Synchronous Teleconsultation Research Articles

Telediagnosis as an effective tool for assessment temporomandibular disorders.

The use of communication technologies has allowed a substantial improvement in telediagnosis. To evaluate the feasibility and diagnostic agreement of synchronous teleconsultation compared to physical standard examination for temporomandibular disorders (TMD) and orofacial pain. Sixty-one patients (50 women, 11 men) with a mean age of 46.07 years referred to the Orofacial Pain Ambulatory Service (SAMDOF -UFPR) were evaluated remotely. They were then examined in person by another evaluator, blinded for the first evaluation. Data on the experience and level of satisfaction with the teleconsultation were also collected. For each type and subtype of TMD, diagnostic agreement values, sensitivity, specificity, positive predictive values and negative predictive values were calculated with a 95% confidence interval. 'Almost perfect' agreement was found for Myalgia (k = 0.915), Arthralgia (k = 0.863), disc displacement without reduction without limited opening (k = 0.955) and no TMD (k = 1.00). 'Substantial' agreement for the subtypes headache attributed to TMD (k = 0.761), disc displacement without reduction with limited opening (k = 0.659) and subluxation (k = 7.82). The diagnoses of local myalgia (k = 0.573), myofascial pain with referral (k = 0.524) and disc displacement with reduction (k = 0.563) obtained 'moderate' agreement. Degenerative joint disease (k = 0.170) and disc displacement with reduction with intermittent locking (k = 0.000) obtained 'weak' and 'no agreement', respectively. More than 90% of the participants were satisfied and reported no discomfort during the assessment, agreeing to participate in another teleconsultation. Synchronous teleconsultation proved to be feasible and presented adequate diagnostic agreement for the main painful TMDs, especially for the diagnosis of myalgia and arthralgia. This format was also well accepted among patients.

Impact of telenurse-led intervention in clinical trials on health literacy, empowerment, and health outcomes in patients with solid tumours: a pilot quasi-experimental study

BackgroundDuring the COVID-19 pandemic, decentralised clinical trials incorporated self-monitoring, self-reporting, and telenursing tools to address health literacy and health empowerment of patients enrolled in clinical trials. We aimed to determine the impact of an educational intervention using telenursing consultations on health literacy, health empowerment, and health-related quality of life in cancer patients enrolled in clinical trials by measuring the level of satisfaction with the care received and assessing the views of healthcare professionals concerning the advanced practice nurse (APN) role in oncology clinical trials.MethodsIn this pilot analytical, descriptive, longitudinal, quasi-experimental, and pre-post test study, an educational intervention was conducted by 5 visits with an APN using synchronous teleconsultation in patients starting cancer treatment for the first time in a clinical trial (n = 60), and health professionals working with the APN (n = 31). A descriptive analysis of the samples and questionnaires were utilised along with statistical comparisons.ResultsAfter the intervention, patients' health literacy (31.7%), health empowerment (18.3%), and health-related quality of life (33.3%) increased (p < 0.05), with a decrease and trend towards resolution of care needs (p < 0.05). Satisfaction with the quality and care received in terms of perceived convenience, transition, and continuity of care showed positive results in 64.9 ± 20.7, 77.6 ± 19.5, and 72.1 ± 20.4 of respondents, respectively. On the overall assessment of the APN role, healthcare professionals expressed a high level of agreement with the statements related to their work performance.ConclusionsThe data indicates that a clinical trial APN-led telenursing educational intervention results in an overall increase in health literacy, an improvement in health empowerment and health-related quality of life, and a decrease in care needs of oncology clinical trials patients. Patients stated that they received a high quality of care and health professionals indicated high levels of acceptance with APNs. Based on these results, we suggest that the APN role should gain more recognition in the Spanish healthcare system and their professional competencies should be aligned with those of other countries.

ATA2023Annual Conference &amp; ExpoMarch 4–6, 2023San Antonio, Texas

ATA2023Annual Conference &amp; ExpoMarch 4–6, 2023San Antonio, Texas

Effectiveness of synchronous teleconsultation for patients with type 2 diabetes mellitus: a systematic review and meta-analysis

The popularity of teleconsultation during the COVID-19 pandemic enabled increased accessibility for individuals with type 2 diabetes mellitus (T2DM). However, previous studies did not distinguish between synchronous and asynchronous teleconsultation....

