In-person Consultation Research Articles

An electronic consultation programme impacts on heart failure patients prognosis: implications for heart failure care

Abstract Background Multidisciplinary care plans that comprise professionals from different levels of care optimize the diagnosis and treatment of patients with heart failure (HF). Purpose Our objective was to analyse the clinical characteristics, 1 year prognosis and the prognostic determinants of patients with a previous diagnosis of HF, categorized by their previous HF-related hospitalization status (<1year or >1 year before or never hospitalized), referred by general practitioners (GPs) to a cardiology department (CD) by an e-consultation. Methods Data were obtained from 4851 HF patients referred by GPs to the cardiology department for an e-consultation from 2013 to 2020. We analysed the clinical characteristics of HF patient. We studied the whole cohort, and then subdivided it into three groups of diagnosis: patients who had never been hospitalized due to HF, patients with a recent HF-related hospitalization (<1 year), and patients with a remote HF-related hospitalization (≥1 year). To assess 1 year prognosis after e-consultation, we analysed the following health outcomes: HF-related hospitalizations, cardiovascular hospitalizations, HF-related mortality, cardiovascular mortality and all-cause mortality (Fig. 1). Qualitative variables are expressed as percentages (%), and quantitative continuous variables as means (standard deviation), or medians (interquartile range) if the distribution was asymmetric. To verify differences between groups, χ2 was used for quantitative variables, and ANOVA for qualitative variables. Results The delay of time to e-consults were solved was 8.6 + 8.6 days with 84.3% solved in <14 days. For the 1 year prognosis evaluation after the e-consult were assessed the cardiovascular hospitalizations, HF-related hospitalizations, HF-related mortality, cardiovascular mortality, and all-cause mortality. Compared with the group without a previous hospitalization, patients with recent and remote HF hospitalization were at higher risk of a new HF-related hospitalization (OR: 19.41 [95% CI: 12.95–29.11]; OR: 8.44 [95% CI: 5.14–13.87], respectively) (Fig 2), HF-related mortality (OR: 2.47 [95% CI: 1.43–4.27]; OR: 1.25 [95% CI: 0.51–3.06], respectively), as well as cardiovascular hospitalizations and mortality and all-cause mortality. Reduction in the time elapsed because e-consultation was solved was associated with lower risk of HF-related mortality (OR: 0.94 [95% CI: 0.89–0.99]), cardiovascular mortality (OR: 0.96 [95% CI: 0.93–0.98]), and all-cause mortality (OR: 0.98 [95% CI: 0.97–1.00]). Conclusions A clinician-to-clinician e-consultation programme between GPs and cardiologists in patients with HF allows to solve the demand of care in around 25% e-consults without an in-person consultation; the patients with a previous history of HF-related hospitalization showed a worse 1 year outcome. A reduction in the time elapsed because e-consultation was solved was associated with a mortality reduction.

A universal electronic consultation programme at the cardiology department after general practitioner referrals improves healthcare outcomes in patients with health failure

Abstract Background Electronic consultation (e-Consult) is an emerging health care innovation developed to address excess wait times for specialist care by enabling primary care physicians (PCPs) to obtain a specialist consultant’s expert opinion in a timely manner 1. A recent wait time report in England showed that in the first 7 months of 2017, 89.4% of patients waited up to 18 weeks to see a specialist. This result failed to meet their standard of 92% of patients waiting no more than 18 weeks for their consult 2. e-Consult services were shown to be effective in terms of providing faster access to specialist’s advice, with short response times (from 1 to 6 days) of the participating specialists and resulting in substantial avoidance of face-to-face referral visits 3. The recent ESC HF guideline made a "may be considered" recommendation for the use of home-based telemonitoring, according on a meta-analysis published in 2017 4,5. Nevertheless, never has been evaluated the impact on access to care and clinical outcomes of a clinician-to-clinician e-consult program as a first step for all the PCPs referrals to cardiologist in heart failure patients. Purpose We aimed to assess in patients with heart failure (HF) the clinical impact of the implementation of an outpatient care model that includes an initial e-consultation (from 2013 to 2021) and to compare it with a one-time in-person consultation model (from 2010 to 2012) for all the primary care physicians’ referrals to a cardiology department. Methods We selected 6,859 HF patients who visited the cardiology service at least once between 2010 and 2021: 4,851 were attended in e-consultation and 2,008 in one-time in-person consultations. Using an interrupted time series regression model, we analysed the impact of incorporating e-consultation into the health care model (started in 2013), and evaluated the elapsed time to cardiology care, cardiovascular (CV) and HF hospital admissions, and HF, CV and all-cause mortality. Results The interrupted time series regression model showed that the introduction of e-consultation substantially decreased waiting times to cardiology care (8.6 [8.7] vs 55.4 [79.9] days, p<0.001). and a reduction in the need for visits to the emergency department 1-year after e-consultation compared with the previous period (HR [IC95%]: 0.07 [0.05-0.08]). After e-consultation implantation, hospital admissions were reduced (RRi [IC95%]: 0,867 [0,875-0,838] for HF, 0,838 [0,825-0,856] for CV and 0,639 [0,635-0,651] all-cause), figure 1; and lower mortality (RRi [IC95%]: 0,981 [0,977-0,983] due to HF, 0,977 [0,970-0,980] for CV and 0,985 [0,984-0,985] for all-cause), figure 2. These results were maintained during the COVID-19 pandemic. Conclusion In HF patients, an outpatient care program that includes an e-consultation significantly reduced waiting times to cardiology care and was safe, with a lower rate of hospital admissions and mortality in the first year.Figure 1Figure 2

