Patient Satisfaction of Telemedicine in Pediatric and Young Adult Type 1 Diabetes Patients During Covid-19 Pandemic

Sustainable development goals: a call for future internal medicine

2030 Agenda Sustainable Development Goals (SDGs) achievement is the main challenge in order to design a sustainable future society. SDG 3 ensure healthy lives and promote well-being for all at all ages, focusing on prevention and treatment of communicable diseases (CDs) and non-communicable diseases (NCDs). Moreover, access to care, affordable drugs, and vaccines is crucial to improve quality of life leaving no one behind. Internal medicine can answer to the United Nations (UN) universal call by taking action both on infectious disease burden and on NCDs challenge, enabling prevention strategies and treatments, providing new drugs and ensuring accessible care for all. Furthermore, thanks to internist holistic and patient-centered approach, together with a multidisciplinary strategy, misallocation of economic and human resources, and medical errors due to healthcare fragmentation could be avoided. Nonetheless, a syndemic approach taking into account economic, social, and environmental dimensions of health will become fundamental for healthcare systems design. In this framework, internal medicine will be crucial giving a comprehensive patient-centered perspective, coordinating multidisciplinary team interventions, and contributing to sustainable healthcare systems.

Graphical abstract

Prevalence of major global causes of death by groups in 2021 according to Wolrd Health Organization World Health Statistics 2024 [12]; Internal Medicine characteristics; Internal Medicine-related SDGs summary; Future challenges for Internal Medicine

Young Adults with Type 1 Diabetes' Clinical Outcomes and Satisfaction Related to the Use of Videoconferencing for Type 1 Diabetes Healthcare: A Narrative Review

INTRODUCTION

Young adulthood is well documented as being a particularly challenging area of type 1 diabetes (T1D) healthcare. Many young adults with T1D (YAT1D) are distracted from effective disease self-management; T1D healthcare service engagement can be problematic and inconsistent, and high rates of unplanned healthcare contacts prevail. Video conferencing use can facilitate services to be flexible and responsive. We aimed to evaluate clinical outcomes and satisfaction related to the use of videoconferencing for T1D healthcare in YAT1D.

METHODS

A quantitative narrative review was undertaken, using a systematic process. PubMed, Scopus and CINAHL were searched (until August 2023) to identify relevant articles, using Medical Subject Headings and keywords. A total of 12 records (eight studies) from four countries were retrieved.

RESULTS

Ten records considered clinical outcomes; eight of these records focused on the effectiveness of videoconferencing as part of routine care. Findings largely demonstrate benefits to glycaemic control, particularly when used during the COVID-19 pandemic; no data were available relating to the impact of videoconferencing use on blood pressure and lipid control in YAT1D. Four records considered satisfaction with use of videoconferencing, with data indicating YAT1D were satisfied with the use of videoconferencing technology.

CONCLUSIONS

There is a need to configure T1D healthcare services to incorporate and offer use of videoconferencing technology, where applicable, appropriate and acceptable for YAT1D, and feasible and workable for service providers. This will require some adjustments from healthcare systems and possible changes to funding mechanisms.

The impact of telemedicine on pediatric type 1 diabetes management: benefits, challenges, and future directions

Telemedicine (TM) has emerged as a valuable tool in managing pediatric type 1 diabetes (T1D), particularly during the COVID-19 pandemic when traditional in-person visits were limited. This narrative review examines the impact of TM on patient-provider relationships, glycemic control, and overall diabetes management in children and adolescents with T1D. Studies consistently demonstrate high levels of patient and provider satisfaction with TM, citing increased consultation frequency, reduced travel burdens, and lower associated costs. However, results regarding the effect of TM on glycemic control, as measured by HbA1c levels, are inconsistent. Some studies show significant reductions in HbA1c levels with TM use, while others report outcomes comparable to or less effective than traditional care. The effectiveness of TM also appears to be influenced by the concurrent use of advanced diabetes technologies, such as continuous glucose monitors and automated insulin delivery systems. Furthermore, TM's impact on quality of life and other clinical outcomes beyond glucose management remains underexplored. Methodological limitations, including inconsistent randomization strategies and lack of long-term follow-up, hinder definitive conclusions. Despite these uncertainties, TM offers several advantages, such as improved accessibility and patient engagement, which may justify its broader implementation. Future research should focus on optimizing TM approaches to enhance glycemic control and quality of life, identifying the most effective strategies for specific patient groups, and addressing technological and economic barriers. This review highlights the need for comprehensive, long-term studies to fully understand TM's potential in pediatric T1D management and its integration into standard care practices.

