Teleconsultation Program Research Articles

Early detection of severe hypertriglyceridemia using teleconsultation in a clinical laboratory setting

BackgroundTeleconsultation in the context of clinical laboratories is a valuable tool for the early detection of dyslipidemia and prevention of cardiovascular risk. Here, we describe a patient who was referred to the Lipid Unit of the Virgen Macarena Hospital due to an alert for severe hypertriglyceridemia through its teleconsultation program. Case presentationA comprehensive clinical and biochemical study of the patient was carried out, and genetic testing was performed on the patient and his family. The proband and his family showed mild to severe hypertriglyceridemia and various secondary factors, together with a genetic background associated with a triglyceride-raising effect. ConclusionThis extensive study has identified a family at high risk of cardiovascular disease and acute pancreatitis. These findings can help maximize lifestyle changes and improve the clinical management of their dyslipidemia.

Clinician Stakeholder Experience With Telemedicine Consults to Assess Neonatal Encephalopathy in a Rural State

BackgroundSerial neonatal encephalopathy (NE) examinations are difficult to perform in rural community hospitals as on-site experts are not readily available. We implemented a synchronous, acute care model of teleconsultation—the Maine Neonatal Encephalopathy Teleconsultation program (Maine NET)—to provide remote, joint assessment of NE by pediatric neurology and neonatology at nine community hospitals and one tertiary care center. We performed a qualitative study to interview clinicians about their experience of this program. MethodsFrom April 2018 to October 2022, we employed a semistructured interview format with 16 clinicians representing all participating hospitals. We utilized deductive analysis to assign a set of predefined codes to the transcribed interviews. ResultsThematic analysis supported the anticipated benefits of Maine NET, demonstrating that clinicians felt resource utilization, collaborative decision making, communication, and continuity of care were improved. Clinicians overwhelmingly supported the program: “This program has truly saved babies' lives and future function. I have not met any parents through this journey, who aren't incredibly grateful for the care that is provided” and emphasized the benefit of collaboration between all care team members. Teleconsultation was felt to be “more than adequate to [assess] NE.” Connectivity issues were cited as a limitation. ConclusionsMaine NET has positively impacted care delivery for newborns with clinical concerns for NE. Additionally, the program has improved resource allocation, collaborative decision making, communication, and equity of care. Addressing technological challenges will be vital to the success and sustainability of the planned Maine NET expansion.

Early detection of severe hypertriglyceridemia using teleconsultation in a clinical laboratory setting

BackgroundTeleconsultation in the context of clinical laboratories is a valuable tool for the early detection of dyslipidemia and prevention of cardiovascular risk. Here, we describe a patient who was referred to the Lipid Unit of the Virgen Macarena Hospital due to an alert for severe hypertriglyceridemia through its teleconsultation program. Case presentationA comprehensive clinical and biochemical study of the patient was carried out, and genetic testing was performed on the patient and his family. The proband and his family showed mild to severe hypertriglyceridemia and various secondary factors, together with a genetic background associated with a triglyceride-raising effect. ConclusionThis extensive study has identified a family at high risk of cardiovascular disease and acute pancreatitis. These findings can help maximize lifestyle changes and improve the clinical management of their dyslipidemia.

La téléconsultation, une modalité prometteuse pour les programmes psychoéducatifs destinés aux parents d’enfants ayant un trouble du spectre de l’autisme

