Telemedicine Consultation Services Research Articles

Public Sector Response to COVID-19 Pandemic in India: Challenges and Lessons Learned

The COVID-19 pandemic has significantly impacted the public sector in India, leading to a range of challenges that have required swift and effective responses. This abstract provides an overview of the challenges faced by the public sector in India in responding to the pandemic and the lessons learned from the experience. The challenges faced by the public sector in India have included a shortage of medical supplies, equipment and hospital beds, as well as limited testing capacity and inadequate health infrastructure. Additionally, India's large population and the spread of the virus in densely populated urban areas have created additional challenges. Despite these challenges, the public sector has responded with a range of measures, including the establishment of COVID-19 hospitals and quarantine facilities, the provision of financial assistance to those affected by the pandemic, and the development of innovative solutions such as telemedicine and online consultation services. The experience of the COVID-19 pandemic has also highlighted a range of lessons for the public sector in India. These include the need for greater investment in healthcare infrastructure, the importance of effective communication and coordination between different levels of government, and the need for proactive planning and preparation for future pandemics. Overall, the response of the public sector in India to the COVID-19 pandemic has been a complex and challenging process, but it has also provided important lessons and insights for the future.

Public sector response to COVID -19 Pandemic in India: Challenges and lessons learned

COVID-19 pandemic has had a significant impact on the public sector in India, leading to a range of challenges that have required swift and effective responses. This abstract provides an overview of the challenges faced by the public sector in India in responding to the pandemic, and the lessons learned from the experience. The challenges faced by the public sector in India have included a shortage of medical supplies, equipment and hospital beds, as well as limited testing capacity and inadequate health infrastructure. Additionally, India's large population and the spread of the virus in densely populated urban areas have created additional challenges. Despite these challenges, the public sector has responded with a range of measures, including the establishment of COVID-19 hospitals and quarantine facilities, the provision of financial assistance to those affected by the pandemic, and the development of innovative solutions such as telemedicine and online consultation services. The experience of the COVID-19 pandemic has also highlighted a range of lessons for the public sector in India. These include the need for greater investment in healthcare infrastructure, the importance of effective communication and coordination between different levels of government, and the need for proactive planning and preparation for future pandemics. Overall, the response of the public sector in India to the COVID-19 pandemic has been a complex and challenging process, but it has also provided important lessons and insights for the future.

Public sector response to COVID -19 Pandemic in India: Challenges and lessons learned

The COVID-19 pandemic has had a significant impact on the public sector in India, leading to a range of challenges that have required swift and effective responses. This abstract provides an overview of the challenges faced by the public sector in India in responding to the pandemic, and the lessons learned from the experience. The challenges faced by the public sector in India have included a shortage of medical supplies, equipment and hospital beds, as well as limited testing capacity and inadequate health infrastructure. Additionally, India's large population and the spread of the virus in densely populated urban areas have created additional challenges. Despite these challenges, the public sector has responded with a range of measures, including the establishment of COVID-19 hospitals and quarantine facilities, the provision of financial assistance to those affected by the pandemic, and the development of innovative solutions such as telemedicine and online consultation services. The experience of the COVID-19 pandemic has also highlighted a range of lessons for the public sector in India. These include the need for greater investment in healthcare infrastructure, the importance of effective communication and coordination between different levels of government, and the need for proactive planning and preparation for future pandemics. Overall, the response of the public sector in India to the COVID-19 pandemic has been a complex and challenging process, but it has also provided important lessons and insights for the future.

Breast cancer in Africa: an extensive surgical burden of paramount importance – letter to the editor

Breast cancer in Africa: an extensive surgical burden of paramount importance – letter to the editor

Providing Low-barrier Addiction Treatment Via a Telemedicine Consultation Service During the COVID-19 Pandemic in Los Angeles, County: An Assessment 1 Year Later.

Los Angeles County Department of Health Services provides medical care to a diverse group of patients residing in underresourced communities. To improve patients' access to addiction medications during the COVID-19 pandemic, Los Angeles County Department of Health Services established a low-barrier telephone service for DHS providers in March 2020, staffed by DATA-2000-waivered providers experienced with prescribing addiction medications. This study describes the patient population and medications prescribed through this service during its initial 12 months. We performed a retrospective evaluation of a provider-entered call registry for the telephone consult line. Information was collected between March 31, 2020, and March 30, 2021. The registry includes information related to patient demographics, the reason for visit, and which addiction medications were prescribed. We conducted descriptive statistics in each of these domains. During the study period, 11 providers on the MAT telephone service logged 713 calls. These calls represented a total of 557 unique patients (mean age of 40 years, 75% male, 41% Latino, 49% experiencing homelessness). Most patients either had Medicaid insurance (77%) or were uninsured (20%). The most prescribed addiction medication was buprenorphine-naloxone (90%), followed by nicotine replacement therapy (5.3%), naltrexone (4.2%), and buprenorphine monotherapy (1.8%). A telephone addiction medication service is feasible to deliver low-barrier medications to treat addiction in underresourced communities, especially to individuals experiencing homelessness. This can mitigate but does not eliminate disparities in access to addiction medications for communities of color.