Synchronous teleconsultation and monitoring service targeting COVID-19: leveraging insights for post-pandemic healthcare.

Although a great number of teleconsultation services have been developed during COVID-19 pandemic, studies assessing usability and healthcare provider satisfaction are still incipient. To describe the development, implementation and expansion of a synchronous teleconsultation service targeting patients with symptoms of COVID-19 in Brazil, as well as to assess its usability and healthcare professionals' satisfaction. This mixed-methods study was developed in five phases: (i) identification of components, technical and functional requirements and system architecture; (ii) system and user interface development and validation; (iii) pilot testing in the city of Divinópolis; (iv) expansion in the cities of Divinópolis, Teófilo Otoni and Belo Horizonte for Universidade Federal de Minas Gerais faculty and students; (v) usability and satisfaction assessment, using Likert scale and open-ended questions. During pilot development, problems to contact users were solved by introducing standardized text messages (SMS) sent to them to obtain their feedback and keep track of them. Until April, 2022, the expanded system achieved 31,966 patients in 146,158 teleconsultations. Teleconsultations were initiated through chatbot in 27,69% of cases. Teleconsultation efficiency per city was 93.7% in Teófilo Otoni, 92.4% in Divinopolis, and 98.8% in Belo Horizonte (university campus), avoiding in-person assistance for the great majority of patients. 60 healthcare professionals assessed the system's usability as satisfactory, despite a few system instability problems. The system provided updated information about COVID-19 and enabled remote care for thousands of patients, which evidenced the critical role of telemedicine in expanding emergency services capacity during the pandemic. The dynamic nature of the current pandemic required fast planning, implementation, development and updates in the system. Usability and satisfaction assessment was key to identifying areas for improvement. The experience reported here is expected to inform telemedicine strategies to be implemented in a post-pandemic scenario.

Service process factors affecting patients’ and clinicians’ experiences on rapid teleconsultation implementation in out-patient neurology services during COVID-19 pandemic: a scoping review

BackgroundThe adoption of teleconsultation for outpatient neurology services was limited until the onset of the COVID-19 pandemic which forced many outpatient neurology services to rapidly switch to virtual models. However, it remains unclear how this change has impacted patients’ and clinicians’ perceptions of service quality. The purpose of this scoping review is to identify process factors that influence patients’ and clinicians’ experiences of outpatient teleconsultation services during COVID-19.MethodsArksey and O’Malley scoping review framework was used to search PubMed, Scopus, CINAHL, and PsycInfo for original peer-reviewed research studies that examined the experiences of synchronous teleconsultation between a clinician and patient in a home-setting since the World Health Organization announced the COVID-19 global pandemic. The service quality model SERVQUAL was used to conduct a deductive thematic analysis to identify the key factors that impacted the patients’ and clinicians’ perception of teleconsultation services.ResultsA total of nineteen studies published between January 1, 2020, and April 17, 2021, were identified. The most common service process factors affecting the patients’ and clinicians’ experiences of teleconsultation were technical issues, addressing logistical needs, communication, ability to perform clinical activities, appropriate triage, and administrative support.ConclusionsOur findings identified six key service process factors affecting the patients’ and clinicians’ teleconsultation experiences in outpatient neurology services. The need for improvement of triage process and standardizing administrative virtual care pathway are identified as important steps to improve patients and clinicians’ teleconsultation experiences compared to pre-COVID era. More research is needed to assess outpatient neurology teleconsultation service quality from patients’ and clinicians’ perspectives.

Teleconsultations at a Pediatrics Outpatient Service in COVID-19 Pandemic: First Results.

