage. Our study aims to characterize the technology usage behavior of users in the ED so as to guide the implementation of IT interventions in the ED. METHODS A cross-sectional survey was conducted in the emergency department of a tertiary hospital. Patients and their caregivers aged 21 and above were recruited. The survey collected demographic information, technology usage patterns, and participant reported comfort level in the usage of MT. We performed descriptive statistics and multivariate logistic regression to identify factors differentially associated with comfort in usage of MT. RESULTS A total of 498 participants were recruited, and 299 (60%) were patients. English was the most commonly written and read language (66.9%) and 64.2% reported a comfort level of 3/5 or more in using MT. Factors that were associated with being comfortable in using MT include having a tertiary education, being able to read and write English, as well as being a frequent user of IT. Caregivers were more likely to display these characteristics. CONCLUSION A large proportion of ED patients are not comfortable in the usage of MT. Factors that predicted comfort level in the usage of MT were common amongst caregivers. Future interventions should take this into consideration in the design of MT interventions.
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Affiliation(s)
- Zhenghong Liu
- SingHealth Emergency Medicine Residency Programme, Singapore Health Services, Singapore
| | - Mingwei Ng
- SingHealth Emergency Medicine Residency Programme, Singapore Health Services, Singapore
| | | | - Huihua Li
- Health Services Research Unit, Singapore General Hospital, Singapore
| | | | - R Ponampalam
- Department of Emergency Medicine, Singapore General Hospital, Singapore
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Hrynyschyn R, Dockweiler C, Iltner J, Hornberg C. [Teleconsultation for vascular- and diabetes-associated chronic wounds : A systematic review of health-related and economic implications]. Hautarzt 2019; 71:114-123. [PMID: 31659390 DOI: 10.1007/s00105-019-04498-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND In addition to lowering the quality of life of those affected, long periods of treatment and high recurrence rates of chronic wounds cause major economic costs for health care systems. Furthermore, inadequate health care and undersupply of care can be observed in Germany. Thus, new forms of care such as teleconsultation are being discussed increasingly. Recent changes in the remuneration system and macerations in the ban of remote treatment support those trends. METHODS A systematic review was conducted in July 2018 using PubMed and CENTRAL databases for randomized controlled trials between 2008 and 2018. Only randomized clinical trials in which patients with chronic wound who received treatment and follow-up by teleconsultation using information and communication technology to share data were included. In total, 6 international clinical trials were identified. RESULTS Regarding the current state of research, there is no definite evidence that teleconsultation can improve the care of chronic wound patients. Most likely, wound healing time was positively influenced. No correlation was found between mortality and hospitalizations when teleconsultation was used. CONCLUSION On the basis of the included studies, the evidence for the care of chronic wounds by teleconsultation is unclear. Further research is needed to examine the health-related and economic benefits of teleconsultation to support integration into health care systems.
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Affiliation(s)
- Robert Hrynyschyn
- Centre for ePublic Health Research, Universität Bielefeld, Universitätsstr. 25, 33615, Bielefeld, Deutschland.
| | - Christoph Dockweiler
- Centre for ePublic Health Research, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| | - Jessica Iltner
- Centre for ePublic Health Research, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| | - Claudia Hornberg
- Medizinische Fakultät, Universität Bielefeld, Bielefeld, Deutschland
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Gamus A, Chodick G. Costs and Benefits of Telemedicine Compared to Face-to-Face Treatment in Patients with Lower Extremity Ulcers. Adv Wound Care (New Rochelle) 2019; 8:291-297. [PMID: 31737419 DOI: 10.1089/wound.2018.0906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 12/18/2018] [Indexed: 12/28/2022] Open
Abstract
Objective: Telemedicine (TM) is an evolving method in lower extremity ulcer (LEU) treatment. Previous studies have demonstrated TM as comparable to the same-room care in clinical outcomes measures. Conversely, economic assessments of TM initiative were scarce and inconsistent. This study aims to analyze the costs and benefits of TM in LEU treatment and to propose a TM implementation decision-scoring model. Approach: This cost minimization analysis was performed at Maccabi Healthcare Services (Israel) during January 1, 2013-June 31, 2017 period. The study was based on cost difference assessment. A decision-scoring model for TM implementation was constructed. Results: The cost per patient in TM modality, compared to the same-room care, was 7% higher; however, in a proportion similar to same-room care, the cost of TM was lower. The TM implementation decision score was 0.236, while the weight of the direct cost factors is 0.70. Face-to-face only model, compared to the study sample, demonstrated 30% higher costs. Innovation: The study brings new evidence to an LEU treatment domain with little previous research. Also, a TM decision implementation scoring model has been provided. Conclusions: The decision support model may be instrumental in the TM implementation process.