The disclosure to parents of a diagnosis of Autism Spectrum Disorder (ASD) for a child has an impact on their mental health and well-being. Programs have been established to support them. One of these programs, “Beyond ASD, parenting skills within my reach!”, created in Quebec, has been tested and validated on Quebec and French populations. So far, the evaluation of the effects of the program on a Canadian population showed interesting results regarding knowledge about ASD, parents’ use of strategies, locus of control, and parental stress, but these variations and positive changes were also observed in a control group with access to another form of intervention. The preliminary results for a French population indicated that parents appeared to be significantly less stressed, and they improved certain areas of their quality of life. These results showed the need to offer support to parents after they were given a diagnosis of autism for their child as a post-diagnosis proposal. Nevertheless, parents are often overwhelmed after their child's diagnosis, because of the accumulation of work, school and specific interventions for their child. French parents also experience difficulties due to transportation problems in the Île-de-France region. The COVID-19 sanitary restrictions only served to heighten these difficulties. Therefore, professional mental healthcare providers aimed to pursue offering a program to parents following the diagnosis of their child in spite of these constraints. Moreover, recent studies have demonstrated the efficacy of teleconsultation for healthcare treatments. The objectives of the present study were to quantitatively assess parental satisfaction and their perception of change in their parenting skills after they participated in the program delivered through teleconsultation, and how they qualitatively expressed themselves about the advantages and limits of the teleconsultation modality. We also sought to be able to determine to which type of parents this program could be recommended, the expected benefits for parents in terms of shared experience, learning and exchanges, and finally to evaluate the program itself as a post-diagnosis proposal. The study involved fourteen parents of children with ASD: eleven French and three French Canadians. The quantitative results showed an average satisfaction of 95.36% and an acceptability of 89.46% of the total score; the qualitative results indicated the satisfaction of parents who participated in the teleconsultation program in France and Quebec. They are consistent with the results obtained in face-to-face sessions. The results show the benefits for parents who used the teleconsultation program, while allowing a greater number of people to participate. This preliminary study of the feasibility and acceptability of the teleconsultation modality for parents of children with ASD makes it possible to consider a validation of this new modality. The quantitative and qualitative data demonstrated that parents reported acquiring new skills at a crucial period for them when they felt the increased needs and challenges in their perceived competencies to deal with self-efficacy and stress compared to other parents. The results confirmed parental interest in psychoeducational programs after their child had been given an ASD diagnosis. They were satisfied with the relationship they had with the professionals and other parents in the teleconsultation program. The results also indicated they felt respected and understood. The use of teleconsultation didn’t seem to interfere with these feelings and helped them during a difficult personal time. The limits of the present study include a possible social bias, a limited number of subjects, and a possible inequality in the participants’ ability to use digital media. Whereas diagnosis and parental intervention represent a societal stake, we need to adapt programs involving new modalities in order to reach the largest number of parents possible, and we need to remain mindful to follow recommendations and parental feedback regarding the necessity of maintaining informal time to encourage exchanges between parents. New challenges seem to be raised and considered for future implementation.

Abstract CT293: eCAN Project : The EU Joint Action on strengthening eHealth including telemedicine and telemonitoring for cancer prevention and care

Abstract The integration of telemedicine tools such as teleconsultation and telemonitoring in cancer patients care may allow to improve person-centered care and patients’ empowerment. The eCAN JA (https://ecanja.eu/) explores the role of telemedicine tools in clinical trials focusing on tele-rehabilitation and tele-psychological support in different populations of cancer patients in 10 European countries.The main aim is to assess the effect of teleconsultation and telemonitoring program focused on rehabilitation and psychological support for cancer patients on patient reported outcomes measures (PROMs) in three different pilot randomized controlled trials. MethodsThe pilot trials have been launched in September 2023 in 10 European countries with a multicentric, prospective, randomized, open label design in patients affected by Breast Cancer (BC) (Pilot 1a), Head and Neck (H&N) (Pilot 1b) and advanced cancer (Pilot 2). According to the sample size calculation, the aim is to enroll a minimum of 354 patients, in 18 European cancer centers. Patients are randomly assigned either to the intervention or control group using a 1:1 ratioThe main objectives of the pilots are: 1-To assess the effect of teleconsultation program and telemonitoring focused on rehabilitation for patients with BC (1a) and H&N (1b) cancer on the PROMs (quality of life (QoL) and pain) compared to usual care.2-To assess the effect of teleconsultation program and telemonitoring focused on psychological support for patients with advanced cancer (pilot 2) on the PROMs (QoL and distress thermometer) compared to usual care. Patients in the intervention group receive weekly teleconsultation during 8 weeks through the secure Edumeet platform. In pilot 1, tele-rehabilitation training is performed by a remote physiotherapist and consist of a series of revalidation exercises. In pilot 2, tele-psychological support is performed by a remote psychologist and consist of techniques for managing emotions and stress.PROMs data will be collected longitudinally during the intervention with dedicated digital application (eCAN app) and distant Telemonitoring with eCAN dashboard. Patients in the control group receive usual (in person) care. Results64/354 patients have been enrolled at present. An interim analysis is planned for the end of January 2024 in order to assess feasibility, patients compliance and dropout rate.. ConclusionThe integration of telemedicine tools such as teleconsultation and telemonitoring may allow to improve person-centered care and patients’ empowerment. The results of the eCAN project will improve our knowledge on benefits and risks for teleconsultation and telemonitoring in cancer patients care and will facilitate health care professionals’ skills in communication with patients and their families in the context of remote care and telemedicine. Co-funded by the European Union (Grant number: 101075326). Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or HaDEA. Neither the European Union nor the granting authority can be held responsible for them. Citation Format: Andrea Pace, Vittorio Castaldo, Marco G. Paggi, Efthyvoulos Kyriacou, Christina Plomariti, Magdalena Rosinska, Tugce Schmitt, Victoria Leclercq, eCAN WP5 research team. eCAN Project : The EU Joint Action on strengthening eHealth including telemedicine and telemonitoring for cancer prevention and care [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT293.