Telemedicine Versus Traditional In-Person Consultations: Comparison of Patient Satisfaction Rates.

Introduction: Data on patient satisfaction with the provision of genetic consultations using telemedicine are limited, especially those involving children. We compared patient satisfaction rates with telemedicine services versus traditional in-person encounters. Methods: A cross-sectional questionnaire-based study was conducted between January and June 2020. Questionnaires were distributed online to 1,672 consecutive patients who had received genetic counseling at our Genetics Institute in the clinical fields of adult and pediatric genetics, oncogenetics, and prenatal genetics, through in-person and/or telemedicine consultation. We used Likert scale with scores of 4-5 representing "satisfied"-"very satisfied" and 1-2 representing "very unsatisfied"-"unsatisfied." Results: The response rate was 27.3% (400 adults and 57 children <18 years), including 330 who had received in-person consultations (72.2%), 80 telemedicine consultations (17.5%), and 47 both consultations (10.3%). Mean satisfactory scores of 4-5 were reported by 82.1% in the in-person group versus 82.5% in the telemedicine group (p = 0.88). Mean scores of 1-2 were reported by 6.3% in the in-person group versus 11.2% in the telemedicine group (p = 0.31). No pediatric telemedicine group patient (n 12 = ) gave scores of 1-2 compared with 2/33 (6%) patients who had in-person pediatric consultations (p = 0.62). Most responders who had been counseled through telemedicine (n = 127, 84%) indicated willingness to use genetic services through telemedicine again. Conclusions: Users of genetic counseling through telemedicine, especially in the pediatric age group, were very satisfied at rates comparable to those of in-person consultations. Future research should evaluate patient compliance and views according to session type, information provided (e.g., diagnostic vs. negative results), and its nature (good vs. bad news).

69 Reducing the Economic Burden of Concussion: A Remote Model of Neuropsychological Care in Rural America

Objective:When neuropsychologists serve as consultants to schools, concussion management programs are associated with fewer referrals, faster cognitive recovery, and reduced incidence of protracted recovery compared to programs with physician consultants. However, accessing neuropsychological services can be challenging due to geographical and financial barriers. Particularly in rural areas, travel associated with post-concussion management can represent as a significant financial and time burden. Increasing accessibility to neuropsychologists has the potential to address these concerns, while also providing quality care to moreindividuals. The current study aims to assess the cost-effectiveness and clinical outcomes of a remote, neuropsychologist-led consultation model of concussion management. We hypothesized that this remote model would save patients both money and time, while also improving patient outcomes.Participants and Methods:604 high school concussion cases occurring between May 2019 and May 2022 were reviewed; 571 were included in the current analysis. The sample was 51% male with a mean age of 15.8 years (SD=1.32). All students took ImPACT tests following suspected concussions, with tests administered at the school by certified athletic trainers or nurses. Test results were electronically reviewed by the consulting neuropsychologist. Interpretations and recommendations were then sent via email to the school official. Cognitive recovery, defined as the days from the injury to the final ImPACT test, and incidence of repeat concussions, or concussions occurring within 3 months of a previous concussion, were used as indicators of patient outcomes. Financial burden was determined by calculating the round-trip distance in miles from the patient’s school to the neuropsychologist’s medical center, then multiplying this number by the 2022 standard mileage reimbursement rate of $0.63/mile to determine the travel cost for a single consultation.Results:The sample consisted of 571 individual concussion cases and 1,285 total ImPACT tests. An average of 2.25 tests were administered for each concussion case (SD=0.90), with an average of 18.47 days to the final test (SD=16.59). 8 concussions (1.4% of total concussions) occurred within 3 months of a previous injury. The distance from schools to the closest available neuropsychologist ranged from 2.4 to 102 miles. The remote nature of the consultation model allowed for patients to avoid up to 204 miles, or up to 4.5 hours, of driving for each consultation. Thus, patients saved anywhere from $3.00 to $127.50 in travel costs per consultation.Conclusions:The remote nature of this consultation model yielded a similar cognitive recovery time to previous literature, indicating that it may be as effective as in-person consultation. Repeat concussions represented less than 1.5% of concussion cases, indicating that care was successful enough to prevent second concussions in the majority of the sample. The remote nature of the model also saved patients time (up to 4.5 hours of driving) and money (up to $127.50 in travel costs). Thus, a remote consultation model has the potential to increase access to first-rate concussion care in rural settings, while also being cost- and time-effective for patients.

