Telemedicine Follow-up Research Articles

Effect of Applying Telemedicine Follow-up versus Scheduled Clinic Follow-up on Renal-Transplanted Patients’ Satisfaction

Effect of Applying Telemedicine Follow-up versus Scheduled Clinic Follow-up on Renal-Transplanted Patients’ Satisfaction

Effect of Applying Telemedicine Follow-up versus Scheduled Clinic Follow-up on Renal-Transplanted Patients’ Satisfaction

Effect of Applying Telemedicine Follow-up versus Scheduled Clinic Follow-up on Renal-Transplanted Patients’ Satisfaction

Need to assess the effect of therapy? Ask the patient!

Achieving a good treatment outcome in rheumatic diseases (RD) requires regular, dynamic patient monitoring and therapy correction if it is not effective or intolerant. The patient assessment must be based on clear criteria to objectify the main manifestations of the disease. For this purpose, the calculation of standard activity and severity indices (DAS28, CDAI, SDAI, BASDAI, ASDAS, DAPSA, PsARC, PASI, etc.) is used. However, this methodology does not always allow the assessment of the fundamentally important parameters of treatment outcome – patient satisfaction and well-being. According to a series of studies, poor therapy satisfaction may be observed in ≈25% of patients with systemic RD who are in remission/low disease activity according to standard indices. Moreover, in 20–30% of cases there is a major discrepancy in the assessment of therapy outcome between the patient and physician. Therefore, a more accurate assessment of the patient’s condition requires, in addition to the calculation of standard indices, the mandatory analysis of patient-reported outcomes – pain, functional impairment, general assessment of disease activity, fatigue, etc. A valuable tool for determining well-being and good therapy outcome from the patient’s point of view is the PASS (“patient acceptable symptom state”). This simple and quite informative index correlates well with core symptoms and indicators of remission/low disease activity. PASS analysis can be used in telemedicine follow-up of patients when an objective examination is not possible. The combined use of PASS and standardized indices can better assess treatment outcomes and improve the quality of life of patients with RD.

Telemedicine for follow-up of systemic lupus erythematosus during the 2019 coronavirus pandemic: A pragmatic randomized controlled trial.

Patients with systemic lupus erythematous were vulnerable to severe coronavirus disease 2019 infection and the negative impact of disrupted healthcare delivery. Telemedicine has been a popular alternative to standard in-person care during the pandemic despite the lack of evidence. This was a 1-year pragmatic randomized-controlled trial. Patients followed at the lupus nephritis clinic were randomized to either telemedicine or standard follow-up in a 1:1 ratio. Patients in the telemedicine group were followed up via videoconferencing. Standard follow-up group patients continued conventional in-person outpatient care. The primary outcome of the study was the proportion of patients in low disease activity after 1 year. Secondary outcomes included cost-of-illness, safety, and various patient-reported outcomes. From 6/2020 to 12/2021, 144 patients were randomized and 141 patients (telemedicine: 70, standard follow-up: 71) completed the study. At 1 year, 80.0% and 80.2% of the patients in the telemedicine group and standard follow-up group were in lupus low disease activity state or complete remission, respectively (p = 0.967). Systemic lupus erythematous disease activity indices, number of flares and frequency of follow-ups were also similar. There were no differences in the cost-of-illness, quality of life or mental health scores. However, significantly more patients in the telemedicine group (41.4% vs 5.6%; p < 0.001) required switch of mode of follow-up and higher proportion of them had hospitalization during the study period (32.9% vs 15.5%; p = 0.016). Being in the telemedicine group or not in low disease activity at baseline were the independent predictors of hospitalization (odds ratio: 2.6; 95% confidence interval: 1.1-6.1, odds ratio: 2.7, 95% confidence interval: 1.1-6.7, respectively) in the post hoc analysis. In patients with systemic lupus erythematous, telemedicine predominant follow-up resulted in similar 1-year disease control compared to standard care. However, it needed to be complemented by in-person visits, especially in patients with unstable disease.

The Attitude of Neurosurgeons Toward Telemedicine During COVID-19 Pandemic

Background and Aim: Telemedicine can be considered a primary modality of patient care for non-emergent conditions in the COVID-19 era. The usage and expansion of telemedicine are important and inevitable issues. We decided to investigate the neurosurgeons’ perspective on telemedicine in the treatment and follow-up of neurosurgical patients during the COVID-19 period. Methods and Materials/Patients: This cross-sectional study was carried out in the Department of Neurosurgery, Tehran, from June 2021 to July 2021. An internet-based questionnaire was distributed among all postgraduate and assistant neurosurgeons at the Tehran University of Medical Sciences. Statistical analysis was performed using SPPS (IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp; 2016). Results: This study was performed among 74 neurosurgeons who were mainly male (89.2%). Their mean age was 33.16±5.69 years (ranging from 27 to 62 years), and telemedicine has not been used previously in 37 precipitants (50%). Most precipitants preferred telemedicine for follow-up (93.24%). The common reasons for unimplemented telemedicine were determined by insurance and repayment obstacles (58.11%). Most of the participants believed that telemedicine should first be adapted to working condition and local setting, then it can be applied more in the future. Eventually, the effectiveness of telemedicine was controversial, according to most neurosurgeons’ replies. Conclusion: This study indicated neurosurgeons’ preference for telemedicine. They considered it a comfortable alternative. However, the effectiveness of telemedicine is controversial as it should be adapted first and then used extensively for future purposes. It is also suggested that future studies compare the results of this research with those of studies performed after the COVID-19 outbreak.