Infant and early childhood teleconsultation and training: Program description and feasibility outcomes from a statewide implementation.

To address high rates of mental health and developmental concerns facing young children ages 0-6 in the United States and internationally, providers across professional sectors need Infant and early childhood mental health (IECMH) training and support. The training and teleconsultation program (TTP) is a state-funded program developed in one Mountain West state in the United States to provide free IECMH training and teleconsultation to any provider working with young children. The TTP included access to webinars and individual or group consultation with licensed mental health providers. Webinars focused on increasing awareness and knowledge related to attachment and child development, supporting parents and caregivers, trauma-informed practice, supporting emotional health of staff and providers, and culturally responsive practices with infants, young children, and caregivers. Teleconsultation included case consultation, reflective individual and group supervision, and collaboration supports/referrals. During the 18-month evaluation period, 1568 unique providers engaged in either training or teleconsultation services, an average of 9% growth in new providers each month, with representation from all professional sectors and all state counties. This program demonstrates the feasibility and need for statewide training and teleconsultation programs to help meet the needs of providers who interact with and support young children and caregivers.

COVID-19 teleassistance and teleconsultation: a matched case-control study (MIRATO project, Lombardy, Italy).

During the COVID-19 pandemic, telemedicine has been recognised as a powerful modality to shorten the length of hospital stay and to free up beds for the sicker patients. Lombardy, and in particular the areas of Bergamo, Brescia, and Milan, was one of the regions in Europe most hit by the COVID-19 pandemic. The primary aim of the MIRATO project was to compare the incidence of severe events (hospital readmissions and mortality) in the first three months after discharge between COVID-19 patients followed by a Home-Based Teleassistance and Teleconsultation (HBTT group) program and those discharged home without Telemedicine support (non-HBTT group). The study was designed as a matched case-control study. The non-HBTT patients were matched with the HBTT patients for sex, age, presence of COVID-19 pneumonia and number of comorbidities. After discharge, the HBTT group underwent a telecare nursing and specialist teleconsultation program at home for three months, including monitoring of vital signs and symptoms. Further, in this group we analysed clinical data, patients' satisfaction with the program, and quality of life. Four hundred twenty-two patients per group were identified for comparison. The median age in both groups was 70 ± 11 years (62% males). One or more comorbidities were present in 86% of the HBTT patients and 89% in the non-HBTT group (p = ns). The total number of severe events was 17 (14 hospitalizations and 3 deaths) in the HBTT group and 40 (26 hospitalizations and 16 deaths) in the non-HBTT group (p = 0.0007). The risk of hospital readmission or death after hospital discharge was significantly lower in HBTT patients (Log-rank Test p = 0.0002). In the HBTT group, during the 3-month follow-up, 5,355 teleassistance contacts (13 ± 4 per patient) were performed. The number of patients with one or more symptoms declined significantly: from 338 (78%) to 183 (45%) (p < 0.00001). Both the physical (ΔPCS12: 5.9 ± 11.4) component and the mental (ΔMCS12: 4.4 ± 12.7) component of SF-12 improved significantly (p < 0.0001). Patient satisfaction with the program was very high in all participants. Compared to usual care, an HBTT program can reduce severe events (hospital admissions/mortality) at 3-months from discharge and improve symptoms and quality of life. www.ClinicalTrials.gov, NCT04898179.

Interprofessional team based learning to enhance behavioral health care for Latinx patients: Results of a teleconsultation program.