Exploring Therapeutic Relational Connection in Virtual Healthcare: Insights From Nurse Practitioner Practice With Young Adults Living With Chronic Illness

AIM

To identify the essential characteristics of therapeutic relational connection (TRC) as viewed by nurse practitioners (NPs) in the practice of their virtual visits caring for young adults living with chronic illness.

DESIGN

This is a qualitative descriptive study of data obtained from open-ended items on an online questionnaire.

METHODS

The sample was recruited through an electronic listserv sent by the National Association of Pediatric Nurse Practitioners (NAPNAP) to access a national sample. Study data were collected and managed using REDCap electronic data capture tools. Data analysis was conducted through open and axial coding towards grounded theory. The 'towards grounded theory' approach adapts and evolves grounded theory principles to incorporate broader perspectives, enhancing flexibility and contextual sensitivity in the co-construction of knowledge between researcher and participants. TRC was the central phenomenon.

RESULTS

Four themes emerged from the data including Characteristics of TRC, Behavioural Manifestations, Potential Outcomes and Environment.

CONCLUSION

The transfer of skills from in-person clinic visits to the virtual setting is not synonymous. As virtual visits continue to be implemented as a mode to provide quality healthcare, identification of best practises for establishing an intentional use of TRC during virtual visits may be an essential component in the patient-provider relationship. Educational interventions can be designed to train providers to identify their current practices and ways in which they might adapt their in-person approach to the virtual visit.

IMPACT

Identifying essential elements of TRC in virtual visits may achieve improved outcomes as an emergent healthcare delivery model for young adults with chronic illness.

PATIENT CONTRIBUTION

No patient or public contribution. Patient or public contribution was not indicated in this study as the aim was to identify the characteristics of TRC from NPs.

Telemedicine for Managing Type 1 Diabetes in Children and Adolescents Before and After the COVID-19 Pandemic

The COVID-19 pandemic has catalyzed the rapid expansion of telemedicine for managing chronic conditions such as type 1 diabetes (T1D) in children and adolescents. This narrative review aims to explore the role of telemedicine in pediatric T1D management by comparing its use before and after the pandemic. We conducted a comprehensive literature review covering studies published between 2000 and 2024, focusing on telemedicine applications in pediatric T1D care. The review includes clinical trials, systematic reviews, and observational studies examining telemedicine's impact on glycemic control, patient satisfaction, and healthcare delivery. Results reveal that telemedicine has enhanced access to care, improved glycated hemoglobin (HbA1c) levels, and reduced diabetic ketoacidosis and hypoglycemic events. Patients and caregivers expressed high satisfaction, especially when using continuous glucose monitoring and insulin pump technologies integrated with telemedicine platforms. However, challenges such as digital literacy gaps, variability in healthcare provider training, and logistical issues like reimbursement policies persist. The pandemic highlighted the potential of telemedicine to supplement traditional in-person care, showing promise in enhancing patient outcomes and reducing healthcare burdens. Further research is needed to optimize telemedicine models for T1D, addressing barriers to implementation and exploring its long-term cost-effectiveness. This review underscores telemedicine's evolving role as a complementary approach in managing pediatric T1D, advocating for the development of standardized care protocols to fully integrate digital health solutions into routine clinical practice.

Impact of Telemedicine Versus In-Person Pediatric Outpatient Type 1 Diabetes Visits on Immediate Glycemic Control: Retrospective Chart Review

BACKGROUND

Children and adolescents with type 1 diabetes require frequent outpatient evaluation to assess glucose trends, modify insulin doses, and screen for comorbidities. Continuous glucose monitoring (CGM) provides a detailed glycemic control assessment. Telemedicine has been increasingly used since the COVID-19 pandemic.

OBJECTIVE

To investigate CGM profile parameter improvement immediately following pediatric outpatient diabetes visits and determine if visit modality impacted these metrics, completion of screening laboratory tests, or diabetic emergency occurrence.

METHODS

A dual-center retrospective review of medical records assessed the CGM metrics time in range and glucose management indicator for pediatric outpatient diabetes visits during 2021. Baseline values were compared with those at 2 and 4 weeks post visit. Rates of completion of screening laboratory tests and diabetic emergencies following visits were determined.

