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Aijaz M, Lewis VA, Murray GF. Advancing equity in challenging times: A qualitative study of telehealth expansion and changing patient-provider relationships in primary care settings during the COVID-19 pandemic. Digit Health 2024; 10:20552076241233148. [PMID: 38434791 PMCID: PMC10906055 DOI: 10.1177/20552076241233148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Objective The patient-provider relationship is critical for achieving high-quality care and better health outcomes. During the COVID-19 pandemic, primary care practices rapidly transitioned to telehealth. While telehealth provided critical access to services for many, not all patients could optimally utilize it, raising concerns about its potential to exacerbate inequities in patient-provider relationships. We investigated technical and workforce-related barriers to accessing telehealth and the impacts on patient-provider relationships for vulnerable populations. Methods Qualitative, semi-structured interviews from May 2021 to August 2021 with 31 individuals (medical directors, physicians, and medical assistants) working at 20 primary care practices in Massachusetts, North Carolina, and Texas. Thematic analysis to better understand how barriers to using telehealth complicated patient-provider relationships. Results Interviewees shared challenges for providers and patients that had a negative effect on patient-provider relationships, particularly for vulnerable patients, including older adults, lower socio-economic status patients, and those with limited English proficiency. Providers faced logistical challenges and disruptions in team-based care, reducing care coordination. Patients experienced technological challenges that made accessing and engaging in telehealth difficult. Interviewees shared challenges for patient-provider relationships as commonly used telephone-only telehealth reduced channels for non-verbal communication. Conclusion This study indicates that barriers to virtual interaction with patients compared to in-person care likely led to weaker personal relationships that may have longer-term effects on engagement with and trust in the healthcare system, particularly among vulnerable patient groups. Additional support and resources should be available to primary care providers to optimize telehealth utilization.
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Affiliation(s)
- Monisa Aijaz
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Valerie A Lewis
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Genevra F Murray
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
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2
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Shawwa L. The Use of Telemedicine in Medical Education and Patient Care. Cureus 2023; 15:e37766. [PMID: 37213963 PMCID: PMC10198592 DOI: 10.7759/cureus.37766] [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: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
The COVID-19 pandemic has accelerated and expanded the adoption of telemedicine globally. This allowed telemedicine to engage medical students in patient care and ensured continuity of care for vulnerable patients. In this review, the history of telemedicine and some of its applications in medical education were reviewed. Furthermore, we also shed light on how to incorporate telemedicine into several curricula and the strategies used to include it. The article also explored how to evaluate telemedicine and the major facilitators and barriers any medical and educational institution must address when using telemedicine. At the end of the review, we explored the future promises telemedicine has for medical education.
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Affiliation(s)
- Lana Shawwa
- Medical Education, King Abdul Aziz University, Jeddah, SAU
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Zou C, Harvard A, Qian J, Fox BI. A systematic review of digital health technologies for the care of older adults during COVID-19 pandemic. Digit Health 2023; 9:20552076231191050. [PMID: 37529545 PMCID: PMC10388634 DOI: 10.1177/20552076231191050] [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] [Received: 02/06/2023] [Accepted: 07/13/2023] [Indexed: 08/03/2023] Open
Abstract
Objective During the Coronavirus Disease 2019 (COVID-19) pandemic, digital health technologies (DHTs) became increasingly important, especially for older adults. The objective of this systematic review was to synthesize evidence on the rapid implementation and use of DHTs among older adults during the COVID-19 pandemic. Methods A structured, electronic search was conducted on 9 November 2021, and updated on 5 January 2023, among five databases to select DHT interventional studies conducted among older adults during the pandemic. The bias of studies was assessed using Version 2 of the Cochrane Risk-of-Bias Tool for randomized trials (RoB 2) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I). Results Among 20 articles included in the review, 14 (70%) focused on older adults with chronic diseases or symptoms, such as dementia or cognitive impairment, type 2 diabetes, and obesity. DHTs included traditional telehealth interventions via telephone, video, and social media, as well as emerging technologies such as Humanoid Robot and Laser acupuncture teletherapy. Using RoB 2 and ROBINS-I, four studies (20%) were evaluated as high or serious overall risk of bias. DHTs have shown to be effective, feasible, acceptable, and satisfactory for older adults during the COVID-19 pandemic compared to usual care. In addition, some studies also highlighted challenges with technology, hearing difficulties, and communication barriers within the vulnerable population. Conclusions During the COVID-19 pandemic, DHTs had the potential to improve various health outcomes and showed benefits for older adults' access to health care services.