THE ACCEPTABILITY OF TELEMEDICINE IN POST-MASS CHARITY CIRCUMCISION IN INDONESIA: A PILOT STUDY

Introduction: Charity circumcision is common in Indonesia. It is usually done by general practitioners or medical students under supervision. Procedures are often held on a mass scale and rarely followed with post-monitoring. We developed a telemedicine follow-up protocol to educate and address post-procedure complications. This pilot study evaluates the acceptability of telemedicine follow-up protocol for charity circumcision in Indonesia. Method: Data were collected from operators and caregivers of children attending charity circumcision. The protocol consisted of text interviews (pain, urinary retention) and surgical sites' four-angle photographs (epithelialization, bleeding, infection, edema, and glans excoriation). The protocol was conducted two-way between caregivers and operators on days 1, 3, 7, and 30 after circumcision. The Ethics Committee of the Faculty of Medicine, Universitas Indonesia, has approved this study. Result: Twenty-five boys with a mean age of 8.02±1.53 years old have similar pre-operative, operative, and postoperative protocols. Twenty-one caregivers completed four times follow-ups, one missed two times follow-ups, and three missed the last follow-up. Mild pain was the most reported complication, with 32% (8/25), 12% (3/25), 8% (2/24) incidence on days 1, 3, and 7, respectively. By the end of the follow-up, there were no persisting complications, and 80% (20/25) of boys showed complete epithelialization. All caregivers and most operators were satisfied with telemedicine for post-mass circumcision monitoring. Conclusion: The telemedicine-based follow-up is acceptable and feasible to be applied in mass charity circumcision. This protocol is beneficial for monitoring the results and adverse events, therefore, should be routinely adopted in mass charity circumcision programs.

Perspective of patients on the use of telemedicine in cardiovascular care

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This study is part of Limburg Clinical Research Center, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. Background Many cardiovascular patients are only seen by a physician once or twice a year unless urgent symptoms occur. However, secondary prevention, including self-management, is important in cardiovascular diseases. The use of digital technologies to follow patients remotely, i.e. telemedicine, is increasing. This creates opportunities to provide a more continuous way of follow-up. It is recommended to involve patients in the development of such tools in order to optimise their implementation in clinical practice. Purpose This survey-based study investigated patients’ perspectives on telemedicine and the defined features/services they consider important for using telemedicine in their (daily) care. Methods At two Belgian hospitals, both cardiology patients with various types of prior telemedicine follow-up and patients who never had a telemonitoring follow-up were included. A new self-developed survey was implemented in Qualtrics and took 5-10 minutes to complete. Patients with previous telemedicine follow-up were contacted by phone. If they agreed to participate, the survey was sent by email and filled in online. On the other hand, patients in the control group were included at the cardiology ward and filled in the survey independently on a tablet. The study was approved by the local Ethical Committees. Results In total, 231 patients (191 telemedicine and 40 controls) of the 786 contacted patients were included. Most patients owned a smartphone (84.8%) and only 2.2% of the patients did not own any digital device. As shown in Figure 1, patients with previous use of telemedicine are more interested in such new technologies than control patients (p=0.020). Of the defined services, personalized medicine in various formats attracted most interest in both groups (i.e. personalized health tips based on the medical history, 89.6%; personalized feedback on entered health parameters, 86.1%; and (personalized) information about their medical condition, 85.3%). Recommendation by a doctor is a motivating factor to use telemedicine (84.8%), while a decrease of in-person visits and replacing these with telemedicine follow-up is rather a barrier (24.7%). Two-thirds of the patients in this Belgian cohort (67.1%) would be willing to pay for telemedicine tools, with more patients in the experienced telemedicine group (69.6%) compared to the control group (55.0%; p=0.073). The patients willing to pay, would pay a mean monthly sum between €12.2 and €21.8 or a yearly global sum between €51.5 and €59.5 for telemedicine that supplements their regular insurance. Conclusion Cardiovascular patients have a positive attitude towards telemedicine, especially when it allows for more personalized care and lifestyle advice. Previous use of telemedicine led to a higher willingness to pay. Addressing patient concerns, highlighting the complementary value of telemedicine services, and maintaining equal access for all patients are important for effective implementation.

