Telehealth and Medicine Today

Patient- and Family-Centered Video Rounds in the Pediatric Intensive Care Unit

2020-10-19T09:45:35-07:00

Objective: Management of the coronavirus disease 2019 (COVID-19) pandemic has required social distancing requirements and personal protective equipment shortages, which have forced hospitals to modify patient care rounds. We describe our process developing telemedicine rounds to maintain synchronous, multidisciplinary, pediatric intensive care unit rounds. By adapting available resources using rapid process improvement (PI), we were able to develop patient- and family-centered video rounds (PFCVR).

Design: When rounding team members were forced to work from home, we adapted an existing telemedicine platform (VidyoConnect) to perform PFCVR. A quality improvement (QI) team developed an initial standard process, which underwent rapid PI using a small multidisciplinary team.

Setting: A 21-bed, mixed medical/surgical/cardiac pediatric intensive care unit.

Participants: Critical care patients, families, physicians, consultants, nurses, and ancillary staff.

Interventions: The QI team initially met daily, then weekly, sought feedback from nurses, families, and other care providers, and utilized small tests of change to improve the rounding process.

Results: We established standardized, socially distanced rounds using VidyoConnect to allow synchronous, multidisciplinary PFCVR. Implementation of a schedule and rounding script facilitated efficient and effective team communication, optimized participation by the entire team, and decreased interruptions.

Conclusions: The COVID-19 pandemic compromised the feasibility of the previous rounding process. PFCVR is a safe and effective tool to facilitate communication while adhering to social distancing guidelines. Use of available platforms and team-based PI is critical for successful implementation.

Assessment of Knowledge, Perception, and Willingness of using Telemedicine among Medical and Allied Healthcare Students Studying in Private Institutions

2020-10-11T07:07:45-07:00

Introduction: Telemedicine is a developing technology in the Indian healthcare sector. The success of any new technology depends on factors such as knowledge, perception, and willingness of users and professionals to engage it. This study assessed the knowledge, perception, and willingness of healthcare students to use telemedicine.

Materials and methods: A cross-sectional survey was conducted among healthcare students from May 10, 2020 to June 30, 2020 in India. In this study, there were 428 individuals selected using Non-Probability Convenience Sampling and were approached through online Google Forms. The pretested study questionnaire that administered had four parts: demographic details, willingness, perception, and knowledge level. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25.

Results: Out of the total study population, 40% were male and 60% were female. Forty-three percentage of the total population reported insufficient knowledge of telemedicine, and 52.1% had insufficient knowledge about its application. However, 90.9% viewed telemedicine as a viable approach, and they were willing to use telemedicine and integrate it in their practice in future. It was determined that perception toward telemedicine influenced willingness for adopting in their careers.

Conclusion: Even though each participant’s knowledge and awareness were limited, the majority of individuals reported positive perception and willingness toward using the telemedicine in their career. Thus, it is essential to build proper and effective communication channels and awareness among students, professionals, and users for telemedicine to succeed in India.

Tele-Rehabilitation for Individuals with Multiple Sclerosis and Mobility Disorders—A Feasibility and Pilot Study

2020-10-02T15:14:24-07:00

Objective: To determine the feasibility of conducting an 8-week physical therapist (PT)-guided tele-rehabilitation (TR) program for persons with multiple sclerosis (MS) and mobility deficits.

Design, setting, and participants: This feasibility study had a pre–post-intervention, non-randomized design. Nine subjects with a confirmed diagnosis of MS without a clinical exacerbation in the last year were selected from the MS Center of Excellence at UF Health Jacksonville (UFHJ). Inclusion criteria included demonstrated mobility deficits on initial examination, basic computer competency, and a home with high-speed internet connection. Examinations were performed face-to-face, pre–post-intervention in the Neurology Research Clinic at UFHJ. TR was delivered to the patient’s homes in Florida and South Georgia.

Intervention: An informed consent was obtained prior to initial examination. Self-reported measures included quality of life (QOL) and fatigue. Mobility measures included timed 10-m walk, five times sit to stand, and Berg balance scale. Following inclusion, home safety was evaluated and computer equipment was installed. TR intervention utilized the Jintronix^® web-based platform system with a kinetic camera that demonstrated selected exercises by an avatar, allowing for real-time feedback on the quality of performance as well as tracking of adherence. The individualized exercises were assigned by the evaluating PT based on the initial assessment. Subjects participated in weekly TR visits with the prescribing PT to further monitor and adjust the therapy program.