Telehealth and chronic pain management from rapid adaptation to long-term implementation in pain medicine: A narrative review.

The COVID-19 pandemic called for drastic changes to expand and rapidly implement telehealth to prevent breach of care for chronic patients. Responding to the challenge of implementing remote care in chronic pain services, a specialty highly dependent on doctor-patient rapport, physical examination, and frequent follow-up visits requires extensive adaptation involving administrative processes and clinical routines. We present our experience of a successful rapid adaptation to telemedicine paradigm as a response to the COVID-19 pandemic during a time of marked restriction of access to ambulatory hospital services for pediatric and adult chronic pain patients. This narrative review covers current scientific evidence for the use of telehealth for chronic pain management and describes in detail the challenges to implement telemedicine in ambulatory clinics from different perspectives. Best practices for telehealth use are recommended. A proposal for remote physical examination of pain patients is made, based on available evidence in the fields of musculoskeletal medicine and neurology comparing in-person vs remote physical examination. As an internal quality control process, an informal online survey was conducted to assess thoughts and experiences among patients and caregivers using telemedicine consultation services at the pediatric pain clinic. Providing chronic pain management services through telehealth is a viable option for many patients and health care professionals. This is reliant on the availability of appropriate materials and training, with guidelines for both patients and health care workers. With the rapid pace of technological advancements, even further integration of telehealth into routine health care is possible.

Acute neurological care in north-east Germany with telemedicine support (ANNOTeM): protocol of a multi-center, controlled, open-label, two-arm intervention study

BackgroundBoth diagnosis and treatment of neurological emergencies require neurological expertise and are time-sensitive. The lack of fast neurological expertise in regions with underserved infrastructure poses a major barrier for state-of-the-art care of patients with acute neurological diseases and leads to disparity in provision of health care. The main purpose of ANNOTeM (acute neurological care in North East Germany with telemedicine support) is to establish effective and sustainable support structures for evidence based treatments for stroke and other neurological emergencies and to improve outcome for acute neurological diseases in these rural regions.MethodsA “hub-and-spoke” network structure was implemented connecting three academic neurological centres (“hubs”) and rural hospitals (“spokes”) caring for neurological emergencies. The network structure includes (1) the establishment of a 24/7 telemedicine consultation service, (2) the implementation of standardized operating procedures (SOPs) in the network hospitals, (3) a multiprofessional training scheme, and (4) a quality management program. Data from three major health insurance companies as well as data from the quality management program are being collected and evaluated. Primary outcome is the composite of first time of receiving paid outpatient nursing care, first time of receiving care in a nursing home, or death within 90 days after hospital admission.DiscussionBeyond stroke only few studies have assessed the effects of telemedically supported networks on diagnosis and outcome of neurological emergencies. ANNOTeM will provide information whether this approach leads to improved outcome. In addition, a health economic analysis will be performed.Study registrationGerman Clinical Trials Register DRKS00013067, date of registration: November 16 th, 2017, URL: http://www.drks.de/DRKS00013068

Economic Evaluation of Robot-Based Telemedicine Consultation Services.

Background: Through information and communication technology, telemedicine can deliver medical care without time and place restrictions, increasing health care accessibility in medically underdeveloped regions. Although there is growing interest in using robots in telemedicine, there are few economic evaluation studies of robot-based telemedicine. Introduction: Robots developed for use in telemedicine consultation services may help address the challenges that result from Korean physicians' efforts to support patients in Vietnam. We perform a cost-benefit analysis to assess the economic feasibility of a robot-based telemedicine consultation system compared with traditional face-to-face outpatient services. Methods: A cost-benefit analysis is performed of a robot-based telemedicine consultation system between S Hospital in Korea and H Hospital in Vietnam. The threshold was calculated as the point at which the cost of providing telemedicine consultation equals the cost of providing the same service using traditional methods. Results: The annual cost of a robot-based telemedicine consultation system was estimated as 6,056.40 USD, whereas the annual benefit from replacing traditional outpatient services was estimated as 1,508.51 USD, resulting in a threshold point of 4.01 visits per year. Consequently, if the telemedicine consultation robot system replaces >4.01 physician visits per year, it is more economical than conventional face-to-face services. If the physician needs to stay longer, the threshold will be lower. Conclusions: As our results show, robot-based systems for telemedicine have economic value and can potentially offer a solution to the unmet health care needs among patients living in medically underdeveloped regions by providing proper and timely medical care.