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Affiliation(s)
- Chenyu Zou
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Abbey Harvard
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Brent I Fox
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
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4
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Tabaeeian RA, Hajrahimi B, Khoshfetrat A. A systematic review of telemedicine systems use barriers: primary health care providers' perspective. JOURNAL OF SCIENCE AND TECHNOLOGY POLICY MANAGEMENT 2022. [DOI: 10.1108/jstpm-07-2021-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose
The purpose of this review paper was identifying barriers to the use of telemedicine systems in primary health-care individual level among professionals.
Design/methodology/approach
This study used Scopus and PubMed databases for scientific records identification. A systematic review of the literature structured by PRISMA guidelines was conducted on 37 included papers published between 2009 and 2019. A qualitative approach was used to synthesize insights into using telemedicine by primary care professionals.
Findings
Three barriers were identified and classified: system quality, data quality and service quality barriers. System complexity in terms of usability, system unreliability, security and privacy concerns, lack of integration and inflexibility of systems-in-use are related to system quality. Data quality barriers are data inaccuracy, data timeliness issues, data conciseness concerns and lack of data uniqueness. Finally, service reliability concerns, lack of technical support and lack of user training have been categorized as service quality barriers.
Originality/value
This review identified and mapped emerging themes of barriers to the use of telemedicine systems. This paper also through a new conceptualization of telemedicine use from perspectives of the primary care professionals contributes to informatics literature and system usage practices.
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5
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Ma T, Zhang S, Zhu S, Ni J, Wu Q, Liu M. The new role of nursing in digital inclusion: Reflections on smartphone use and willingness to increase digital skills among Chinese older adults. Geriatr Nurs 2022; 48:118-126. [PMID: 36155310 DOI: 10.1016/j.gerinurse.2022.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study explores the willingness of older adults to use smartphones and improve their digital skills and encourages nursing to actively participate in bridging the digital divide. METHODS Subject analysis was used to conduct qualitative research, and 23 older adults were interviewed. RESULTS We identified four themes: (1) the current situation of smartphone use; (2) the digital dilemma of smartphone use; (3) social support for digital skills; and (4) the willingness to learn digital skills. Older adults in China are willing to accept and use smartphones for simple operations, and peer learning may be an effective way to improve their digital skills. CONCLUSION Community support is necessary to develop the digital skills of older adults with smartphones and reduce the digital divide to the greatest extent possible. Nursing may play a role in promoting digital inclusion for older adults.
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Affiliation(s)
- Tianjiao Ma
- School of Nursing, Jilin University, No. 965, Xinjiang Street, Chaoyang District, Changchun, Jilin 130012, People's Republic of China
| | - Siyu Zhang
- School of Journalism and Communication, Jilin University, No.2699, Qianjin Street, Chaoyang District, Changchun, Jilin 130012, People's Republic of China
| | - Siying Zhu
- School of Journalism and Communication, Jilin University, No.2699, Qianjin Street, Chaoyang District, Changchun, Jilin 130012, People's Republic of China
| | - Jingqi Ni
- School of Journalism and Communication, Jilin University, No.2699, Qianjin Street, Chaoyang District, Changchun, Jilin 130012, People's Republic of China
| | - Qiqi Wu
- School of Journalism and Communication, Jilin University, No.2699, Qianjin Street, Chaoyang District, Changchun, Jilin 130012, People's Republic of China
| | - Mingzheng Liu
- School of Journalism and Communication, Jilin University, No.2699, Qianjin Street, Chaoyang District, Changchun, Jilin 130012, People's Republic of China.
