Remote Delivery Of Healthcare Services Research Articles

Evaluation of the use of telehealth in Dietetics’ practice during the COVID-19 pandemic in the Kingdom of Saudi Arabia

Telehealth, which involves the remote delivery of healthcare services through virtual technologies, has been shown to have benefits such as reducing hospitalisations and length of stay for patients (1,2). The global COVID-19 pandemic has greatly accelerated the adoption of telehealth among clinical nutritionists. For instance, in the USA, telehealth usage for nutritional care has increased from 37% to 78% among clinical nutritionists (3), while in Italy, the adoption of telenutrition services by Registered Dieticians (RDNs) has risen from 16% to 63% (4). These statistics highlight the rapid integration of telehealth into dietetics practices as a response to the global health crisis, reflecting a growing trend towards virtual care delivery as an effective method for providing nutritional care. While telehealth has made progress in Saudi Arabia (5), there is a research gap regarding its prevalence and effectiveness in dietetics practice. This study aims to evaluate the current implementation of telehealth in dietetics practice during the COVID-19 pandemic in Saudi Arabia.In this cross-sectional, a web-based online survey was used from mid-December 2022 to mid-May 2023. The study was distributed in several Saudi Arabian regions including (central, western, eastern, south, and north) and was completed by 306 clinical Registered Dietitians (RDNs) in public and private healthcare facilities who met the study’s inclusion criteria. The survey consisted of 28 questions divided into four sections, covering sociodemographic information, past or current experiences, obstacles and challenges of telehealth usage, and the future prospects of telehealth. In this study, participants were requested to reflect on their current observations and previous experiences pertaining to the utilisation of telehealth in the field of dietetics. To ensure the validity and relevance of the survey, it was reviewed by a panel of experienced dietitians in Saudi Arabia to obtain their feedback before being used to collect data.Our research findings reveal that 76% of RDNs in Saudi Arabia utilize telehealth in their practice. The most common obstacles reported by RDNs using telehealth include internet connectivity issues (21.9%), patient disengagement and lack of enthusiasm (21.3%), and difficulties in coordinating with patients (21%). Telehealth interventions used by RDNs primarily involve diet recall (33.7%), weight- related measurements (30.6%), lab findings (26%), and only 8% reported using telehealth for vital signs. A majority of participants (69.4%) believed that telehealth could improve patient accessibility and help reduce no-show rates (68.9%). Additionally, over 70% of participants agreed that telehealth offers them flexibility in inpatient consultations.In conclusion, telehealth is widely utilised among RDNs in Saudi Arabia, with potential benefits such as decreased no-show rates. Further research is needed to gain a better understanding of telehealth usage among RDNs in Saudi Arabia.