RESULTS

A total of 269 outpatient visits (41.2% telemedicine) were included. Mean time in range increased by 1.63% and 1.35% at 2 and 4 weeks post visit (P=.003 and .01, respectively). Mean glucose management indicator decreased by 0.07% and 0.06% at 2 and 4 weeks post visit (P=.003 and .02, respectively). These improvements in time in range and glucose management indicator were seen across both telemedicine visits and in-person visits without a significant difference. However, patients seen in person were 2.69 times more likely to complete screening laboratory tests (P=.03). Diabetic emergencies occurred too infrequently to analyze.

CONCLUSIONS

Our findings demonstrate an immediate improvement in CGM metrics following outpatient visits, regardless of modality. While statistically significant, the magnitude of these changes was small; hence, multiple visits over time would be required to achieve clinically relevant improvement. However, completion of screening laboratory tests was found to be more likely after visits occurring in person. Therefore, we suggest a hybrid approach that allows patient convenience with telemedicine but also incorporates periodic in-person assessment.

Loss to Follow-Up: Patients with Type 1 Diabetes During the SARS-CoV-2 Pandemic

The SARS-CoV-2 (severe acute respiratory syndrome related coronavirus 2) pandemic revealed many flaws in our health care system. This review aims to explore the significance of loss to follow-up on patients with type 1 diabetes during the pandemic, the morbidity and mortality associated, and strategies to prevent loss to follow-up or to re-engage patients in longitudinal care. [Pediatr Ann. 2024;53(7):e254-e257.].

Pharmacist perceptions of delivering patient care through telehealth

PURPOSE

To evaluate pharmacists' perceptions of the benefits of and barriers to telehealth as experienced in actual telehealth visits with patients.

METHODS

This qualitative study used virtual focus groups and a validated questionnaire (the Health Optimum Telemedicine Acceptance [HOTA] survey) to assess telehealth facilitators and barriers. Participants were included if they were licensed pharmacists utilizing telehealth in the outpatient setting. Pharmacist focus group responses were transcribed and analyzed using Miles and Huberman's qualitative data analysis model.

RESULTS

Six pharmacists participated in this study. Their responses were placed into 2 categories: clinical effectiveness and patient experience. All participants had performed at least 20 virtual visits, and all agreed that telehealth improved patients' health status. Respondents agreed that telehealth results in more frequent patient interactions and allows for provision of multiple types of care virtually. However, technological difficulties and the inability to provide physical examinations and obtain laboratory values were identified limitations. The surveyed pharmacists agreed that the main benefit that patients gained from telehealth was the elimination of transportation concerns, allowing increased access to care. However, pharmacists voiced their concern for patient privacy and barriers to educating patients on proper use of medical devices.

CONCLUSION

Pharmacists felt that telehealth was useful in several clinical scenarios. However, they also identified opportunities to improve its development in clinical practice. Further investigation must be done to better grasp impediments to telehealth in order to provide the most effective patient care.

Use of tele-nursing in primary care: A qualitative study on its negative and positive aspects

OBJECTIVE

To analyze the opinions of nursing professionals on the current limitations and future potential of digital tools in healthcare.

DESIGN

Qualitative and descriptive study.

LOCATION

The study took place during an asynchronous MOODLE course on the use of ICT in healthcare, specifically aimed at nursing professionals.

PARTICIPANTS

The number of nurses enrolled in the course was 150.

METHODS

A qualitative study was conducted focusing on the positive and negative aspects that telenursing can offer in the context of a Moodle training in new technologies for nurses. A thematic analysis was carried out following the method proposed by Braun and Clarke.

RESULTS

In the end 68 nurses participated in the forum. Their statements, opinions and perceptions were analyzed and 28 descriptive codes were obtained and subsequently categorized into positive and negative aspects.

CONCLUSIONS

Nurses positively value the usefulness of digital tools and identify a wide range of benefits of telenursing in daily practice. At the same time, they point out crucial limitations that may slow down the adoption of telenursing, pointing to areas for improvement such as training and digital literacy of both patients and professionals. They consider that telenursing can humanise care, but insist on the need to prevent its use from increasing health inequalities.

Child and caregiver voices about inpatient care: What do they report as positive and as needing improvement?