Culturally sensitive behavioral health services are scarce, particularly in rural and underserved areas. To expand integrated behavioral health care training for providers, specifically those working in rural communities and federally qualified health centers, an interprofessional teleconsultation program was developed. Given the desire to focus on culturally informed care training, this was done in partnership with a nonprofit community mental health agency which focuses on behavioral health within Latinx populations. The teleconsultation sessions were provided bimonthly using Zoom and included didactic components and case-based discussion using the Multidimensional Ecosystemic Comparative Approach (MECA; Falicov, 1995; Falicov, 2017). Participants represented a diverse, interprofessional group composed of behavioral health professionals (45.2%), primary care physicians (26.8%), family medicine residents (15.3%), and others (medical students and administrative staff [12.7%]). The program evaluation demonstrates that participants valued the teleconsultation sessions and articulated specific skills that they subsequently planned to integrate into their clinical practice to enhance care. This teleconsultation model allows interprofessional training across multiple types of organizations to enhance knowledge in providing integrated behavioral health care for Latinx populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

“You can only help them save the patient once they trust you”: Clinician perspectives and theories of use of a pediatric emergency teleconsultation program

While telemedicine applications in low- and middle-income countries are growing rapidly, few studies address the social and organizational factors of implementation essential to sustaining clinician engagement. This study aims to explore clinician experiences and perspectives of a pediatric emergency teleconsultation support program in Sindh, Pakistan, and theories of use behind its implementation in government hospitals. We conducted in-depth interviews with 20 stakeholders of the teleconsultation program, including program administrators (n ​= ​3), teleconsultants (n ​= ​7) and on-site physicians and nurses (n ​= ​10) purposively sampled for maximum variation across perceived fidelity and acceptability on a preliminary questionnaire. Interview questions and probes were designed to elicit rich perspectives on communication structures, enabling and constraining factors, and overall effects of teleconsultation on clinical routines and quality of care. Transcripts were analyzed thematically using combined inductive and deductive coding. We found that, behind the technical adaptation to using telemedicine in the resuscitation room, providers perceived a dynamic reconfiguration of professional roles and routines of consultation according to opportunities and constraints associated with mutual confidence or trust, constructions of distance, subjectivity of information, and the interface of technological artifacts with medical practice. Descriptions of communication patterns revealed an unstable tension between two competing theories of use premised on either inherent contextual differences or presumed asymmetries in expertise. Long-term sustainability of telemedicine applications to pediatric emergency care requires serious consideration of how such conflicting theories of use and their associated assumptions about end-user needs crystallize in practice and affect clinician engagement and perceived benefits to patient care in the future.

Content of Tele-Palliative Care Consultations with Patients Receiving Dialysis.

Background: Little is known about the content of communication in palliative care telehealth conversations in the dialysis population. Understanding the content and process of these conversations may lead to insights about how palliative care improves quality of life. Methods: We conducted a qualitative analysis of video recordings obtained during a pilot palliative teleconsultation program. We recruited patients receiving dialysis from five facilities affiliated with an academic medical center. Palliative care clinicians conducted teleconsultation using a wall-mounted screen with a camera mounted on a pole and positioned mid-screen in the line of sight to facilitate direct eye contact. Patients used an iPad that was attached to an IV pole positioned next to the dialysis chair. Conversations were coded using a preexisting framework of themes and content from the Serious Illness Conversation Guide (SICG) and revised Edmonton Symptom Assessment System-Renal. Results: We recruited 39 patients to undergo a telepalliative care consultation while receiving dialysis, 34 of whom completed the teleconsultation. Specialty palliative care clinicians (3 physicians and 1 nurse practitioner) conducted 35 visits with 34 patients. Median (interquartile range) duration of conversation was 42 (28-57) minutes. Most frequently discussed content included sources of strength (91%), critical abilities (88%), illness understanding (85%), fears and worries (85%), what family knows (85%), fatigue (77%), and pain (65%). Process features such as summarizing statements (85%) and making a recommendation (82%) were common, whereas connectional silence (56%), and emotion expression (21%) occurred less often. Conclusions: Unscripted palliative care conversations in outpatient dialysis units through telemedicine exhibited many domains recommended by the SICG, with less frequent discussion of symptoms. Emotion expression was uncommon for these conversations that occurred in an open setting.