Objective: Describe our experiences using teleconsultation approach to care for pediatric subspecialty follow-up patients during pandemic period. Methods: Synchronous teleconsultation solution was developed and implemented as a multiplatform/multimodality service, capable or running on desktop browsers and smartphones, and capable to handle chat, audio, and video. Term of consent was applied. Absolute number and percentage of patients assisted, as well as the form of consultation and the mean of attendance per patient were presented. Results: A telemedicine service was started using tools provided by The Santa Catarina State Integrated Telemedicine and Telehealth System offering real-time chat, through an online-based teleconsultation service. We assisted 75 patients in 109 consultations in 3 months, of which 69.7% were performed by chat. Mean of consultations per patient was 1.45. Conclusion: To our knowledge this is the first service in offering this modality of medicine for Brazilian public health care system. Patients and health care personnel reported satisfaction.

Use of smartphone video calls in the diagnosis of oral lesions: Teleconsultations between a specialist and patients assisted by a general dentist

BackgroundTeleassistance in dentistry enables the support of dentists in areas without access to specialists. The aim of this study was to assess the feasibility and accuracy of synchronous teleconsultation in oral medicine. MethodsPatients referred for specialized care owing to oral lesions were evaluated in person by a general dentist who obtained photographs of the lesions with a smartphone. The images were sent via a mobile application to an oral medicine specialist, with whom a video call was initiated on the same instant messaging application. After interviewing the patient, the specialist formulated a diagnostic hypothesis and suggestions for case management. Then a second specialist, blinded to the first evaluation, assessed the oral lesion in person and defined a diagnosis, which was considered as the reference standard. Diagnoses from the remote and the face-to-face consultations were compared in percentage levels of agreement and κ coefficient. ResultsThirty-three patients, 25 through 83 years old, had 41 oral lesions. The average teleconsultation length was approximately 10 minutes. In 92.7% of the cases, there was concordance between the telediagnosis and the reference standard (κ = 0.922). ConclusionsSynchronous teleconsultation can provide reliable remote diagnosis through the support to primary care health care professionals in management of oral lesions. Practical ImplicationsEarlier diagnosis of malignancies, improvement of access for unassisted populations, and reduction of unnecessary referrals are possible practical implications of remote support of a specialist in the management and diagnosis of oral lesions.

SYNCHRONOUS TELECONSULTATION IN ORAL MEDICINE

Objective: To assess the feasibility and accuracy of synchronous teleconsultation in oral medicine. Study Design: Individuals referred for specialized care due to oral lesions were evaluated in person by a general dentist who took photographs of the lesions with a smartphone. The images were sent through WhatsApp application to an oral medicine specialist, with whom a video call was initiated on the same instant messaging application. After interviewing the patient, the specialist gave a diagnostic hypothesis and suggestions for conduct. After the call ended, a second specialist, blinded to the first evaluation, assessed the oral lesion in person and suggested a diagnostic hypothesis. Results: Twenty-eight individuals, from 25 to 83 years old, presented with 32 lesions. Most participants (57%) used buses to get to the consultation and 32% of the sample was not from the city where the study was conducted. The average teleconsultation length was 11 minutes. The most frequent hypothesis was non-neoplastic proliferative processes (32%). In 81% of the cases, there was concordance between specialists regarding diagnostic hypotheses, reaching an almost perfect agreement (κ = 0.835). Conclusion: Synchronous teleconsultation can increase and accelerate diagnosis through the support of health professionals from primary care in oral lesions management.

Tecnologias de informação e comunicação para formação profissional em Odontologia: uma proposta do Telessaúde/ES

O Telessaúde/ES, com o auxílio de Tecnologias de Informação e Comunicação (TIC), promove a ampliação da Educação Permanente à Saúde (EPS) aos profissionais atuantes nas equipes de Estratégia Saúde da Família (ESF) do estado do Espírito Santo. O presente estudo objetivou apresentar uma proposta de um ambiente virtual em Odontologia, no âmbito do Telessaúde/ES, proporcionando um espaço exclusivo de compartilhamento de informações às Equipes de Saúde Bucal (ESB). Trata-se de uma pesquisa-ação, método adequado para propor soluções para a melhoria do acesso e utilização das ferramentas do Telessaúde/ES pelas ESB mediante às necessidades identificadas. Em 2017, o Telessaúde Bucal iniciou suas atividades no Telessaúde/ES, disponibilizando os serviços de webpalestras, teleconsultorias assíncronas e síncronas e materiais oficiais da área, ofertados na última sexta-feira de cada mês. O ambiente virtual de Telessaúde Bucal apresentado estará incluso no espaço de “Programas Especiais”, permitindo o acesso a qualquer serviço. O Telessaúde Bucal é um serviço que poderá promover conhecimento e troca de experiências para a efetivação da EPS, estimulando maior participação dos profissionais da Odontologia.