Patient Experience with Video Telemedicine Neurology Follow-up Visits at Community Clinics (P1-4.001)

<h3>Objective:</h3> To assess patient satisfaction and perception of physician empathy following implementation of video telemedicine neurology follow-up visits at community clinics <h3>Background:</h3> There is a growing shortage of neurologists in the US who provide care outside of metropolitan areas[1]. Within the region of our academic medical center, neurologists drive approximately 2 hours round-trip each day to provide care at community clinics. Telemedicine minimizes travel time for both patients and physicians while maintaining/improving access. We aimed to develop a telemedicine service and assess patient experience. <h3>Design/Methods:</h3> We implemented video conferencing with tablet for patient to interact with neurologist and a pan and tilt zoom camera attached to a moveable cart to enable neurologist to perform neurological exam. Telemedicine visits were offered to patients who had previously been seen face-to-face by the neurologist performing follow-up. Implementation was at a clinic 45 miles from tertiary center(site 1) between February 2020–January 2021 and at a clinic 43 miles from tertiary center(site 2) between July 2021–January 2022. After the telemedicine visit, a survey was completed by patient and/or caregiver, which included the consultation and relational empathy(CARE)[1] and telemedicine patient satisfaction measures(TPSM)[2]. <h3>Results:</h3> 31 patients from site 1 and 38 patients from site 2 participated in telemedicine follow-up visit and completed the survey. Mean age was 66 years. Follow-up reasons were Parkinson disease/parkinsonism(36.2%), migraine(20.3%), dementia(17.4%), epilepsy(14.5%), and other(11.6%). CARE measure mean responses indicated patients’ perception of relational empathy was excellent(65%), and very good(25%). TPSM mean responses were strongly agreed(71%) and agreed(28%) with regard to patient satisfaction. The neurologists involved anecdotally reported improved work-life balance. <h3>Conclusions:</h3> Patient satisfaction and perceived physician empathy was high for video telemedicine neurology follow-up at our community clinics, supporting expansion of this model. This model also improved work-life balance for the neurologist. Study of care outcomes and use for new patient consultations is needed. <b>Disclosure:</b> Dr. Truitt has stock in NVTA. Dr. Truitt has stock in QTRX. Dr. Truitt has stock in EXAS. Dr. Truitt has stock in ALC. Dr. Truitt has stock in ACAD. Dr. Truitt has stock in ABBV. Dr. Truitt has stock in NVS. Dr. Truitt has stock in VRTX. Dr. Truitt has stock in MRK. Dr. Truitt has stock in ATRI. Dr. Truitt has stock in HZNP. Dr. Truitt has stock in ZM. Dr. Arumaithurai has nothing to disclose. Dr. Young has nothing to disclose.

Do live-stream telemedicine follow-up appointments for a Ponseti-treated clubfoot caseload compare favourably with a face-to-face review? Observed clinical outcomes and treatment provision during the COVID-19 pandemic

Restrictions on face-to-face (F2F) healthcare services during the recent COVID-19 pandemic necessitated novel provision of care for Ponseti-treated clubfoot patients. This retrospective review compares the effectiveness of telemedicine (TM) using live-stream videoconferencing compared to conventional F2F review, in two cohorts of 78 patients attending routine follow-up, during Ponseti-treated clubfoot bracing in their first 5 years. Rates of compliance, recurrence of deformity, and type of intervention provided were compared between cohorts. The TM cohort was re-evaluated F2F as part of routine follow-up care. Attendance rates were compared between cohorts and with an equivalent time period the previous year. There was no significant difference in the rate of compliance between cohorts (77% in the TM group, 74% in the F2F group), or in the rate of recurrence. Subsequent F2F review of the TM cohort showed that compliance had improved in some patients, indicating successful TM intervention. There were no missed cases of recurrence. TM follow-up appointments offered similar rates of management of skin problems, brace adjustment, and provision of exercises. At least one element of intervention was provided in 64% of the TM group, and 72% of the F2F group. TM connection was successful in 74% of booked appointments. The number of patients attending was similar to F2F bookings one year prior. The use of TM for routine follow-up of Ponseti-treated clubfoot patients can be as clinically effective as F2F assessment, and has potential for integration into routine follow-up care.