PURPOSE

In pediatric healthcare, patient satisfaction queries exclude children and solicit quantitative ratings from caregivers. We sought satisfaction perspectives from hospitalized children 7 to 17 years and their caregivers by qualitatively analyzing interview responses.

DESIGN AND METHODS

English and Spanish-speaking children and their parents on five inpatient units completed two open-ended questions about their satisfaction at hospital discharge (T1, face to face) and 7 to 10 days later (T2, telephone). The questions asked about what was good and what could be better at the hospital. Responses were analyzed using descriptive semantic content analysis and consensus coding methods.

RESULTS

Patients' mean age was 11.9 years (SD = 3.17); 51% were male. At T1, 362 patients offered 833 responses; 600 parents offered 1496 responses. At T2, 252 patients offered 552 responses; 488 parents offered 1290 responses. At T1 and T2, the most frequent patient response to what was good was 'Staff took good care of me' and for caregivers was 'Staff behaving professionally'. At T1, the most frequent patient response about what could be better was 'more activities for kids', and at T2, 'Nothing' and 'More food options and better food quality'; for caregivers at T1, 'Nothing' and 'Not liking the physical space', and at T2, 'Nothing', and 'More communication and professionalism from hospital staff'.

CONCLUSIONS

Pediatric patients and their caregivers are willing and able to offer perspectives about satisfaction with care, and suggestions for improvement before discharge.

PRACTICE IMPLICATIONS

Pediatric patients and their caregivers' perspectives about care yield actionable recommendations for hospital systems.

The development of evaluation scale of the patient satisfaction with telemedicine: a systematic review

BACKGROUND

Since the outbreak of the COVID-19 pandemic, telemedicine become more and more popular, patients attempt to use telemedicine to meet personal medical needs. Patient satisfaction is a key indicator of insight into the patient experience.

PURPOSE

This systematic review aims to explore the measurement factors of patient satisfaction with telemedicine and develop a more comprehensive and systematic scale of patient satisfaction with telemedicine.

METHODS

In February 2023, a literature search was conducted on the PubMed, EMBASE, and Web of Science, identifying measurement factors and tools of patient satisfaction with telemedicine. For inclusion, the studies had to have or make a questionnaire about patient satisfaction with telemedicine delivered through video/audio visits in English. The quality of the studies was evaluated according to the Critical Appraisal Tool for Analytical Cross-Sectional Studies of the Joanna Briggs Institute (JBI). The dimensions and items in each tool were also analyzed.

RESULTS

The initial search showed 14,020 studies. After eliminating duplicates and utilizing inclusion and exclusion criteria, 44 studies were included. This systematic review identified and integrated the measurement factors and develops a scale of patient satisfaction with telemedicine, which was divided into 9 dimensions and consists of 37 items.

CONCLUSION

Future measurement and evaluation of telemedicine will benefit from scale that was developed in this study, and it will more directly reflecting patient needs when patient satisfaction with telemedicine is evaluated.

Overcoming Barriers to Diabetes Management in Young Adults with Type 1 Diabetes by Leveraging Telehealth: A Pilot Study

OBJECTIVE

The LIFT-YA (leveraging intensive follow-up treatment in young adults) quality improvement program was developed to address clinical and social barriers in young adults (YA) with type 1 diabetes (T1D), using telehealth visits to promote clinic attendance and improve diabetes care.

METHODS

LIFT-YA enrolled YA aged 18-30 with T1D and HbA1c >8% (64 mmol/mol) who had established adult care in our diabetes clinic. The 6-month, 7-visit hybrid program was facilitated by a case manager serving as the liaison between participants and the care team. The primary end-points were within-group and between-group changes from the baseline in HbA1c at the last visit and adoption of continuous glucose monitoring (CGM).

RESULTS

Of the 57 eligible YA, 24 were enrolled and 33 were unable to participate (UTP). Thirteen of the enrolled participants attended at least 4/7 visits ("completers", C), whereas 11 were noncompleters (NC). HbA1c at the end of the program was significantly lower in the C versus UTP group [median -1.0; IQR (-0.6, -2.5) vs -0.25 (0.2, -1.0) in UTP; P < .05]. The percentage of CGM users significantly increased by 70% in the C group (P < .05), but did not change in the NC and UTP groups. Limited access to telehealth and the high cost of frequent visits were the main hurdles preventing enrollment into or completion of the program.