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Gao J, Fan C, Chen B, Fan Z, Li L, Wang L, Ma Q, He X, Zhai Y, Zhao J. Telemedicine Is Becoming an Increasingly Popular Way to Resolve the Unequal Distribution of Healthcare Resources: Evidence From China. Front Public Health 2022; 10:916303. [PMID: 35874991 PMCID: PMC9301261 DOI: 10.3389/fpubh.2022.916303] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Few studies focused on the general situation of telemedicine in China. Objectives The purpose of this review is to investigate telemedicine in China, from the aspects of necessity, history, scale, and operation procedure, to improve the further development and implementation of telemedicine service. Methods A literature search for peer-reviewed studies was conducted using the primary electronic databases. Additional documents from the official websites of Chinese government departments involved telemedicine was also collected. We extracted telemedicine related information focused on China from the final retrieved materials, and the general situation of telemedicine was drawn. Results In China, telemedicine offers a feasible solution to the unequal allocation of healthcare resources, which makes telemedicine increasingly become an important alternative to close the gap between rural and urban in the capability and quality of medical services. China initiated telemedicine in the late 1980s. In 2018, China's telemedicine network has covered more than 3,000 hospitals across the country. As of 2019, almost all of the 31 provinces and municipalities in mainland have established regional telemedicine centers, and the market size of telemedicine reached about USD 2.68 billion. Based on the telemedicine network, remote rural patients can apply for healthcare services of top-tier urban hospitals through local county-level medical institutions. Conclusions Through improving the capacity, quality, and efficiency of healthcare in underserved areas, and reducing the unequal distribution of medical resources, telemedicine can help solve the problems of the difficulty and high cost to access to medical services in China.
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Affiliation(s)
- Jinghong Gao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China.,Henan Province Telemedicine Center of China, National Telemedicine Center of China, Zhengzhou, China
| | - Chaolin Fan
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Baozhan Chen
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China.,Henan Province Telemedicine Center of China, National Telemedicine Center of China, Zhengzhou, China
| | - Zhaohan Fan
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China
| | - Lifeng Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China
| | - Linlin Wang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China.,Henan Province Telemedicine Center of China, National Telemedicine Center of China, Zhengzhou, China
| | - Qianqian Ma
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China.,Henan Province Telemedicine Center of China, National Telemedicine Center of China, Zhengzhou, China
| | - Xianying He
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China.,Henan Province Telemedicine Center of China, National Telemedicine Center of China, Zhengzhou, China
| | - Yunkai Zhai
- National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China.,Management Engineering School, Zhengzhou University, Zhengzhou, China
| | - Jie Zhao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China.,Henan Province Telemedicine Center of China, National Telemedicine Center of China, Zhengzhou, China
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7
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Schutz S, Walthall H, Snowball J, Vagner R, Fernandez N, Bartram E, Merriman C. Patient and clinician experiences of remote consultation during the SARS-CoV-2 pandemic: A service evaluation. Digit Health 2022; 8:20552076221115022. [PMID: 35959197 PMCID: PMC9358347 DOI: 10.1177/20552076221115022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/05/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives During the SARS-CoV-2 pandemic, clinicians were instructed to move all but
emergency consultations to remote means to reduce the spread of the virus.
The aim of this study was to evaluate patients’ and clinicians’ experiences
of moving to remote means of consultation with their health care
professionals during the SARS-CoV-2 pandemic. Methods The study design was a qualitative service evaluation. Twenty-six clinicians
and forty-eight patients who met the inclusion criteria consented to be
interviewed. Clinician participants were from either medical, nursing, or
allied health professional backgrounds. Patients were recruited from
diabetes, acute care, and haematology and cancer areas. Data analysis was
conducted using a thematic analysis framework. Results Following coding and thematic analysis of the data collected from clinicians,
five themes were identified: personal and professional well-being; providing
a safe and high-quality experience; adapting to a new way of working; making
remote consultations fit for purpose and an awareness of altered dynamics
during consultation. Patient data was coded into 3 themes: remote
consultation adds value; remote consultation brings challenges and concerns
about remote consultation. Conclusions Clinician and patient experiences reported here are reflected in the
literature. The study indicates that remote consultation is not suitable for
all patients and in all contexts. Whilst maintaining the benefits to
patients, remote means of consultation needs organisational support and
preparation. A way forward that maintains the benefits whilst addressing
concerns seems urgent.
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Affiliation(s)
- Sue Schutz
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Helen Walthall
- Nursing and Midwifery Research and Innovation, Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Joanna Snowball
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Raluca Vagner
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Nicola Fernandez
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Emilia Bartram
- Oxford University Hospitals NHS Foundation Trust and Oxford Biomedical Research Centre, Oxford, UK
| | - Clair Merriman
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
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