A qualitative approach to exploring nurse practitioners’ provision of telehealth services during the COVID-19 pandemic in Australia

BackgroundIn adapting to provide socially distanced healthcare during the COVID-19 pandemic, the Australian government encouraged the use of telehealth consultations in circumstances where face-to-face consultations could be avoided. For nurse practitioners, four telephone and four telehealth Medicare Benefit Schedule items were established. AimTo explore nurse practitioners' perspectives on their provision of telehealth services during the COVID-19 pandemic in Australia. MethodsSemi-structured interviews were conducted with nurse practitioners (n = 16) recruited through snowball sampling. Interview data were analysed inductively (Phase 1) and deductively (Phase 2). Reported here in accordance with the Consolidated Criteria for Reporting Qualitative Research guideline. FindingsTelehealth provided a viable alternative to in-person consultations during the pandemic, the most common reasons for presentations were medication prescriptions, provision of medical certificates, and management of chronic conditions. The priorities to include in programs to educationally prepare nurse practitioners to provide telehealth were knowledge of telehealth technology, systems and processes, patient assessment via telephone or video telehealth, limitations of scope of practice, and ensuring cultural safety. DiscussionWhile the rapid transition to telehealth during COVID-19 was perceived to improve patient access to care, it was challenging to provide without having already established the systems and processes required, and without prior telehealth experience or education. ConclusionsSince the height of the COVID-19 pandemic, telehealth has become an accepted means of operating for many healthcare services, including those provided by nurse practitioners. The findings suggest that the educational preparation of nurse practitioners to provide care via telephone or telehealth services is important and should be considered as part of the design of tertiary education leading to nurse practitioner endorsement in Australia.

Effect of telehealth-integrated antenatal care on pregnancy outcomes in Australia: an interrupted time-series analysis

During the COVID-19 pandemic, rapid integration of telehealth into antenatal care occurred to support ongoing maternity care. A programme of this scale had not been previously implemented. We evaluated whether telehealth-integrated antenatal care in an Australian public health system could achieve pregnancy outcomes comparable to those of conventional care to assess its safety and efficacy. Routinely collected data for individuals who gave birth at Monash Health (Melbourne, VIC, Australia) during a conventional care period (Jan 1, 2018, to March 22, 2020) and telehealth-integrated period (April 20, 2020, to April 25, 2021) were analysed. We included all births that occurred at 20 weeks' gestation or later or with a birthweight of at least 400 g (if duration of gestation was unknown). We excluded multiple births, births for which private antenatal care was received, and births to individuals transferred from other hospitals or who had no antenatal care. Baseline demographics, telehealth uptake, and pregnancy complications (related to pre-eclampsia, fetal growth restriction [FGR], gestational diabetes, stillbirth, neonatal intensive care [NICU] admission, and preterm birth [<37 weeks' gestation]) were compared using comparative statistics and an interrupted time-series analysis. Results were stratified by care stream, with high-risk models consisting of obstetric specialist-led care, and all other streams categorised as low-risk models. The impact of the integrated period on outcomes was also assessed with stratification by parity. 17 873 births occurred in the conventional period and 8131 in the integrated period. Compared with the conventional period, women giving birth during the integrated period were slightly older (30·63 years vs 30·88 years) and had slightly higher BMI (25·52 kg/m2vs 26·14 kg/m2), and more Australian-born women gave birth during the integrated period (37·37% vs 39·79%). There were no significant differences in smoking status or parity between the two groups. 107 (0·08%) of 129 514 antenatal consultations in the conventional period and 34 444 (45·94%) of 74 982 in the integrated period were delivered by telehealth. No significant differences between the conventional and integrated periods were seen in median gestational age at pre-eclampsia diagnosis (low-risk models 37·4 weeks in the conventional period vs 37·1 weeks in the integrated period, difference -0·3 weeks [-0·7 to 0·1]; high-risk models 35·5 weeks vs 36·3 weeks, difference 0·3 weeks [-0·3 to 1·1]), incidence of FGR below the 3rd birthweight percentile (low-risk models 1·62% vs 1·74%, difference 0·12 percentage points [-0·26 to 0·50]; high-risk 4·04% vs 4·13%, difference 0·089 percentage points [-1·08 to 1·26]), and incidence of preterm birth (low-risk models 4·99% vs 5·01%, difference 0·02% [-0·62 to 0·66]; high-risk models 15·76% vs 14·43%, difference -1·33% [-3·42 to 0·77]). Parity did not affect these findings. Interrupted time-series analysis showed a significant reduction in induction of labour for singletons with suspected FGR among women in low-risk models during the integrated period (-0·04% change per week [95% CI -0·07 to -0·01], p=0·0040), and NICU admission declined after telehealth integration (low-risk models -0·02% change per week [-0·03 to -0·003], p=0·018; high-risk models -0·10% change per week, -0·19 to -0·001; p=0·047). No significant differences in stillbirth rates were observed. The proportion of women diagnosed with gestational diabetes was significantly higher in the integrated period compared with the conventional period for both low-risk care models (22·28% vs 25·13%, difference 2·85 percentage points [1·60 to 4·11]) and high-risk care models (28·70% vs 34·02%, difference 5·32 percentage points [2·57 to 8·07]). However overall, when compared with the conventional period, there was no significant difference in proportion of women with gestational diabetes requiring insulin therapy (low-risk models 8·08% vs 7·73%, difference -0·35 percentage points [-1·13 vs 0·44]; high-risk models 14·81% vs 15·71%, difference 0·89 percentage points [-1·23 to 3·02]), or proportion of women with gestational diabetes who gave birth to a baby with macrosomia in the integrated period (low-risk models 3·16% vs 2·33%, difference -0·83 percentage points [-1·77 to 0·12]; high-risk models 5·58% vs 4·81%, difference -0·77 percentage points [-3·06 to 1·52]). Telehealth-integrated antenatal care replaced around 46% of in-person consultations without compromising pregnancy outcomes. It might be associated with a reduction in labour induction for suspected FGR, particularly for women in low-risk models, without compromising FGR detection or perinatal morbidity. These findings support the ongoing use of telehealth in providing flexible antenatal care. None.