CONCLUSIONS

The LIFT-YA pathway was associated with a significant HbA1c reduction and an increase in the adoption of CGM. Policy changes are necessary to expand access to LIFT-YA and other programs for high-risk YA with T1D in underserved communities and across all backgrounds.

Management of Type 1 Diabetes in a school setting: effectiveness of an online training program for school staff

Background and aims

Since Type 1 Diabetes (T1D) onset usually occurs at a young age, a relevant number of affected people attend school for most of their time; it is necessary that school personnel receive appropriate education and training. We aimed to evaluate the effectiveness of the online training program offered by IRCCS Istituto Giannina Gaslini during and after COVID-19 pandemic.

Methods

The Institute's Diabetes team offered an online training program to school staff of the Region during COVID-19 pandemic. A validated questionnaire was proposed to all the schools in which training meetings were held in the previous 2 years (2020-2021 and 2021-2022). The questionnaire consisted of four sections: Section 1 (Socio-demographical data), Section 2 (Theoretical knowledge on T1D), Section 3 (Confidence in handling T1D), and Section 4 (Practical skills and Glucagon Administration). To evaluate the effectiveness of the online training program, the answers between participants (Group A) and non-participants (Group B) were then compared.

Results

225 subjects from 19 schools participated in the survey. People who participated to the training (Group A, n = 53) demonstrated better T1D theoretical knowledge compared to non-participants (Group B, n = 154; p < 0.001). Group A revealed to feel more confident in the management of children with T1D during scholastic (p = 0.006) and extra-scholastic activities (p = 0.01), in supporting the children in the administration of insulin (p < 0.001) and in recognizing hypoglycaemia (p = 0.006). Moreover, results confirmed good levels of confidence among scholastic personnel who participated in the training of administration of glucagon in case of severe hypoglycaemia.

Conclusion

School staff who took part in the online training program on management of T1D showed better theoretical knowledge and better confidence in the management of daily needs and possible emergencies of students with T1D. It appears essential to offer educational programs on T1D for school staff by implementing the use of technological tools to reach a wider population. Moreover, it is advisable to offer a more practical approach, involving educational nurses.

Perceptions of Patients, Caregivers, and Healthcare Professionals toward Telemedicine Use for Cognitive and Movement Disorders in the Aegean Islands, Greece: A Pilot Study of the SI4CARE European Project

BACKGROUND

Patients with neurodegenerative diseases who live in remote areas often have limited access to specialized healthcare, and telemedicine represents a useful solution. The aim of this study was to investigate the perceptions toward the use of a specialized-tertiary telemedicine service of patients with cognitive and movement disorders, caregivers, and local healthcare professionals (HPs) in the Aegean Islands.

METHODS

Data were derived from the "Specialized Outpatient Clinic of Memory, Dementia and Parkinson's disease through the National Telemedicine Network", March 2021-March 2023. The survey included 10 questions (5-point Likert scale).

RESULTS

We received 64 questionnaires (25 patients, 18 caregivers, 21 HPs). Most participants positively perceived all aspects of telemedicine, including comfort (mean ± standard deviation: patients 4.5 ± 0.9, caregivers: 4.8 ± 0.5, HPs: 4.6 ± 0.7), access to specialized care (4.7 ± 0.6, 4.7 ± 0.5, 4.9 ± 0.4), number of transportations (4.6 ± 0.8, 4.6 ± 0.9, 4.8 ± 0.5), adequacy of follow-up (4.6 ± 0.7, 4.4 ± 0.8, 4.2 ± 0.7), future telemedicine selection (4.8 ± 0.4, 4.8 ± 0.4, 4.6 ± 0.6), perceived reliable medical assessment (4.7 ± 0.5, 4.6 ± 0.6, 4.3 ± 0.6), information delivery (4.7 ± 0.6, 4.6 ± 0.5, 4.4 ± 0.9), health status improvement (4.6 ± 0.7, 4.6 ± 0.6, 4.0 ± 0.7), cost (4.6 ± 1, 4.6 ± 1, 5.0 ± 0.2), and general satisfaction (4.8 ± 0.4, 4.7 ± 0.5, 4.5 ± 0.6). The commonest recommendations were more frequent visits, medical specialties, and dissemination of information.