Digital Transformation in Healthcare Challenges and Prospects

The following are presented, by the global community, as the main fields of Digital Transformation (DT) in Healthcare: Telemedicine Telemedicine is the remote delivery of healthcare services through Information and Communication Technologies (ICTs). It could be particularly beneficial in a range of services such as medical consultation, diagnosis remote monitoring of patients’ status and educational purposes. Patients could con- nect with healthcare providers at a distance using video calls, messaging platforms, or other communication tools. Telemedicine enhances accessibility to healthcare by overcoming geographical barriers while at the same time provides a transformative approach to healthcare services. Big Data Big data represents vast and diverse health information sets collected from several sources like Electronic Health Records (EHRs), wearable devices and social media. Big data can extract valuable insights and patterns, assisting clinical decision-making, public health management, personalised medicine and disease forecasting. Internet of Things (IoT) The Internet of Things (IoT) in healthcare refers to the interconnected network of medical devices, sensors and sys- tems that collect and exchange health data through the Inter- net. These devices offer real-time exchange of various data monitoring like patient's vital signs, and remote patient’s care, which could eventually result in the improvement of operational efficiency within healthcare systems, and patients' monitoring and care delivery. Virtual Reality (VR) in Health Virtual Reality (VR) employs immersive computer-generated environments into realistic experiences to transform medical training and education, rehabilitation, surgical planning and pain management. Employing VR tools such as headsets, users engage with three-dimensional simulation scenarios for training and skill practice in a safe environment without risking personal and patient safety. In addition, VR offers opportunities to improve outcomes, provide safer experiences to patients, while promoting the evolution of healthcare systems and care delivery. Artificial Intelligence (AI) in Health AI in healthcare is an umbrella term for the applications of Machine Learning (ML) algorithms used in medical contexts. AI algorithms analyse medical data, aiding in diagnostics, drug discovery, personalised medicine, and patient management. Virtual (personal) Assistants in Health Virtual Health Assistants (VHAs) are tools designed to engage patients, provide personalised health information and assist in various aspects of health services administration. Using Natural language Processing (NLP) and ML algorithms, VHAs offer support to remote communication between patients and healthcare providers, understand patients’ inquiries and healthcare-related issues. Also, VHAs could facil- itate appointment scheduling, symptom assessment, medication management, and health coaching, resulting at the enhancement of accessibility in healthcare and the empower- ment of the patient. Blockchain in Health Blockchain is an emerging technology, which utilises decentralised systems to record and manage healthcare information and patient data. By linking data blocks, blockchain can enhance security, interoperability and traceability, and address significant challenges such as data breaches, interoperability issues, and inefficiencies in data sharing, thus providing a stan- dardised and secure platform for data exchange across health- care systems and stakeholders. Medical Wearables Wearables emerge positive outcomes on continuing monitoring, tracking and early detecting of health issues. Wearables are devices wore on the body or putted on clothing allowing constant monitoring of health data and behaviour. They enable individuals to engage a proactive approach to their health and well-being, by empowering them to take control of their health. In addition, wearables have the potential to enhance telemedicine and population health management, while reducing healthcare costs.

A Study on Consumer Perceptions Towards Telemedicine in Vadodara

A Study on Consumer Perceptions Towards Telemedicine in Vadodara

A review of emerging trends in telemedicine: Healthcare delivery transformations

Telemedicine, characterized by the remote delivery of healthcare services using technology, has undergone remarkable transformations in recent years. This review explores the emerging trends in telemedicine and their profound impact on healthcare delivery. The paper begins by providing a background on telemedicine, tracing its evolution, and emphasizing its growing significance in the healthcare landscape. The primary objective is to shed light on the current state of telemedicine, identify key trends, and analyze their transformative effects on healthcare delivery. The technological landscape of telemedicine is examined, focusing on innovations in video conferencing, virtual consultations, and the integration of electronic health records. Furthermore, the role of artificial intelligence (AI) is explored, encompassing diagnostic assistance through medical imaging algorithms and the integration of chatbots and virtual health assistants. Specialized areas of telemedicine, such as mental health services and chronic disease management, are discussed in detail to highlight specific transformations in these domains. The critical aspect of patient and healthcare provider adoption is scrutinized, emphasizing patient engagement, overcoming technological barriers, and addressing the challenges faced by healthcare professionals in virtual settings. Anticipating the future of telemedicine, the review outlines upcoming innovations such as virtual reality applications and the impact of 5G technology. Simultaneously, it addresses persisting challenges, including health inequalities, ensuring quality of care, and ethical considerations. This review synthesizes the current state of telemedicine, identifies transformative trends, and provides insights into the future of healthcare delivery. It calls for continued research, policy development, and strategic implementation to maximize the potential of telemedicine in creating a more accessible, efficient, and patient-centric healthcare system.

Implementation of a Hybrid Care Model for Telemedicine-based Cancer Pain Management at the Cancer Center of Naples, Italy: A Cohort Study.