A Retrospective Cohort Study to Assess the Impact of an Inpatient Infectious Disease Telemedicine Consultation Service on Hospital and Patient Outcomes.

Here, we review our experience of providing inpatient infectious disease (ID) consultations using real-time interactive telemedicine assessments. We sought to obtain a baseline and document trends regarding the use of telemedicine ID (teleID) consults as an adjunct to the standard of care through the time period in which teleID consultations were introduced. Data were pulled via manual, retrospective chart reviews of the electronic medical record. Primary outcomes included lengths of stay (LOS), antibiotic usage, and relapse incidences. There were a total of 244 patients at 1 remote hospital site who were provided with ID consultations, either in person, via teleID, or both. Before the availability of teleID (pre-teleID), there were 73 patients transferred for ID consults, while 171 patients were seen via teleID once available. While all 73 patients in the pre-teleID group were transferred from the remote hospital to the hub hospital, only 14 (8.2%) of all remote hospital patients assessed by teleID were transferred. Patient LOS across both facilities decreased when patients were seen via teleID, compared to pre-teleID (P = .0001). The median number of days that patients received antibiotics decreased in the teleID group (median 15, interquartile range [IQR] 9-25), compared to the pre-teleID group (median 19, IQR 11-28), but this decrease was not statistically significant (P = .0770). There was no statistically significant difference in relapse rates, although data were lacking because of patients being lost to follow-up. ID telemedicine practice directed at inpatients appears to be a promising route of care.

Informed collaboration in health care: An embedded‐cases study in geriatric telepsychiatry

AbstractTelemedicine, the delivery of medical consultation and services, is enabled by information and communications technologies. Participants in telemedicine consultation services (ie, clinicians, patients, and other parties) use video conferencing, special‐purpose software and/or hardware, and data and notes from electronic medical records and other systems to formulate effective treatment plans. Telemedicine is a particular mode of informed collaboration—information and communications technology–supported collaborative activity in which collaborators rely (wholly or in part) on digitally stored information retrieved from various sources to pursue their collective objectives. We report on an embedded‐cases study of a long‐running geriatric telepsychiatry clinic in the north‐eastern United States. Our analysis draws on the theory of distributed cognition (DCog) to explicate the ways in which information and cognitive effort are distributed across individuals and artefacts to support psychiatric consultation from a distance and how these processes play out over time in routines. On the basis of this case study, we offer a refinement of DCog theory, focusing on four interrelated dynamic processes that, we propose, act as critical enablers of informed collaboration: cognitive offloading, visibility of action, intersubjective understanding, and knowledge redundancy. We discuss practical implications for designing telemedicine services and tools, and we offer suggestions for further research on informed collaboration.

Patient experience survey in telemedicine for spinal cord injury patients.

Patient feedback study. To measure how patients value the telemedicine consultation service at the National Spinal Injuries Centre over a period of 8 months. United Kingdom (south of England). Telephone survey conducted by an external surveyor who does not work in the department. Our study showed that most patients (n=29) found the service of high quality and useful to their care. This provides evidence, from the spinal cord injury patients' perspective, that telemedicine service has an important role in their management.

Wartime toxicology: evaluation of a military medical toxicology telemedicine consults service to assist physicians serving overseas and in combat (2005-2012).