Organisational aspects and determinants on intention to seek psychotherapeutic consultation at work

Abstract Background Worldwide, a minority of people suffering from mental illness receives adequate treatment. Psychotherapeutic consultation at work (PT-A) offers low-threshold and short-term access to psychotherapeutic care for employees with mental burden. However, utilisation has been low so far. Therefore, this study aimed to identify employees’ preferences on organisational aspects and determinants on intention to seek PT-A. Methods In total, 755 employees answered online questions on organisational aspects of PT-A (type, time, location, scope and purpose) and on determinants (sociodemographic variables, psychological well-being, stigma-related barriers and psychosocial safety climate) of intention to seek PT-A. To identify organisational preferences, various repeated measures analyses of variances were conducted. Multiple linear regressions were used to identify determinants of intention to seek PT-A. Results Results showed that employees prefer in-person consultations that take place outside of working hours and outside company premises, with treatment sessions included in addition to diagnostics. Intention to seek PT-A for occupational reasons was higher than for private reasons. The study also found that male gender, higher psychological well-being and higher perceived stigma-related barriers were associated with a lower intention to seek PT-A. However, these associations were found to depend on whether participants currently showed symptoms of depression. Conclusions These results provide practical indications under which conditions employees would make use of PT-A. Furthermore, recommendations that might increase utilisation can be derived from these results (e.g. anti-stigma campaigns). Nevertheless, longitudinal studies are necessary to confirm whether these factors determine actual utilisation. Key messages • Results suggest that employees prefer PT-A as in-person consultation during working hours and off company premises. • Interventions like anti-stigma campaigns or target group specific advertising might address the determinants on intention to seek PT-A found in this study.

Bone health in rural Australia: a mixed methods study of consumer needs

SummaryThis mixed methods study explores osteoporosis among adults living in a regional area of Victoria, Australia. Three major themes emerged from interviews, which reflected the findings of surveys, concerns regarding the adequacy of care in rural areas, a desire for tailored, local care, and a desire for hybrid telemedicine or in-person services.PurposeOsteoporosis or osteopenia affects over half of adults aged over 50 years. People living outside major cities in Australia have higher hip fracture rates than people living in cities, along with reduced access to bone densitometry and osteoporosis specialists. This study explores osteoporosis risk factors, knowledge, experiences of and preferences for care in people living in a regional area, to inform development of osteoporosis care programs.MethodsAdults living in a large non-metropolitan region of Australia were invited to participate in a mixed methods study: a survey (phase 1) followed by semi-structured interviews (phase 2) with triangulation of results. Data collected included osteoporosis diagnosis, risk factors, management, knowledge, preferences for care and experience using telemedicine. Surveys were analysed quantitatively, with linear and logistic regression used to assess factors related to osteoporosis knowledge or satisfaction with telemedicine. Interview transcripts were analysed using thematic analysis by two researchers, with in-depth discussion to identify themes.ResultsSixty-two participants completed the survey, and 15 completed interviews. The mean (SD) age of survey participants was 62.2 (14.1) years, 57% had a screening test for osteoporosis, and 12 (19%) had a diagnosis of osteoporosis. The mean osteoporosis knowledge score was 8.4 / 19 and did not differ with age, education, or history of osteoporosis. The majority wanted access to more information about osteoporosis but preferred method differed, and the majority preferred in-person medical consultations to telemedicine. Interview participants were aged between 57 and 87 years, and included 8 with osteoporosis or osteopenia. Three major themes emerged: concerns regarding the adequacy of care in rural areas, a desire for tailored local car and a desire for hybrid telemedicine or in-person services.ConclusionGaps exist in rural osteoporosis care, including knowledge, screening and management. People have differing experiences of care, access to services and preferences for care. High-quality care, tailored to their needs, was preferred. Improving osteoporosis services for regional Australia will require a flexible, multi-faceted approach, addressing needs of the local community and providers.