PWE-132 Is The NHS Ready for Video-Conference Consultations in Outpatient Clinics?

Introduction Past literature has explored qualitative differences between teleconsultation and conventional face-to-face consultation in the context of diabetes care. However, designing the algorithm of such innovative consultations necessitates inclusion of patients’ ideas and concerns so as to optimise their practicality and be adequately tailored to patients’ needs. Hence, the Centre of Gastroenterology at the Royal Free Hospital in London decided to involve patients through a questionnaire focusing on the design of synchronous teleconsultation through video-conferencing. Methods We aimed to identify: 1)Patients’ responses to introducing video-conferencing and explore factors contributing to their decision and 2)Patient groups in which video-conferencing would be more applicable. We analysed responses of 137 patients attending the gastroenterology outpatient clinic between April-August 2015. ‘Positive response’ (PR) was defined as patients who would consider a video-conference consultation compared to a conventional face-to-face method/’negative response’ (NR). Further analysis identified potential factors contributing to a PR such as age and employment status as well as device, software and consultation type preferences. We were also interested as to whether video-conferencing would improve patient attendance. Results PRs (n = 68): Also refer to figure 1. >50% were The majority had current/previous work experience (full-time 62%,part-time 62% and retired 68%). Patients indicated preference towards bigger screens:computer(56%), portable device(47%) and smartphone(36%). 70% preferred Skype and 30% facetime while 1/3 preferred having a video-conference as their 1st appointment and 2/3 as their follow-up. 41% indicated they would be more likely to attend a video-conference compared to 59% who indicated their attendance would either decrease or remain unaffected. Reasons for NRs (n = 69) Lack of confidence with device (57%), Lack of privacy at home/work(12%) and Other reasons (38%). Conclusion Results suggested that a traditional face-to-face interaction is more suitable for a first consultation, however video-conferencing could be a beneficial alternative for follow-up.Video-conferencing would be more applicable to patients aged Disclosure of Interest None Declared

Teleaudiologia: comunicação profissional-paciente na programação e adaptação de aparelhos de amplificação sonora individuais via teleconsulta

Objetivo Avaliar se a teleconsulta afeta a comunicação profissional-paciente e a satisfação com o atendimento para programação e adaptação do aparelho de amplificação sonora individual (AASI), em comparação à consulta presencial. Métodos Quarenta candidatos ao uso do AASI, com idade superior a 18 anos e perda neurossensorial simétrica, de grau leve a severo, foram distribuídos aleatoriamente, em grupos controle (presencial) e experimental (teleconsulta síncrona assistida por um facilitador). As consultas foram filmadas, cronometradas e seu conteúdo analisado, de acordo com o “Código de Observação de Davis” (DOC). Os participantes também responderam ao “Questionário de Experiência do Paciente” (PEQ), para avaliar a satisfação com a consulta. Resultados Nas teleconsultas, as explicações do profissional sobre a estrutura da consulta e realização de procedimentos foram mais frequentes e expressões espontâneas do participante sobre a sua condição foram menos observadas do que nas consultas presenciais. Não houve diferença entre os grupos, quanto às seguintes dimensões do PEQ: “Resultados da Consulta”, “Barreiras de Comunicação”, “Experiência de Comunicação”. Pontuações significativamente maiores foram obtidas para a teleconsulta na dimensão “Emoções após a Consulta”. O grupo experimental teve experiência positiva com a presença do facilitador. Conclusão Houve impacto da condução da programação e adaptação do AASI, via teleconsulta, em alguns aspectos da comunicação profissional-paciente sem, contudo, afetar a satisfação do paciente quanto ao serviço recebido.