Main outcome measures: Primary outcome measures were patient satisfaction, safety, and compliance. Secondary outcome measures were projected travel cost, self-reported fatigue and QOL, and mobility testing measures. To compare the TR effect on mobility, a comparator persons with MS group was selected retrospectively. Eight persons with MS referred from the MS Center at UFHJ for outpatient (OP) PT from January 2018 through September 2019 were identified by UFHJ electronic database search for ICD 10 code G35. The inclusion criteria for mobility deficits and functional measurements were the same as those in TR group.

Results: Eight subjects completed the TR program with no adverse events. They reported satisfaction, demonstrated compliance, and saved $8,487 in projected travel costs. All TR subjects noted improvement in self-reported fatigue, QOL, or mobility measures. Improvement in mobility measures had wide variability but did not differ between TR and OP groups.

Conclusions: The 8-week PT-monitored TR program was shown to be feasible, safe, and well received by persons with MS. Larger studies focused on specific dysfunction leading to mobility deficits and longer intervention times will be necessary to determine efficacy.

Assessing the remote management of Family Medicine education during the SARS-CoV-2 Pandemic

2020-10-29T09:25:36-07:00

Introduction: The SARS-CoV-2 (COVID-19) coronavirus pandemic has changed lifestyles, work styles and, of course, training and teaching.

Objective: To evaluate the telematic training of the subject of family medicine at the University of Castilla la Mancha.

Methods: it was proposed to implement a methodology of telematic classes, allowing the student to self-manage their time and receive the contents at distance. The acceptance of the new methodology was subsequently evaluated through satisfaction surveys and the effect of the methodology on the students’ grades was evaluated comparatively.

Results: Favorable results were obtained with a global average for the course of 4.95 out of 5 for the year 2020 and 4.85 and 4.87 for the years 2018 and 2019. The specks obtained above all in the theory exam are higher than that of these years.

Conclusion: It is concluded that the telematic approach is a learning methodology valued positively by the students with a favorable impact on their academic results.

Telemental Health Care: A Review of Efficacy and Interventions

2020-10-02T15:24:11-07:00

Objective: Mental illness continues to rise in the United States, burdening a healthcare system set to dive further into a shortage of mental health practitioners. The effects of this are already being felt in many rural areas, which are all too frequently understaffed to address the mental health concerns of their populations. To further compound this growing crisis, COVID-19 has led to a reduction in access to in-person care. Furthermore, COVID-19 has led to reduced access to in-person care. As a result, Telehealth has become more essential. Knowledge of the strategies and barriers to implement a successful Telehealth program is necessary to deliver a sustainable, accessible, and quality care.

Design: In this review, we analyze published research on the efficacy of Telehealth for mental health, discuss how these services have been implemented, and explore how to address barriers to quality care delivery via Telehealth.

Results: Telehealth, when the appropriate resources and supports are considered, is effective in a wide range of patient populations and care locations. Multiple modalities, including via video, apps, and telephone were shown to be efficacious. Interventions have been shown to increase the accessibility to care without compromising quality of care.

Conclusions: Telehealth constitutes a well-researched, efficacious tool to address the issues in access to care. Telemental health programs should address the barriers to implementation, including training, access to technology, reimbursement and regulations, and adequate program oversight. Telehealth interventions should be strongly considered in areas facing shortages of mental health practitioners and long wait times for patients with mental health disorders, to reduce the burden of mental illness on healthcare.

Uses of Telehealth to Support Identification and Treatment of Health Disorders in the Criminal Justice System

2020-10-29T08:22:37-07:00

Telehealth, the interactive, electronic exchange of information for diagnosis, treatment, support, or care management, is a critical component of many systems of care.¹ The variety of telehealth uses, technologies, and approaches, when implemented successfully, can improve access to care and overcome typical geographic and workforce barriers.¹ The opioid epidemic and recent social distancing requirements due to coronavirus disease (COVID-19) have prompted public safety, behavioral health, and other community partners to explore how telehealth can be used for identification and treatment of disorders in the criminal justice system.

Telehealth offers an innovative strategy for intervention and treatment within the criminal justice system, which is greatly needed given the prevalence of justice-involved populations affected by opioid-use disorder. For one, it is costly to provide treatment and care to people who are incarcerated, and telehealth can help reduce that cost.² Using telehealth to connect these people to providers can also help avoid resource-heavy and potentially dangerous transfers to care settings. In addition, a telehealth strategy can minimize the burden associated with recruiting and retaining healthcare providers on site, particularly behavioral health providers, who are often in short supply.

Offering options virtually is one way to ameliorate organizational challenges. Services that can be provided via telehealth include inpatient and outpatient medical services, behavioral health, physical and occupational therapy, disaster management, health education,¹ and coordination of care support for inmates, providers, and officials. Telehealth can also be used to facilitate release of inmates by connecting people who are in prison or jail with community-based services before release.