Dermacure – An Advanced Skin Disease Detection using Deep Learning Algorithm

Skin diseases are common and can cause discomfort, pain, and even disfigurement if left untreated. Unfortunately, many people do not seek treatment due to a lack of knowledge about them. To address this issue, raising awareness and providing access to resources are essential. Recent advances in deep learning techniques have shown promising results in detecting skin diseases from images. Combining this technology with a user-friendly application can help to provide preliminary diagnosis and connect patients with qualified dermatologists for in-person or remote consultation. The proposed application will allow users to upload images of their skin ailments and receive an immediate diagnosis using deep learning techniques. The application will be equipped with a user-friendly interface and will be capable of detecting any type of skin disease such as allergies, viral infections, cancer, etc. Once the diagnosis is made, the application will then integrate the patient with a qualified dermatologist for further consultation. The application will provide various options for the patient to connect with the doctor, including call, chat or appointment scheduling. The doctor will have access to the patient's medical history and images of their skin condition, enabling them to make an informed diagnosis and provide appropriate treatment. In addition, a fundraising campaign will be conducted for patients who require financial assistance for their treatment. Public health campaigns and community outreach programs can also help to increase awareness about skin diseases and encourage people to seek treatment when necessary. By doing so, we can improve the overall health and well-being of our communities

No Detectable Association Between Virtual Setting for Vasectomy Consultation and Vasectomy Completion Rate.

The COVID-19 pandemic has fueled widespread incorporation of telehealth into urology practices. Vasectomy consultation via telehealth is convenient and improves access to care for male contraception. However, it does not allow for physical examination, inherently leading to possible day-of-procedure cancellations due to unforeseen anatomic concerns. This study aimed to compare vasectomy completion rates between patients undergoing virtual vs in-person consultation. All patients seen by a single provider at NYU Langone Health for vasectomy consultation between October 2016 and June 2022 were included in the study. Most patients seen before March 2020 had in-person consultations, whereas the majority of patients seen afterwards had virtual consultations without option for in-person visit due to the emergence of COVID-19. All patients seen virtually were examined in a consult room prior to being prepped for the vasectomy in the procedure room. Visit type, demographic information, and clinical outcomes data were collected for all patients. A chi-square test was used to compare the rate of vasectomy completion between those with in-person and virtual consultation. Analysis was performed using R, version 4.0.5. Four hundred ninety-one patients were seen by a single provider for vasectomy consultation between October 2016 and June 2022. One hundred ninety-seven (40.1%) consultations were performed virtually and 294 (59.9%) consultations were performed in person. Three hundred seventy (75.4%) of all patients seen for consultation (both virtual and in person) ultimately underwent vasectomy. There was no evidence of difference in rate of completing vasectomy after virtual (75.6%) and in-person (75.2%) consultation (P = .91). Two of the 197 (1%) patients who consulted virtually had their vasectomy procedures cancelled on the day of the procedure based on their preoperative exam; one because of abnormal epididymal sensitivity after prior scrotal infection, the other because of a history of orchiopexy that the patient was not aware of until the surgeon started inquiring about scrotal scars present. Despite the lack of physical examination, virtual vasectomy consultation is both feasible and effective, with rates of vasectomy completion comparable to traditional in-person consultation.

Preferences and willingness-to-pay for a blood pressure telemonitoring program using a discrete choice experiment

This study aimed to elicit the preferences and willingness-to-pay for blood pressure (BP) telemonitoring programs. This study also investigated the different factors or participant characteristics that could influence preferences and choice behaviors. Participants with hypertension were identified from an online survey panel demographically representative of Singapore’s general population. Participants completed a discrete choice experiment (DCE) with 12 choice sets, selecting their preferred BP monitoring program differing on five attributes: mode of consultation, BP machine type (with Bluetooth or not), BP machine price, monthly fee, and program duration. The base reference population (male, married, higher income, more formal education years, full-time worker, aged 55 to <65 years, and digital skills score of 36) preferred teleconsultation over in-person consultation, Bluetooth feature, lower machine price, lower monthly fee, and shorter program duration. A subgroup of participants can be considered teleconsultation-resistant, and three demographic factors were associated with lower preference for teleconsultation: female, fewer formal education years, and lower income. Considering the reference population and Bluetooth attribute, participants were willing to pay 66 SGD (~49 USD) additional for the machine to obtain the Bluetooth feature. Considering the reference population and teleconsultation attribute, participants were willing to pay 6.80 SGD (~5.10 USD) extra monthly fee for a program using teleconsultation. Here we report that amongst participants with hypertension, there is strong preference for the use of teleconsultation and a BP machine with Bluetooth feature in a BP monitoring program. However, a subgroup of participants are teleconsultation-resistant and would prefer in-person consultation.