Those medical providers deployed to remote countries and tasked with caring for military personnel must diagnose and treat diseases and nonbattle injuries that result from exposures rarely seen in developed countries. Military providers must also function with limited resources and a lack of access to physician specialists, to include medical toxicologists. There have been limited published approaches to addressing this clinical gap for medical toxicology. To address this void, the US Army Medical Department deployed an electronic mail telemedicine system to provide teleconsultations for remote health-care providers worldwide, including Iraq and Afghanistan. This study aimed to describe the types and the frequency of toxicology teleconsultation and consultant responses using electronic mail to assist physicians serving in resource-limited locations. This was a retrospective observational study in which an unblinded data extractor independently reviewed all medical toxicology email consultations. Using a previously developed data collection worksheet, the extractor recorded the type of question asked by the consultant (overdose case, envenomation, occupational exposure, etc.) and the duration of time from when the teleconsultation was placed until the consultant replied. The extractor also recorded if the patient was adult or pediatric and if the patient was US military, US contractor, or local national. The extractor also recorded how often the toxicologist provided the consulting physician with information, resources, or protocols to aid in the management of future cases. In addition, for clinical teleconsultations, the extractor documented the frequency that the consulted toxicologist (i) provided a differential diagnosis or specific diagnosis, (ii) provided specific management guidelines for a patient, and (iii) recommended to evacuate or not evacuate a patient. The results were analyzed using descriptive statistics. Of the 99 consultations evaluated, the most common consultation was for snake envenomation and antivenom recommendations (n = 23, 23%) followed by accidental chemical exposures (n = 14, 14%), drug testing (n = 13, 13%), and substance abuse (n = 10, 10%). In 41% of consults, the toxicologist provided a differential diagnosis or specific diagnosis, and in 60% of cases, the toxicologist provided specific management or evaluation guidelines. In 11% of cases, the toxicologist recommended for or against evacuation of the patient. In 25% of consults, the toxicologist provided the consulting physician with information, resources, or protocols to aid in the management of future cases. The most frequent consultations for the military telemedicine consultation service were for direct patient cases, specifically snake envenomation management and accidental chemical exposures. Our results may be used to educate physicians prior to military deployment or international humanitarian efforts and to create toxicology clinical guidelines for remote locations. Expansion of the current military teleconsultation program capabilities to include video teleconsultation may improve the effectiveness of military medical toxicology teleconsultation.

Telemedicine in an Academic Center—The Arizona Telemedicine Program

This article provides background information on the history of telemedicine in Arizona and the Arizona Telemedicine Program (ATP). Following a brief overview of the growth of the ATP over the past 16 years, special focus is directed toward a description of the ATP business model, sustainability efforts of the Program, and ATP's future directions and goals. The ATP was established by the Arizona State Legislature in 1996 and, today, operates a large university-based statewide telemedicine consortium. It provides a spectrum of telemedicine support services to dozens of independent healthcare organizations throughout Arizona and bordering states. The ATP's backbone is a regional, 160-site dedicated healthcare and education broadband telecommunications network called the Arizona Telemedicine Network (ATN). The ATN is a fixed-cost network operated 24/7 by ATP engineers. In addition to providing access to the ATN, the ATP also provides its member individuals and organizations with benefits including biomedical communications services and expertise, telemedicine training on financial, legal, regulatory, and administrative support aspects, and access to subspecialty telemedicine consultation services.

We Did Not Use Telemedicine That Time:Can Critical Incidents Analysis Explain Non-Use?

This paper discusses findings from four case studies of patient-present telemedicine consultation services, in which “hub” specialist physicians provide assistance to “spoke” clinicians located at a distance, using video conferencing and sometimes also electronically exchanging other clinical information. In interviews we sought to identify why clinicians sometimes choose not to use telemedicine consultation services. Hub specialists (who provide the telemedicine consultation services) and doctors, nurses, and social workers (“spoke clinicians,” who receive these services) were asked to discuss their views about telemedicine systems strengths and weaknesses in the context of specific clinical episodes. For this paper we analyzed critical incident narratives to reveal insights regarding two research questions: 1) From clinicians who sometimes use telemedicine, what can we learn from their critical incident stories in which telemedicine was not used yet the clinician feels it might have been helpful? What can we learn from other critical incident stories, in which telemedicine was not used?

Tele-pharmacy in remote medical practice: the Royal Flying Doctor Service Medical Chest Program

In recent times remote medical practice has been developed into a unique discipline in its own right with telehealth one of the eight defining key features. Since 1942, the telemedicine consultation service provided by the Royal Flying Doctor Service in Australia has been supported by a tele-pharmacy program known as the Medical Chest Program. The contents of the chest comprise more than 85 items, including medications and equipment which can be prescribed during a telehealth consultation to cover both emergency care and definitive treatment for less serious conditions. By 2006 there were 3500 medical chests placed throughout Australia. Specifically, the state of Queensland had 21 470 telehealth consultations from 1 July 2005 to 30 June 2006, resulting in the prescription of at least one medical chest item in 2938 (13.7%) consultations. Queensland data regarding medication indicate that antibiotics (26%), analgesics (23%) and gastrointestinal medications (12%) were the most common categories of dispensed medications, and that the most common clinical diagnostic categories for the consultation resulting in dispensed medications were respiratory (17%), skin (15%) and abdominal conditions (13%). In summary, the RFDS medical chest program continues to be a successful large scale provider of medications to those living in remote Australia, enabling early access to medications for both emergencies and definitive care, while minimising the need for mail-order pharmacy or patient travel. This model of care may provide an important template for those designing service delivery models in other remote jurisdictions.