A Teleconsultation on a Patient Presenting with Acute Hemichorea Led to a Successful Treatment: A Case Report

Although hemichorea is a rare manifestation of acute ischemic stroke, in cases of sudden onset of hemichorea, acute stroke should always be considered first. Physicians should also be aware of other neurological deficit, dysarthria, facial weakness, or other signs of cortical abnormalities since these deficits may be masked by the hyperkinetic movement disorders. A teleconsultation program for the management of movement disorders in the areas with inadequate specialists should be implemented to improve patients’ access to specialty care. Keywords: Acute hemichorea; Movement disorders; Teleconsultation; Acute stroke

Telehealth and Telecare: A Real-Life Integrated Experience in the COVID-19 Pandemic

Background: In the first few months of 2020, Lombardy was the hardest-hit region in Italy for COVID-19 cases. Our Rehabilitation Institute offered a telemedicine service to COVID-19 patients discharged after hospitalization. Methods: Patients transferred from Emergency, Intensive Care, and Pulmonology departments of the principal regional hospital hubs had an average stay in our hospital of 2-3 weeks. On discharge, at home, they underwent a telecare nursing and specialist teleconsultation program for 3 months, including monitoring of vital signs and symptoms. Patients completed the SF-12 questionnaire at the start and end of the program and rated their satisfaction with it. Results: The program involved 130 patients (51%). During the period, there were 14 ± 2 (1,800 in total) telenursing support phone calls per patient made, and 12.5 ± 3.4 oxygen saturation readings per patient (1,631 in total). Persisting symptoms, frequently in combination, were present at the start of the program in 124 (94%) patients. There was a significant reduction of symptoms (p < 0.0000) after the telecare program. The physical component of SF-12 significantly improved at the end [Δ(t1-t0) = 6.7 ± 9.3, p < 0.0001]. On the contrary, the mental component of SF-12 remained unchanged or decreased slightly in patients ≤70 years of age [Δ(t1-t0) = -2.7 ± 12.3, ns], while it decreased significantly [Δ(t1-t0) = -5.4 ± 12.4, p = 0.0367] in older patients (although remaining mild). Patient satisfaction with the program was very high in all 130 patients. Conclusions: Our Telehealth and Telecare Service offers an example of rapid scaling and adaptation of an existing program to meet the needs of COVID-19 patients. Our findings indicate that telemedicine can be an integral part of clinical practice if supported by the institution with training and IT support provided to patients, nurses, and clinicians.

Evaluation of a non-face to face multidisciplinary health care model in a population with rheumatoid arthritis vulnerable to covid-19 in a health emergency situation

Objectives: The COVID-19 pandemic has impacted everyday practice pattern of health care in rheumatoid arthritis (RA) patients. The objective was to evaluate the implementation of a tele-consultation program in an adult population with RA Methods: Analytical observational study longitudinal cohort (Clinical trials NCT04768413) that evaluated the effectiveness of a tele consultation model compared with a face-to-face consultation model in adult RA patients. Patients were followed 12 weeks (Jul-Oct 2020) at an RA center of excellence in Colombia. Simple random sampling was done. Two groups were included: Group A, patients who were cared for by tele-consultation care and Group B, thosewho wished to continue with the usual face-to-face consultation. Data regarding activity of disease (Week 0,6,12) [Patient Activity Scale (PAS) in both groups and DAS28 in group B], and Quality of life [EQ-5D-3L], disability [Health Assessment Questionnaire (HAQ)], therapeutic adherence [Morisky-Green Adherence Scale (MGLS)] and self-care capacity [Appraisal of Self-care Agency Scale -Revised (ASA-R)] were evaluated (weeks 0-12). Outcomes regarding COVID-19 were evaluated. Bivariate analysis was done (StataV-13;P-value remote>presential (p = 0,0001);the same result was documented in the group presential>remote>presential, with an increase in adherence (p = 0,033). 7 patients developed COVID-19 (one patient hospitalized/group A and one patient died/mixed model) Conclusion: In the tele consultation model patients remained adherent to their RA treatment, without major differences compared to the face-to-face model. It is important to know these results due to the impact they have, given the changes that will follow in the care of RA patients due the current pandemic. Studies with a longer follow-up period are required to corroborate these results.

Mental health Project ECHO Autism: Increasing access to community mental health services for autistic individuals.