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Affiliation(s)
- Alexander Gamus
- Maccabi Healthcare Services, Tel Aviv, Israel
- Epidemiology Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv. Israel
| | - Gabriel Chodick
- Maccabi Healthcare Services, Tel Aviv, Israel
- Epidemiology Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv. Israel
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Synchronous video telemedicine in lower extremities ulcers treatment: A real-world data study. Int J Med Inform 2019; 124:31-36. [DOI: 10.1016/j.ijmedinf.2019.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/30/2018] [Accepted: 01/14/2019] [Indexed: 01/15/2023]
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40
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Lee JK, Hung CS, Huang CC, Chen YH, Chuang PY, Yu JY, Ho YL. Use of the CHA2DS2-VASc Score for Risk Stratification of Hospital Admissions Among Patients With Cardiovascular Diseases Receiving a Fourth-Generation Synchronous Telehealth Program: Retrospective Cohort Study. J Med Internet Res 2019; 21:e12790. [PMID: 30702437 PMCID: PMC6374726 DOI: 10.2196/12790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/08/2019] [Accepted: 01/13/2019] [Indexed: 01/15/2023] Open
Abstract
Background Telehealth programs are generally diverse in approaching patients, from traditional telephone calling and texting message and to the latest fourth-generation synchronous program. The predefined outcomes are also different, including hypertension control, lipid lowering, cardiovascular outcomes, and mortality. In previous studies, the telehealth program showed both positive and negative results, providing mixed and confusing clinical outcomes. A comprehensive and integrated approach is needed to determine which patients benefit from the program in order to improve clinical outcomes. Objective The CHA2DS2-VASc (congestive heart failure, hypertension, age >75 years [doubled], type 2 diabetes mellitus, previous stroke, transient ischemic attack or thromboembolism [doubled], vascular disease, age of 65-75 years, and sex) score has been widely used for the prediction of stroke in patients with atrial fibrillation. This study investigated the CHA2DS2-VASc score to stratify patients with cardiovascular diseases receiving a fourth-generation synchronous telehealth program. Methods This was a retrospective cohort study. We recruited patients with cardiovascular disease who received the fourth-generation synchronous telehealth program at the National Taiwan University Hospital between October 2012 and June 2015. We enrolled 431 patients who had joined a telehealth program and compared them to 1549 control patients. Risk of cardiovascular hospitalization was estimated with Kaplan-Meier curves. The CHA2DS2-VASc score was used as the composite parameter to stratify the severity of patients’ conditions. The association between baseline characteristics and clinical outcomes was assessed via the Cox proportional hazard model. Results The mean follow-up duration was 886.1 (SD 531.0) days in patients receiving the fourth-generation synchronous telehealth program and 707.1 (SD 431.4) days in the control group (P<.001). The telehealth group had more comorbidities at baseline than the control group. Higher CHA2DS2-VASc scores (≥4) were associated with a lower estimated rate of remaining free from cardiovascular hospitalization (46.5% vs 54.8%, log-rank P=.003). Patients with CHA2DS2-VASc scores ≥4 receiving the telehealth program were less likely to be admitted for cardiovascular disease than patients not receiving the program. (61.5% vs 41.8%, log-rank P=.01). The telehealth program remained a significant prognostic factor after multivariable Cox analysis in patients with CHA2DS2-VASc scores ≥4 (hazard ratio=0.36 [CI 0.22-0.62], P<.001) Conclusions A higher CHA2DS2-VASc score was associated with a higher risk of cardiovascular admissions. Patients accepting the fourth-generation telehealth program with CHA2DS2-VASc scores ≥4 benefit most by remaining free from cardiovascular hospitalization.
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Affiliation(s)
- Jen-Kuang Lee
- Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.,Department of Laboratory Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Chi-Sheng Hung
- Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Ching-Chang Huang
- Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Ying-Hsien Chen
- Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Pao-Yu Chuang
- Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiun-Yu Yu
- Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Business Administration, College of Management, National Taiwan University, Taipei, Taiwan
| | - Yi-Lwun Ho
- Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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