Sentiment Analysis of Telemedicine Applications on Twitter Using Lexicon-Based and Naive Bayes Classifier Methods

Since the onset of the COVID-19 pandemic in Indonesia, many people have turned to telemedicine programs as an alternative to minimize social interactions, opting for consultations from the safety of their homes using smartphones and internet connectivity. Given the necessity for physical distancing and avoiding crowded places, these applications have become indispensable substitutes for in-person medical consultations. Numerous apps facilitating access to healthcare services have been introduced in Indonesia, ranging from business startups to initiatives by the Ministry of Health. Telemedicine can potentially revolutionize healthcare in Indonesia, addressing critical health challenges. A significant issue within Indonesia's healthcare system is the scarcity of doctors and their uneven distribution. With only four doctors per 10,000 people, this figure falls far below the WHO guideline of 10 doctors per 1,000. Sentiment analysis of these applications was conducted to evaluate how telemedicine applications meet public needs and offer an alternative solution. Lexicon-based and naive Bayes methods were employed to classify tweet data into positive, neutral, and negative sentiments. The results revealed 908 positive tweets, 172 negative tweets, and 168 neutral tweets, indicating predominantly positive public perceptions of telemedicine applications. The naive Bayes classifier exhibited a 74% accuracy rate, with a precision of 98% and a recall of 86%. These findings underscore the positive impact and acceptance of telemedicine applications among the Indonesian populace, emphasizing their significance in augmenting the nation's healthcare landscape.

A comparison of the characteristics of adult medicine patients seeking telemedicine consultations versus in-person consultations in a Philippine public hospital

Background Telemedicine employs the use of technology to increase access to health care. This is especially relevant in developing countries where accessibility is an important issue. In developed countries, studies have shown that despite greater availability and accessibility, there are still disparities in telemedicine use. In the Philippines, however, it is unknown what factors are related to telemedicine use since its underutilization precludes proper characterization of telemedicine patients. We sought to compare the characteristics of telemedicine patients and patients consulting in-person in the internal medicine outpatient department of a Philippine public hospital. Methods This is a retrospective descriptive study. Chart reviews were done for patients who consulted from May 2021 to July 2021. They were classified as either having telemedicine consults only or having in-person consults only. Each group was characterized and compared according to demographics, socioeconomic characteristics, health behaviors, and reasons for consultation. Results Unadjusted analyses showed that younger, single, or employed individuals were more likely to use telemedicine. However, in adjusted analyses, no demographic factors were associated with telemedicine use. Only the patient type and medical concern were significantly different between patient groups in this public hospital setting. New patients and those consulting for clearance/referral purposes or endocrine-related symptoms were more likely to seek teleconsults. Conclusions The findings showed which patients are more likely to use telemedicine in the Philippines. Continued telemedicine use for these patients should be explored to complement in-person medical care.

Comparison of Glycemic Control Between In-Person and Virtual Diabetes Consults in Hospitalized Patients With Diabetes.

There is limited evidence that the diabetes in-person consult in hospitalized patients can be replaced by a virtual consult. During COVID-19 pandemic, the diabetes in-person consult service at the University of Miami and Miami Veterans Affairs Healthcare System transitioned to a virtual model. The aim of this study was to assess the impact of telemedicine on glycemic control after this transition. We retrospectively analyzed glucose metrics from in-person consults (In-person) during January 16 to March 14, 2020 and virtual consults during March 15 to May 14, 2020. Data from virtual consults were analyzed by separating patients infected with COVID-19, who were seen only virtually (Virtual-COVID-19-Pos), and patients who were not infected (Virtual-COVID-19-Neg), or by combining the two groups (Virtual-All). Patient-day-weighted blood glucose was not significantly different between In-person, Virtual-All, and Virtual-COVID-19-Neg, but Virtual-COVID-19-Pos had significantly higher mean ± SD blood glucose (mg/dL) compared with others (206.7 ± 49.6 In-person, 214.6 ± 56.2 Virtual-All, 206.5 ± 57.2 Virtual-COVID-19-Neg, 229.7 ± 51.6 Virtual-COVID-19-Pos; P = .015). A significantly less percentage of patients in this group also achieved a mean ± SD glucose target of 140 to 180 mg/dL (23.8 ± 22.5 In-person, 21.5 ± 20.5 Virtual-All, 25.3 ± 20.8 Virtual-COVID-19-Neg, and 14.4±18.1 Virtual-COVID-19-Pos, P = .024), but there was no significant difference between In-person, Virtual-All, and Virtual-COVID-19-Neg. The occurrence of hypoglycemia was not significantly different among groups. In-person and virtual consults delivered by a diabetes team at an academic institution were not associated with significant differences in glycemic control. These real-world data suggest that telemedicine could be used for in-patient diabetes management, although additional studies are needed to better assess clinical outcomes and safety.