Telemedicine, the remote delivery of healthcare services, represents a great opportunity for cancer pain management. A care model of telemedicine that combines remote visits and hospital access could be an effective and safe strategy for pain management of cancer patients. A retrospective study was conducted using the dataset of the telemedicine program at the Istituto Nazionale Tumori of Naples, Italy for assessing the efficacy of a telehealth-based model of care. Demographic, clinical, and process variables were investigated. A total of 226 cases and 489 visits were included in the analysis. The mean age of patients was 63.4 years (SD=12.4 years), and no sex differences were observed. Approximately 55% of patients were ECOG-PS ≤2 and 87% suffered from metastatic disease. More than half of the patients were treated with high doses of opioids. Each patient had a mean of 2 remote visits and half of the patients had more than 1 telehealth consultation. The dropout ratio was 5.3%. Most visits (n=472) were conducted on patients in the Campania Region, Italy. The maximum covered distance from the Cancer Center and the patients' location was 555.22 Km. A significant difference in the overall number of visits (p=0.006) and the number of pro-capita remote visits (p=0.010) was found, in favor of the group of patients treated before the end of the Covid-19 emergency in Italy, compared to those treated after the pandemic. Despite various positive outcomes, the analysis highlights several weaknesses, such as the need to assist patients with advanced and non-advanced disease located outside the regional territory. Overall, the telehealth processes should be adapted to post-pandemic scenarios towards their implementation in routine clinical practice.

'The key to this is not so much the technology. It's the individual who is using the technology': Perspectives on telehealth delivery for autistic adults during the COVID-19 pandemic.

The COVID-19 pandemic meant that a lot of healthcare services had to move online, such as to video-calls, or to telephone. However, not many studies have looked at how autistic adults feel about this kind of service delivery. It is important to know this, as autistic people may have poorer health than non-autistic people, and they may also struggle to access services more than non-autistic people. This study asked 11 autistic adults (aged 27-67 years), seven family members/carers (aged 44-75) reporting about autistic adults and six service providers about their experiences of accessing or providing a telehealth service. These experiences were collected through interviews, which were then analysed through thematic analysis. Two main themes were: technology aids communication and access - except when it doesn't, and in/flexibility. The themes pointed out some positive aspects of telehealth delivery, including improved communication and decreased stress. The themes also pointed out negative aspects of telehealth, such as increased rigidity of the healthcare system, amplifying pre-existing barriers. Because autistic people have many barriers to accessing healthcare, this study encourages researchers and healthcare providers to think about how such barriers could be addressed through telehealth, and about the possible limitations of telehealth for some autistic people.

Pruning of Health Data in Mobile-Assisted Remote Healthcare Service Delivery

Abstract The use of cloud computing and mobile devices is increasing in healthcare service delivery primarily because of the huge storage capacity of cloud, the heterogeneous structure of health data and the user-friendly interfaces on mobile devices. We propose a healthcare delivery scheme where a large knowledge base is stored in the cloud and user responses from mobile devices are input to this knowledge base to reach a preliminary diagnosis of diseases based on patients’ symptoms. However, instead of sending every response to the cloud and getting data from cloud server, it may often be desirable to prune a portion of the knowledge base that is stored in a graph form and download in to the mobile devices. Downloading data from cloud depends on the storage, battery power, processor of a mobile device, wireless network bandwidth and cloud processor capacity. In this paper, we focus on developing mathematical expressions involving the above mentioned criteria and show how these parameters are dependent on each other. The expressions built in this paper can be used in real-life scenarios to take decisions regarding the amount of data to be pruned in order to save energy as well as time.

Establishing a Telemedicine Program for Breast Reconstruction.

Summary:Telemedicine is an application of modern technology that allows for the remote delivery of healthcare services to diagnose and treat patients. The potential patient benefits of such a program include added convenience, lowered costs, and improved access. From a practical standpoint, establishing a telemedicine program may seem daunting to the plastic surgeon; success requires not only patient and provider adoption, but also integration of new technology. Despite these challenges, breast reconstruction patients are among those who stand to benefit most from telemedicine technology, as this patient population remains vulnerable to limitations to access following an emotion-provoking breast cancer diagnosis. Geographical limitation, especially in rural areas, represents a major barrier to access. To date, the application of telemedicine in caring for breast reconstruction patients has not been described in the literature. In this article, we describe the protocol developed and implemented by our academic plastic surgery group to care for new breast reconstruction candidates and discuss the role of telemedicine in improved access to breast reconstruction care.