Despite the high prevalence of co-occurring autism spectrum disorders and mental health condition(s), there exist substantial barriers to mental health treatment for autistic individuals. These barriers are exacerbated by a lack of mental health provider training and self-efficacy in providing adapted services to autistic individuals. One method which has been effective in mitigating similar service gaps is the Extension for Community Healthcare Outcomes (Project ECHO) Autism model, a tele-mentoring platform that connects primary care physicians to autism spectrum disorder experts to improve physicians’ knowledge, self-efficacy, and practice. This study developed and implemented a pilot mental health version of Project ECHO Autism designed to increase mental health provider knowledge, self-efficacy, and problem-solving. Community mental health providers (N = 51) participated in the 6-month Project ECHO Autism including mental health–focused didactics and provider case presentations. Analysis of pre- and post-measures revealed improvements in all domains, including significant increases in provider knowledge of autism spectrum disorders, self-efficacy, and problem-solving. Participants additionally reported high satisfaction with their experience. Taken together, preliminary results indicate that Project ECHO Autism may be a feasible, accessible, and effective method for increasing mental health provider competence and ultimately increasing access to services for autistic individuals who have co-occurring mental health diagnoses.Lay abstractAlthough many autistic individuals have additional mental health conditions, most have a hard time getting services from mental health providers. One reason why these services can be hard to access is that many mental health providers do not feel confident in their ability to provide services to autistic individuals. To share autism expertise with local community providers and boost their confidence in working with autistic individuals, we created a mental health version of the Extension for Community Healthcare Outcomes (Project ECHO) Autism virtual teleconsultation program. In this pilot study, we recruited 51 community mental health providers to participate in Project ECHO Autism. During each biweekly session, providers received information from autism experts about how to tailor mental health interventions (e.g. attention-deficit hyperactivity disorder or anxiety interventions) for use with autistic individuals. They also had the opportunity to ask questions and get advice on their current cases. At the end of the 6-month study, mental health providers showed improvements in their confidence, in their knowledge of autism, and in their problem-solving skills. Nearly half (45%) of these providers participated from rural counties, suggesting that the Project ECHO Autism teleconsultation model was able to reach mental health providers who might not have been able to get training otherwise. This study supports the feasibility of using Project ECHO Autism to share autism knowledge with mental health providers, consequently expanding mental health service options for autistic individuals with co-occurring mental health conditions.

Study of the impact of a telemedicine service in improving pre-hospital care and referrals to a tertiary care university hospital in Nepal.

Background:Telemedicine is a process which involve medical experts to exchange valid information for diagnosis, clinical management, treatment and counseling for both healthcare workers and patients remotely in rural setting from urban healthcare center. Providing quality healthcare services in Nepal is challenging due to many reasons such as difficult geographic terrain, limited availability of funding and many other issues.Methods:The study design was a cross sectional and will adopt an interpretative case study approach which supports the researcher to develop a deep insight in to study phenomenon and outcomes. Study was conducted at in two rural-telemedicine programme implementation sites, namely Patle, Fikkal Bazaar and one central consultation site BPKIHS Dharan.Result:A total of 315 patients were undergone teleconsultation process during the study period. The total patients consulted after teleconsultation program in each of center were 1386 (Phikal) and 508 (Patle). Among them 205 (Phikal) and 110 (Patle) were called on the teleconsultation day. Among the patients who were seen via teleconsultation, 36 (2.6 %) from Phikal and 22 (4.3%) from Patle were referred to BPKIHS. The total number of referred patient from those center to other center were 327(Phikal) and 208 (Patle) among those referred 205 (Phikal) and 110 (Patle) came during teleconsultation Process.Conclusion:Telemedicine can be used as a critical component in the solution of the healthcare crisis. Telemedicine will be the best as a substitute to improve the access to healthcare, to provide the healthcare cost-effectively. The current paradigm of care can be taken by telemedicine due to which improved health outcomes can be achieved in cost effective Ways.

Feasibility of Advanced Practice Nurse - Led Telehealth Service in Patients with Myeloproliferative Neoplasm in the Community: A Singapore Single-Centre Report