Use of Telemedicine and Telehealth Services in Providing Veterinary Care in India

Purpose: The aim of the study was to investigate use of telemedicine and telehealth services in providing veterinary care.&#x0D; Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries.&#x0D; Findings: The findings allowed for increased accessibility to veterinary services, particularly in remote areas, and reduced the need for physical visits, minimizing stress for animals and clients alike. It also played a crucial role in maintaining continuity of care during the COVID-19 pandemic when in-person consultations were restricted. Overall, the adoption of telemedicine and telehealth services in veterinary care demonstrated their potential to enhance efficiency and accessibility while ensuring the well-being of animals.&#x0D; Unique Contribution to Theory, Practice and Policy: Diffusion of Innovation Theory, Technology Acceptance Model and One Health Theory may be used to anchor future studies on use of telemedicine and telehealth services in providing veterinary care. practitioners should establish clear protocols for telehealth consultations, ensuring that they meet the same standards of care as in-person visits. Policymakers can encourage telehealth adoption by providing incentives or subsidies for practices to invest in telemedicine infrastructure.

Perceptions and Challenges of Telehealth Obstetric Clinics Among Pregnant Women in Hong Kong: Cross-Sectional Questionnaire Study.

Integrating telehealth in an obstetric care model is important to prepare for possible infection outbreaks that require social distancing and limit in-person consultations. To ensure the successful implementation of obstetric telehealth in Hong Kong, it is essential to understand and address pregnant women's concerns. This study aimed to assess pregnant women's attitudes, concerns, and perceptions regarding telehealth obstetric clinic services in Hong Kong. We conducted a prospective cross-sectional questionnaire study at Queen Mary Hospital between November 2021 and August 2022. Utilizing a 5-point rating scale, the questionnaire aimed to capture pregnant women's preferences, expectations, feasibility perceptions, and privacy concerns related to telehealth clinic services. We used statistical analyses, including chi-square tests and multinomial logistic regression, to compare questionnaire responses and investigate the association between advancing gestation and attitudes toward telehealth clinics. The study included 664 participants distributed across different pregnancy stages: 269 (40.5%) before 18 gestational weeks, 198 (29.8%) between 24 and 31 weeks, and 197 (29.7%) after delivery. Among them, 49.8% (329/664) favored face-to-face consultations over telehealth clinics, and only 7.3% (48/664) believed the opposite. Additionally, 24.2% (161/664) agreed that telehealth clinics should be launched for obstetric services. However, the overall preference for telehealth clinics was <20% for routine prenatal checkups (81/664, 12.2%) and addressing pregnancy-related concerns, such as vaginal bleeding (76/664, 11.5%), vaginal discharge (128/664, 19.4%), reduced fetal movement (64/664, 9.7%), uterine contractions (62/664, 9.4%), and suspected leakage of amniotic fluid (54/664, 8.2%). Conversely, 76.4% (507/664) preferred telehealth clinics to in-person visits for prenatal education talks, prenatal and postpartum exercise, and addressing breastfeeding problems. Participants were more comfortable with telehealth clinic tasks for tasks like explaining pregnancy exam results (418/664, 63.1%), self-administering urinary dipsticks at home (373/664, 56.4%), medical history-taking (341/664, 51.5%), and self-monitoring blood pressure using an electronic machine (282/664, 42.8%). %). During the postpartum period, compared to before 18 weeks of gestation, significantly more participants agreed that telehealth clinics could be an option for assessing physical symptoms such as vaginal bleeding (aOR 2.105, 95% CI 1.448-3.059), reduced fetal movement (aOR 1.575, 95% CI 1.058-2.345), uterine contractions (aOR 2.906, 95% CI 1.945-4.342), suspected leakage of amniotic fluid (aOR 2.609, 95% CI 1.721-3.954), fever (aOR 1.526, 95% CI 1.109-2.100), and flu-like symptoms (aOR 1.412, 95% CI 1.030-1.936). They were also more confident with measuring the symphysis-fundal height, arranging further investigations, and making diagnoses with the doctor via the telehealth clinic. The main perceived public health advantage of telehealth clinics was the shorter traveling and waiting time (526/664, 79.2%), while the main concern was legal issues from wrong diagnosis and treatment (511/664, 77.4%). Face-to-face consultation remained the preferred mode of consultation among the participants. However, telehealth clinics could be an alternative for services that do not require physical examination or contact. An increased acceptance of and confidence in telehealth was found with advancing gestation and after delivery. Enforcing stricter laws and guidelines could facilitate the implementation of telehealth clinics and increase confidence in their use among pregnant women for obstetric care.

Consumers' experiences, preferences, and perceptions of effectiveness in using telehealth for cancer care in Australia.