Telemedicine for Diabetic Retinopathy Screening in Croatia

Diabetic retinopathy (DR) is the leading cause of preventable blindness in working-age adults associated with devastating personal and socioeconomic consequences. The increasing use of anti-vascular endothelial growth factor (anti-VEGF) agents over the past decade and telemedicine implementation in systematic DR screening resulted in a decliningtrend of new blindness due to diabetes in several countries. Telemedicine is the remote delivery of healthcare services over the telecommunications infrastructure. It allows healthcare providers to evaluate, diagnose, and treat patients without the need for an in-person visit. Teleophthalmology is a telemedicine branch, mostly focused on diabetic retinopathy and retinopathy of prematurity. Screening for DR in Croatia is commonly performed annually, only by ophthalmologists using dilated slit-lamp biomicroscopic fundus examination. Due to the insufficient number of ophthalmologists and the lack of a formal call system, many diabetic patients do not perform annual screening. In an ideal DR screening model in Croatia, each diabetes center in university or general hospitals throughout Croatia (17 centers) would have one small digital fundus camera and an educated nurse who would perform dilated fundus photography. Electronic images from diabetes centers would be transferred for remote grading to the same hospitals’ ophthalmology departments or a central grading center for DR screening in Croatia. Grading for DR would be performed by an ophthalmologist, medical retina specialist. Patients would be annually invited by mail from the National Diabetes Registry to come to the nearest diabetes center for a fundus photographing and DR screening. Each patient with a positive result would be promptly referred to the medical retina specialist at the closest ophthalmology department for further examination and treatment.

Authorship Trends in Telemedicine Research

Telemedicine is the remote delivery of healthcare services, such as health assessments or consultations, over the telecommunications infrastructure. The aim of the study is to analyze the research output on telemedicine. The publications indexed in Scopus database have been used for this study for a period of twenty five years. Retrieved data has been analyzed with various bibliometric tools such as Co-Authorship Index, Multi Authorship Index, Citations per Paper, Relative Citation Index and Relative Uncitedness Index. Highly cited publications and frequently used words in titles are discussed. Analysis reveals that 36949 publications were published in the area of telemedicine with maximum number of publications in the year 2015. Nearly 80% of the total research output has been published with co-authors. Nearly one third of the publications (32.28%) have yet to receive citations.

Telemedicine utilization by providers in accountable care organizations.

Accountable care organizations (ACOs) aim to improve healthcare quality and reduce spending. Telemedicine, or the remote delivery of healthcare services using a variety of telecommunications devices, offers the potential to advance these goals by expanding patients’ timely access to care, reducing costs, and enabling better coordination of care among providers and care settings (1). Recognizing the potential value telemedicine offers to ACOs, the Centers for Medicare & Medicaid Services (CMS) provided fraud and abuse waivers protecting ACO participants who share in the costs of telemedicine services. CMS is now proposing additional changes to the Medicare Shared Savings Program to further accelerate telemedicine use (2). While Medicare policy to promote telemedicine has largely focused on ACOs, the current use of telemedicine by ACO providers is unknown.

Engaging telehealth to drive value-based urology

Telehealth, or the remote delivery of healthcare services using telecommunications technology, has the potential to revolutionize the delivery of healthcare and contribute to ongoing efforts to provide high-value care. We discuss several categories of telehealth that have been applied to healthcare. Several of these approaches, in particular video visits and teleconsultations, have promising early data demonstrating the significant benefits of telehealth technology with respect to the quality of care, access, cost savings, and patient experience. Nonetheless, considerable knowledge gaps still exist regarding how and for which patients and diseases telehealth modalities should be applied. Finally, we discuss the barriers to widespread adoption at the institutional, state, and federal levels. Maximizing the value of healthcare is an important goal for hospitals, physicians, and policymakers. Telehealth leverages advances in technology and the widespread availability of telecommunications devices to make healthcare communication more available, more convenient, and more efficient for patients and providers. With appropriate policies and incentives, telehealth initiatives can improve the value of urologic care and smooth the transition to a value-based healthcare system.