Telenutrition: An Integrated Approach to Delivering Medical Nutrition Therapy to Bariatric Surgery Patients via Synchronous Teleconsultation

Bariatric surgery has emerged as a safe and effective means to substantial weight loss with subsequent resolution of comorbid conditions, improvement in quality of life, and increased longevity for the morbidly obese. Achieving significant and sustained weight loss following surgery requires lifelong dietary and behavior modifications. Bariatric patients are challenged to adhere to the postoperative plan and the clinician to provide the necessary support services to promote the patient’s adherence. Long-term outcomes rely on lifelong patient adherence and follow-up care. Dietary management is central to weight loss, and medical nutrition therapy (MNT) provides the patient with the knowledge and skills needed to modify dietary behaviors. Telenutrition offers a novel and innovative approach to nutritional counseling for bariatric patients who might otherwise have limited or no access. This article presents the use of synchronous teleconsultation to augment patient care following bariatric surgery by connecting patients with the registered dietitian through web conferencing. The objectives of this multicomponent telenutrition program are to improve patient access to MNT, augment clinician–patient interaction between office visits, increase patient satisfaction, and improve patient adherence to prescribed treatment plans, thereby optimizing both short- and long-term outcomes following bariatric surgery.

System of telesonography with synchronous teleconsultations and asynchronous telediagnoses (Togo)

Objectif. Concevoir un systeme de tele-expertise echographique, en temps reel et a bas prix, et de telediagnostic echographique en differe, entre un centre expert (CHU) et un site isole (hopitaux peripheriques et dispensaires). Materiels et methodes. Un systeme de communication via Internet transferant des videos echographiques et d’ambiance entre les deux sites permet une tele-expertise en temps reel, en presence d’un echographiste peu experimente sur le site isole. Si le site isole ne dispose pas d’echographiste, un operateur non initie realise une capture volumique par mouvements de tilt de ± 40 par rapport a la verticale avec une sonde echographique en deux dimensions (2D) en se servant d’une cartographie de localisation des fenetres acoustiques. Un programme de reconstruction tridimensionnelle (3D) original permet a l’expert de naviguer dans le volume d’image envoye par le centre isole pour un telediagnostic en differe. Resultats. Le systeme a ete teste entre le CHR Tsevie (Togo) et les CHU experts de Campus (Lome, Togo) et de Trousseau (Tours, France) avec une connexion Internet moyenne de 2 Mbps. Une tele-expertise en temps reel etait realisee a partir des videos echographiques de qualite tres satisfaisante acheminees avec un delai maximal de 1,5 s. Un telediagnostic echographique en differe etait aussi realise avec des resultats satisfaisants. Conclusion. Ce systeme de tele-echographie necessitant une infrastructure peu onereuse, et presentant des resultats preliminaires satisfaisants, constitue une methode de telemedecine, utilisable tant dans les pays developpes que dans les pays en developpement.

Telessaúde: avaliação da eficácia da teleconsulta na programação e adaptação de aparelho de amplificação sonora individual

To evaluate teleconsultation's efficacy for hearing aid fitting. Fifty hearing impaired individuals with ages ranging from 39 to 88 years and mean audiometric thresholds between 30 and 68.75 dBHL participated in this study. Participants were divided into two groups (stratified randomization): control group (n=25), submitted to face-to-face procedures, and experimental group (n=25), submitted to synchronous teleconsultation with interactive video and remote applicative control. The hearing aids were programmed and verified (with microphone probe), and the subjects received instructions regarding use and care for the device. Time taken for the procedures was measured. Following the consultations, an evaluator (blind to the groups) applied the Hearing in Noise Test (HINT-Brazil). Approximately one month after consultations, the daily time of hearing aid use was verified, and the International Outcome Inventory for Hearing Aids (IOI-HA) was administered. A greater time for programming and verification and a smaller time for orientation were observed for the experimental group. No difference was found between groups for the total consultation time. The real ear measures' matching to their respective targets was similar for both groups. No difference was observed between groups for the HINT results (silence and noise), the daily amount of use of hearing aids in hours, and the IOI-HA scores. Teleconsultation is an efficient procedure for hearing aid programming, verification and fitting when face-to-face services are not available.