COVID-19 accelerated telehealth (video and telephone) use for cancer care to reduce disease exposure and transmission. Understanding consumers' health service delivery needs is required to sustain telehealth activity and develop new models of care. We explored consumers' experiences of telehealth in cancer care and their perspectives on improving and sustaining telehealth uptake in the future. Exploratory design mixed-methods study using the Model for Assessment of Telemedicine (MAST) framework. Consumers affected by cancer completed an online survey and semistructured interviews. Quantitative data were analyzed using descriptive statistics and chi-square. Qualitative data from the MAST consumer domain were thematically analyzed. There were 1162 survey respondents and 18 interview participants. Video and telephone were used in cancer care with various providers. Telephone was used more frequently. Most respondents (85%) had reliable internet connections for video, however, 36% were not offered a video consultation. Video compared with telephone users were statistically significantly more likely to be satisfied with the quality of their treatment and perceived their consultation achieved as much as an in-person consultation. Telephone users (51%) compared with video users (31%) were more likely to perceive their concerns would have been better understood by their care provider if they were seen in person. Five themes emerged from the qualitative data. Consumers want modality choice, video provides superior experiences versus telephone, consultation mode preference is fluid, and consultation scheduling and administration need further consideration. Consumers support telehealth in cancer care. Consumers want consultation mode choices based on their needs and purpose of consultation.

Exploring Patients' Intentions for Usage of Video Telemedicine Follow-Up Services: Cross-Sectional Study.

Background: Data suggest that regarding completion rates and lower readmission rates, video telemedicine follow-up is as efficient as in-person consultations. However, evidence of patients' intention to adopt such service is lacking. The objective of this study was to determine the essential factors influencing Chinese patients' intention to adopt video telemedicine follow-up. Methods: The researchers extended the technology acceptance model (TAM) by incorporating trust, subjective norms (SNs), perceived risk (PR), and perceived disease threat (PDT). A survey was conducted with 793 Chinese patients, and the collected data were analyzed using the partial least-squares approach. Results: The study revealed that trust emerged as the strongest factor influencing patients' behavioral intention (BI) to use video telemedicine follow-up, followed by SNs, perceived ease of use (PEOU), and perceived usefulness (PU). PR and PDT had no significant influence on patients' intention to adopt video telemedicine follow-up. PEOU mediated the relationship between trust, SNs, and BI, and PU mediated the relationship between trust and BI. The study also found that gender, age, and usage experience moderated certain relationships in the model. Conclusions: Our findings support the use of the extended TAM in understanding individual's motivations for using video telemedicine follow-up in China. In addition, this study contributes to the existing literature on telemedicine promotion by identifying significant mediation mechanisms. These findings have practical implications for planning, creating, and implementing improved video telemedicine follow-up services.

Using telemedicine to improve early medical abortion at home (UTAH): a randomised controlled trial to compare telemedicine with in-person consultation for early medical abortion

ObjectivesTo compare telephone consultations with in-person consultations for the provision of medical abortion (using mifepristone 200 mg and misoprostol 800 µg). We hypothesised that telemedicine consultations would be non-inferior to...

Telehealth effectiveness for pre-exposure prophylaxis delivery in Brazilian public services: the Combine! Study.

Pre-exposure prophylaxis (PrEP) delivery based on user needs can enhance PrEP access and impact. We examined whether telehealth for daily oral PrEP delivery could change the indicators of care related to prophylactic use in five Brazilian public HIV clinics (testing centres, outpatient clinics and infectious disease hospitals). Between July 2019 and December 2020, clients on PrEP for at least 6 months could transition to telehealth or stay with in-person follow-up. Clients were clinically monitored until June 2021. A desktop or mobile application was developed, comprising three asynchronous consultations and one annual in-person consultation visit. Predictors influencing telehealth preference and care outcomes were examined. The analysis encompassed intent-to-treat (first choice) and adjustments for sexual practices, schooling, age, duration of PrEP use and PrEP status during the choice period. Of 470 users, 52% chose telehealth, with the adjusted odds ratio (aOR) increasing over time for PrEP use (aOR for 25-months of use: 4.90; 95% CI: 1.32-18.25), having discontinued PrEP at the time of the choice (aOR: 2.91; 95% CI: 1.40-6.06) and having health insurance (aOR: 1.91; 95% CI: 1.24-2.94) and decreasing for those who reported higher-risk behaviour (aOR for unprotected anal sex: 0.51; 95% CI: 0.29-0.88). After an average follow-up period of 1.6 years (95% CI: 1.5-1.7), the risk of discontinuing PrEP (not having the medication for more than 90 days) was 34% lower with telehealth (adjusted hazard ratio: 0.66; 95% CI: 0.45-0.97). When adjusted by mixed linear regression, no differences in adherence (measured by mean medication possession rate) were found between in-person and telehealth (p = 0.486) or at pre- and post-telehealth follow-ups (p = 0.245). Sexually transmitted infections increased between the pre-follow-up and post-follow-up choices and were not associated with in-person or telehealth (p = 0.528). No HIV infections were observed. Our findings indicate that telehealth for PrEP delivery can enhance service rationalization and reinforce the prevention cascade. This approach reduces prophylaxis interruptions and is mainly preferred by individuals with lower demands for healthcare services.