Introduction Telehealth is fast becoming a promising alternative service for face-to-face consultation in healthcare to improve access to healthcare in a cost effective manner. An academic medical centre (AMC) piloted a tele-consultation program for patients with myeloproliferative neoplasm (MPN), a disease with an abnormal mutation in the bone marrow leading to overproduction of any combination of white cells, red cells and platelets. The program aimed to demonstrate the feasibility and safety of the use of telehealth in managing patients with MPN. Methods For this program only patients with Essential Thrombocytosis (ET) and Polycythemia Vera (PV) who met the criteria were recruited and enrolled into the program. Workflows, logistics and education materials were developed and briefed to stakeholders prior to the commencement of the program. The program utilised the Advanced Practice Nurses' (APNs) expertise in the haematology unit to support the service. APNs were provided addition training on both clinical practice knowledge and the appropriate use of the telehealth equipment. Data was collected between January and July 2020. Prospective outcome indicators measured were i) correct treatment prescribed according to guidelines; ii) number of emergency visits due to events related to MPN and its complications, iii) deterioration in cardiovascular health (namely hypertension, diabetes mellitus and hyperlipidermia) iv) number of patient visits right-sited to the community and v) barriers and facilitators for the uptake of the program. Results A total of 21 patients with 44 tele-consults over 7 months was captured. Average age of the patients were 70.1 years. Thirteen patients were diagnosed with ET and 8 patients have PV. Only 1 patient was on a combination of hydroxyurea and anagrelide, the rest of the patients were on hydroxyurea. A total of 14 dosage adjustments were made based on patients' complete blood count, and all of patients' blood countsremained stable during the following review. Two venesections were prescribed for patients with PV. None of the patients required ED visit or admission due to events related to MPN and its complications. One patient was referred back to physician earlier due to non-compliance to telehealth review. All patients had their blood pressure reviewed within 1 year. Sixteen patients had fasting glucose/HbA1c within 2 years, and 14 patients had fasting lipid within 2 years. None of the patients required cardiovascular medication titration, thus there is no deterioration in their cardiovascular health since recruitment. For 9 of the telehealth review, patients did their blood tests concurrently with other medical appointments they had at an earlier date, hence saving a separate trip to hospital for blood test. We were also able to consolidate blood tests and reduce repetition for these 9 patients. Only 8 telehealth blood tests were done in the community, largely due to the closure of satellite blood test service during COVID pandemic. There were only 6 home medicine deliveries, largely because many of the patients had collected adequate medications lasting half a year to a year during physical consult with physicians. The MPN telehealth service has right sited a total of 67 hospital visits to the community. We determined the barriers and facilitators to the program are due to patient, physician and workflow factors. Some of our older patients do not own a mobile device, or prefer traditional, physical consultations with physicians. Some physicians are unfamiliar with telehealth referral workflow. Potential facilitators include older, immobile patients with multiple comorbiditieswanting to cut down hospital visits, as well as patients whose work schedule did not permit frequent hospital visits. Conclusions Our results show that utilising APN-led telehealth service is a feasible and safe method to deliver care to patients with myeloproliferative neoplasm in the community. Right-siting of patient care could reduce patient visits to hospitals especially during COVID pandemic. Ongoing challenges include increasing the number of blood test facilities in the community to facilitate blood taking in the community. Other proposed intangible benefits would include improving patients' psychosocial well-being by transiting them to a new normalcy with minimal hospital visits to a haematology centre. There is potential cost- saving as well that will be explored. Disclosures Chng: Janssen: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Novartis: Honoraria; Abbvie: Honoraria; Amgen: Honoraria, Research Funding.

Letter: Emergency Response Plan During the COVID-19 Pandemic: The University of Alabama at Birmingham Experience.

Letter: Emergency Response Plan During the COVID-19 Pandemic: The University of Alabama at Birmingham Experience.