Asynchronous and synchronous teleconsultation for diabetes care: a systematic literature review.

A systematic literature review, covering publications from 1994 to 2009, was carried out to determine the effects of teleconsultation regarding clinical, behavioral, and care coordination outcomes of diabetes care compared to usual care. Two types of teleconsultation were distinguished: (1) asynchronous teleconsultation for monitoring and delivering feedback via email and cell phone, automated messaging systems, or other equipment without face-to-face contact; and (2) synchronous teleconsultation that involves real-time, face-to-face contact (image and voice) via videoconferencing equipment (television, digital camera, webcam, videophone, etc.) to connect caregivers and one or more patients simultaneously, e.g., for the purpose of education. Electronic databases were searched for relevant publications about asynchronous and synchronous tele-consultation [Medline, Picarta, Psychinfo, ScienceDirect, Telemedicine Information Exchange, Institute for Scientific Information Web of Science, Google Scholar]. Reference lists of identified publications were hand searched. The contribution to diabetes care was examined for clinical outcomes [e.g., hemoglobin A1c (HbA1c), dietary values, blood pressure, quality of life], for behavioral outcomes (patient-caregiver interaction, self-care), and for care coordination outcomes (usability of technology, cost-effectiveness, transparency of guidelines, equity of access to care). Randomized controlled trials with HbA1c as an outcome were pooled using standard meta-analytical methods. Of 2060 publications identified, 90 met inclusion criteria for electronic communication between (groups of) caregivers and patients with type 1 and 2 or gestational diabetes. Studies that evaluated teleconsultation not particularly aimed at diabetes were excluded, as were those that described interventions aimed solely at clinical improvements (e.g., HbA1c or lipid profiles). In 63 of 90 interventions, the interaction had an asynchronous teleconsultation character, in 18 cases interaction was synchronously (videoconferencing), and 9 involved a combination of synchronous with asynchronous interaction. Most of the reported improvements concerned clinical values (n = 49), self-care (n = 46), and satisfaction with technology (n = 43). A minority of studies demonstrated improvements in patient-caregiver interactions (n = 28) and cost reductions (n = 27). Only a few studies reported enhanced quality of life (n = 12), transparency of health care (n = 7), and improved equity in care delivery (n = 4). Asynchronous and synchronous applications appeared to differ in the type of contribution they made to diabetes care compared to usual care: asynchronous applications were more successful in improving clinical values and self-care, whereas synchronous applications led to relatively high usability of technology and cost reduction in terms of lower travel costs for both patients and care providers and reduced unscheduled visits compared to usual care. The combined applications (n = 9) scored best according to quality of life (22.2%). No differences between synchronous and asynchronous teleconsultation could be observed regarding the positive effect of technology on the quality of patient-provider interaction. Both types of applications resulted in intensified contact and increased frequency of transmission of clinical values with respect to usual care. Fifteen of the studies contained HbA1c data that permitted pooling. There was significant statistical heterogeneity among the pooled randomized controlled trials (chi(2) = 96.46, P < 0.001). The pooled reduction in HbA1c was not statically significant (weighted mean difference -0.10; 95% confidence interval -0.39 to 0.18). The included studies suggest that both synchronous and asynchronous teleconsultations for diabetes care are feasible, cost-effective, and reliable. However, it should be noted that many of the included studies showed no significant differences between control (usual care) and intervention groups. This might be due to the diversity and lack of quality in study designs (e.g., inaccurate or incompletely reported sample size calculations). Future research needs quasi-experimental study designs and a holistic approach that focuses on multilevel determinants (clinical, behavioral, and care coordination) to promote self-care and proactive collaborations between health care professionals and patients to manage diabetes care. Also, a participatory design approach is needed in which target users are involved in the development of cost-effective and personalized interventions. Currently, too often technology is developed within the scope of the existing structures of the health care system. Including patients as part of the design team stimulates and enables designers to think differently, unconventionally, or from a new perspective, leading to applications that are better tailored to patients' needs.