CONCLUSIONS

The positive perception of participants highlights the value of telemedicine for specialized healthcare for neurodegenerative disorders, especially in remote areas.

Advanced Hybrid Closed Loop users' satisfaction of telemedicine and telenursing in pediatric and young adult type 1 diabetes

Background and aims

The aim of the study was to evaluate the satisfaction of the use of telemedicine and telenursing in children and young adults with Type 1 Diabetes (T1D) using Advanced Hybrid Closed Loop systems (AHCL) with a focus on the role of connectivity, data download and the ease of technical steps in the set and sensor change procedures.

Methods

An online anonymous survey was administered to AHCL users. The questionnaire consisted of five Clusters: Cluster A-B-C included questions related to the general satisfaction in the use of telemedicine, Cluster D was focused on the role of data download and connectivity, Cluster E was related to satisfaction in telenursing and Cluster F to the perception of ease of execution of the technical steps like changing the infusion set and the sensor.

Results

We collected 136 completed questionnaires. 83.8% of AHCL users were overall satisfied with the quality of the telemedicine service. 88.2% of patients downloaded AHCL data before visits and the overall quality of televisits (data sharing, connectivity, ease of use) was satisfactory for 85.3% of users. Telenursing support during set and sensor change procedures was considered effective by 98% of AHCL users. The sensor and insulin infusion set change procedure is perceived as different for the two systems: set change simpler for Medtronic (p = 0.011) users, while sensor change was simpler for Tandem users (p = 0.009).

Conclusion

Telemedicine and telenursing have an essential role in diabetology and are highly appreciated in AHCL users. The nurse support in the education of the use of AHCL systems is effective and must be implemented. Unfortunately, not all patients have the technological tools needed for downloading data at home and using telemedicine services; this represents an important challenge for the future of diabetology and for the equity in accessibility to care.

Multiple influences of the COVID-19 pandemic on children with diabetes: Changes in epidemiology, metabolic control and medical care

The coronavirus disease 2019 (COVID-19) pandemic has heavily affected health worldwide, with the various forms of diabetes in children experiencing changes at various levels, including epidemiology, diabetic ketoacidosis rates and medical care. Type 1 diabetes showed an apparent increase in incidence, possibly owing to a direct damage of the virus to the β-cell. Diabetic ketoacidosis also increased in association with the general fear of referring patients to the hospital. Most children with diabetes (both type 1 and type 2) did not show a worsening in metabolic control during the first lockdown, possibly owing to a more controlled diet by their parents. Glucose sensor and hybrid closed loop pump technology proved to be effective in all patients with type 1 diabetes during the pandemic, especially because the downloading of data allowed for the practice of tele-medicine. Telemedicine has in fact grown around the world and National Health Systems have started to consider it as a routine activity in clinical practice. The present review encompasses all the aspects related to the effects of the pandemic on the different forms of diabetes in children.

Telehealth Use in Pediatric Care during the COVID-19 Pandemic: A Qualitative Study on the Perspectives of Caregivers

This qualitative study surveyed caregivers regarding their perspectives on the benefits of, challenges with, and suggestions for improving telehealth during the COVID-19 pandemic. Caregivers who had the responsibility for caring for at least one child aged under 18 years of age in Genesee County, MI, participated. The caregivers were biological parents, stepparents, foster parents, adoptive parents, and guardians. A total of 105 caregivers completed a survey with open-ended questions via Qualtrics. Two independent coders developed themes based on the responses using grounded theory. Participants were primarily biological parents and non-Hispanic White and African Americans. According to the participants, the benefits of telehealth included prevention of exposure to the COVID-19 virus, quality communication with physicians, savings in travel time, and cost-effective methods to receive care. The challenges included a lack of in-person interaction, fear of compromised confidentiality, and the potential for misdiagnosis. Suggestions for improvement by caregivers included increasing access to telehealth for poorer families, offering a media educational campaign to promote telehealth use, and creating a universal platform to share patient information. Future studies may test the effectiveness of interventions such as those suggested by caregivers in this study to improve telehealth.