65 Fourteen Years of Worldwide Teleconsultation Support for Burn Patient Care

Abstract Introduction The onset of hostilities in 2003 in Iraq generated large numbers of burned combat casualties and civilians, but most U.S. deployed providers are inexperienced in burn care. To help address this gap, the U.S. military established a Burn Teleconsultation (BTC) program in 2005. The BTC was one of 21 specialty TC programs. We reviewed this experience. Methods TC was a store-and-forward system based on e mail. BTC was one of the earliest TC programs established (Jan 2005). Users accessed BTC by sending an e mail (often with photos) to burntrauma.consult.army@mail.mil. This reached a group of Burn Center providers, as well as the overall TC program manager (PM). The PM ensured a timely response and documented resolution. BTC was publicized in numerous educational and other materials. Other TCs included Dermatology (Derm, Apr 2004), Ophthalmology (Jul 2004), and Infectious Diseases (ID, Jan 2005). Results TC program as a whole. The TC program was active for 176 months. 3766 providers requested TCs; 14763 TCs were completed; and at least 333 patient evacuations were prevented and 775 were facilitated. The median response time (RT) was 2 hours, 57 min. RT was &amp;lt; = 1 hour in 26.3% of cases, and &amp;lt; = 24 hours in 96.4%. Leading programs were Derm (5616 patients, 38.0%), Orthopedics (1428, 9.7%), and ID (1103, 7.5%). TC was transitioned to another platform in Jan 2019. BTC program. BTC provided 197 (1.3%) TCs. Peak years were among the peak war years: fiscal years 2006 (24 patients), 2008 (32), and 2009 (34). Location of the requesting provider included Iraq (95 consultations, 48.2%), Afghanistan (56, 28.4%), and the continental US (20, 10.2%). The affiliation of the patient was predominantly non-combatant (76 patients, 38.6%), U.S. Army (37, 18.7%), and U.S. Marine Corps (12, 6.1%). The median RT was faster than for the overall TC program at 1 hour, 25 min. RT was &amp;lt; = 1 hour in 45.4% of cases, and &amp;lt; =24 hours in 98.3%. Conclusions TC took advantage of the availability of e mail to most deployed providers; it did not depend on wide-band video-teleconferencing, which was not available. Like the leading TC program (Derm), BTC relied on digital photos to enhance communication. BTC achieved a faster RT than the TC as a whole, making it appropriate for rapid, if non-immediate, consultation. The fact that non-combatants constituted the largest group of BTC patients represents the role of civilians with burns on the battlefield. It argues for more training in burn care, to include care well past initial resuscitation, for those who deploy. Applicability of Research to Practice Asynchronous teleconsultation should be considered for non-emergent burn care support.

СУЧАСНА ВІЙСЬКОВА ТОКСИКОЛОГІЯ: СВІТОВА ПРАКТИКА ВПРОВАДЖЕННЯ ДИСТАНЦІЙНИХ КОНСУЛЬТАТИВНИХ ТЕХНОЛОГІЙ У СФЕРУ ВІЙСЬКОВОЇ МЕДИЦИНИ

SummaryIntroduction. The experience of armed conflicts, local wars and emergencies inrecent decades has shown that modern military medicine needs an effective informationresource to provide emergency consultative toxicological assistance to militaryhealthcare providers, especially during participating some units in the internationalcampaigns aimed to support peace and security.The aim of the study. Analysis of the introduction of remote advisory technologiesin the field of U. S. military medicine in order to provide access for special medicalassistance to damaged.Material and methods. Sources of scientific information on the application oftelemedicine technologies in wartime. Research methods were applied as follows:system, comparative and content analysis.Results. In 2005–2012, the Army Knowledge Online (AKO) e-mail systemconducted 99 toxicology consultations for military medical facilities operating inSouthwest Asia (Iraq, Kuwait, and Afghanistan) as well as others countries (Qatar,mainland USA, Djibouti, Germany). The range of consultation duration was 0.06–29.18hours. All consultations were provided by 8 toxicologists. The most common topics ofteleconsultations were as follows: snake bites, accidental chemical poisoning duringemergencies, psychoactive substance abuse, and others. In general, the system hasproved its effectiveness in many respects, significantly approximating highly specializedcounseling to the victims at a great distance.Conclusions. The experience of the U. S. Army Medical Department (AMEDD) inimplementing the toxicological teleconsultation program should be consideredpromising area of military medicine that can ensure the timeliness and effectiveness ofhighly specialized medical care to the military personnel.

Feasibility of model adaptations and implementation of a perinatal psychiatric teleconsultation program

ObjectiveGiven the critical shortage of perinatal psychiatrists, combined with the prevalence of psychiatric conditions in the perinatal period, teleconsultation may help to maximize the efficiency of psychiatrists to reach this population. The Periscope Project (TPP) is a Wisconsin-based program offering real-time provider-to-provider teleconsultation, community resource information, and provider education. This paper describes model adaptations and implementation of TPP and the first 18 months of program data. MethodEnrollment and satisfaction data was collected via self-reported online surveys. Encounter data was entered by TPP team members through communication with providers. All data was housed in REDCap. ResultsFour hundred eight-five providers enrolled and 268 unique providers accessed services at least once. There were 594 encounters with 85% of encounters resulting in a teleconsultation. Mean call-back time from the psychiatrist was 6.8 min. Over half of utilizing providers practiced in obstetrical settings and 23% practiced in mental health settings. Provider satisfaction with the service was 100%. ConclusionsUtilization and satisfaction with TPP suggest that perinatal psychiatry access program models can vary in structure and process and experience similar utilization rates. Model adaptations are feasible and demonstrate the teleconsultation service is accepted by providers and may improve the population's health over time.