Use of Telemedicine Healthcare Systems in Children and Adolescents with Chronic Disease or in Transition Stages of Life: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP) and of the Syndicate of Family Pediatrician Doctors (SIMPeF)

Telemedicine is considered an excellent tool to support the daily and traditional practice of the health profession, especially when referring to the care and management of chronic patients. In a panorama in which chronic pathologies with childhood onset are constantly increasing and the improvement of treatments has allowed survival for them into adulthood, telemedicine and remote assistance are today considered effective and convenient solutions both for the chronic patient, who thus receives personalized and timely assistance, and for the doctors, who reduce the need for direct intervention, hospitalizations and consequent management costs. This Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, has the objectives to propose an organizational model based on the relationships between the actors who participate in the provision of a telemedicine service aimed at minors with chronic pathologies, identifying specific project links between the areas of telemedicine in the developmental age from the first 1000 days of life to the age adult. The future scenario will have to be able to integrate digital innovation in order to offer the best care to patients and citizens. It will have to be able to provide the involvement of patients from the very beginning of the design of any care pathway, increasing where possible the proximity of the health service to citizens.

Satisfaction with pediatric telehealth according to the opinions of children and adolescents during the COVID-19 pandemic: A literature review

Objective

To review satisfaction with telehealth among children and adolescents based on their own opinions during the COVID-19 pandemic.

Methods

In the PubMed, CINAHL, PsycINFO, and Embase databases, we searched for peer-reviewed studies in English on satisfaction with telehealth among children and adolescents (rather than parents). Both observational studies and interventions were eligible. The review was categorized as a mini review because it focused on the limited time frame of the COVID-19 pandemic. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Reviewers extracted information from each study and assessed risk of bias.

Results

A total of 14 studies were eligible. Studies were conducted in Australia, Canada, Italy, Israel, Poland, South Korea, the United Kingdom, and the United States. They focused on a variety of health conditions. Two of the 14 studies were interventions. Participants expressed high satisfaction with video and telephone visits and home telemonitoring while also preferring a combination of in-person visits and telehealth services. Factors associated with higher satisfaction with telehealth included greater distance from the medical center, older age, and lower anxiety when using telehealth. In qualitative studies, preferred telehealth features among participants included: a stable Internet connection and anonymity and privacy during telehealth visits.

Conclusion

Telehealth services received favorable satisfaction ratings by children and adolescents. Randomized-controlled trials on the effectiveness of pediatric telehealth services compared to non-telehealth services may assess improvements in satisfaction and health outcomes.

Use of Telemedicine in Pediatric Services for 4 Representative Clinical Conditions: Scoping Review

BACKGROUND

Telemedicine is becoming routine in health care. Postpandemic, a universal return to face-to-face consultations may risk a loss of some of the advantages of telemedicine. However, rapid implementation and adoption without robust evaluation of usability, efficacy, and effectiveness could potentially lead to suboptimal health outcomes and downstream challenges to providers.

OBJECTIVE

This review assesses telemedicine interventions against international guidance and sufficiency of evidence to support postpandemic utilization in pediatric settings.

METHODS

This scoping review was performed following searches on PubMed, Embase, and CINAHL databases on April 15, 2021, and May 31, 2022, and examined studies focused on telemedicine, remote consultation, video call, or remote patient monitoring in children (0-18 years) receiving outpatient care for diabetes, asthma, epilepsy, or renal disease. Exclusion criteria included studies published before 2011 as the technologies used have likely been improved or replaced, studies in adult populations or where it was not possible to disaggregate data for participants younger than 18 years as the focus of the review was on pediatric care, and studies not published in English. Data were extracted by 4 authors, and the data were corroborated by a second reviewer. Studies were examined for feasibility and usability, clinical and process outcomes, and cost-effectiveness.

RESULTS

Of the 3158 studies identified, 56 were suitable for final inclusion and analysis. Data on feasibility or usability of interventions (48 studies) were overwhelmingly positive in support of telemedicine interventions, with common themes including convenience, perceived cost savings, and ease of use. However, use in preference to usual care was rarely explored. Clinical and process outcome data (31 studies) were mostly positive. Across all studies, there was limited measurement of standardized clinical outcomes, although these were more commonly reported in asthma (peak flow) and diabetes (glycated hemoglobin [HbA1c]). Implementation science data generally supported cost-effectiveness of telemedicine with a reduction of health care costs.

CONCLUSIONS

There is promising evidence supporting telemedicine in pediatric settings. However, there is a lack of evaluation of telemedicine in comparison with usual outpatient care for noninferiority of clinical outcomes, and this review highlights the need for a more standardized approach to evaluation of digital interventions.