Early and sustained increase in time in range 1 year after initiation of hybrid close loop therapy via telemedicine in type 1 diabetes patients

Background and AimsEvidence supports the efficacy and safety of the Hybrid Close loop (HCL) system in patients with type 1 diabetes (T1D). However, limited data are available on the long-term outcomes of patients on HCL with telemedicine follow-up.MethodsA prospective observational cohort study including T1D patients, who were upgrading to HCL system. Virtual training and follow-up were done through telemedicine. CGM data were analyzed to compare the baseline time in range (TIR), time below range (TBR), glycemic variability and auto mode (AM), with measurements performed at 3, 6 and 12 months.Results134 patients were included with baseline A1c 7.6% ± 1.1. 40.5% had a severe hypoglycemia event in the last year. Baseline TIR, measured two weeks after starting AM was 78.6 ± 9.94%. No changes were evident at three (Mean difference − 0.15;CI-2.47,2.17;p = 0.96), six (MD-1.09;CI-3.42,1.24;p = 0.12) and 12 months (MD-1.30;CI-3.64,1.04;p = 0.08). No significant changes were found in TBR or glycemic variability throughout the follow-up. Use of AM was 85.6 ± 17.5% and percentage of use of sensor was 88.75 ± 9.5% at 12 months. No severe hypoglycemic (SH) events were reported.ConclusionsHCL systems allow to improve TIR, TBR and glycemic variability safely, early and sustained up to 1 year of follow-up in patients with T1D and high risk of hypoglycemia followed through telemedicine.

Telemedicine for the management of diabetic patients in a high-complexity Latin American hospital

BackgroundNoncommunicable diseases such as diabetes mellitus (DM) have gained attention worldwide. Latin America experienced a rise in rates of DM. During the COVID-19 pandemic, a telemedicine program was implemented in a quaternary care academic complex in Latin America to continue the follow-up of patients with diabetes.ObjectiveThe aim of this study is to describe the clinical experience of DM patient management through telemedicine and the HbA1c behavior of patients followed-up through this modality.Materials and methodsWe conducted a retrospective cohort study including all patients with type 1 or 2 diabetes who were treated via telemedicine from March to December 2020. A Wilcoxon statistical test was used to compare the changes in glycosylated hemoglobin between the first teleconsultation and after 6 months of telemedicine follow-up.ResultsA total of 663 patients were included, 17.65% (117) of whom had type 1 diabetes and 82.35% (546) of whom had type 2 diabetes. Patients with both types of diabetes, presented with stable HbA1c values regardless of the length of follow-up.ConclusionThe use of telemedicine can be a helpful tool for both patients and health care providers to support the continuity of care to maintain acceptable control levels within glycemic control goals.

SARS-CoV-2 (COVID-19) infection in patients with HTLV-1 infection in Peru - case series

Introduction: Peru has suffered a prolonged sanitary emergency and has the highest COVID – 19 mortalities per capita in the world. Some risk factors (diabetes, HIV, cardiovascular diseases, etc.) are currently considered by the CDC to develop severe COVID-19 infection. CDC considers as possible risk factors (evidence is mixed), other immunodeficiency conditions, one of them would be infection by HTLV-1 (human T-cell lymphotropic virus type 1). It is not known whether subjects with HTLV – 1 infection have a higher risk for severe COVID – 19 disease. Materials and methods: We identified 51 patients with HTLV-1 and COVID-19. The patients recruited for this article belong to the HTLV-1 cohort of the Institute of Tropical Medicine Alexander von Humboldt - Cayetano Heredia Hospital and to the study cohort: "The effect of Strongyloides Stercoralis on HTLV-1 disease progression”. Periodic telemedicine follow-up was carried out on our patients during the lockdown from April 2020 to November 2021, and information related to SARS-CoV-2 infection was recorded. Results: 51 patients from cohorts were diagnosed with COVID-19 during the pandemic between April 2020 and October 2021. The majority are female (29 patients, 56.85%). 76.47% (39 patients) underwent a molecular/PCR, antigenic or serological test; while 23.53% (12 patients) developed symptoms compatible with COVID-19 in a context of family outbreak and positive direct contact. 74.51% (38 patients) developed a mild form of the disease, 15.69% (8 patients) a moderate form and 9.80% (5 patients) were asymptomatic. The most frequent symptoms were general malaise and/or fever (82.35%), headache (80.39%) and cough (76.47%). Discussion: the course of SARS-CoV-2 in patients infected with HTLV-1 follows similar patterns in percentage and symptoms compared to the general population. 81% usually develop a mild condition, while for our data 74.51% did. 14% usually develop moderate to severe disease worldwide, in our cohort, 15.69% developed moderate disease. The patients show a clinical picture similar to what is described in the literature as a common presentation of SARS-CoV-2. American studies show that the most frequent symptoms are headache (76%) and sore throat (65%); in our cohort, 80.39% reported headache and 35.29% sore throat. Conclusion: Patients with HTLV-1 who become infected with SARS-CoV-2 develop mild or moderate disease in similar proportions to the general population. More studies are needed to elucidate the risk of developing severe SARS-CoV-2 disease in patients infected with HTLV-1 and its associated comorbidities.

Long-Term Outcomes and Return to Work After Isolated Coronal Shear Fractures of the Capitellum

The purpose of this study was to analyze the ability of patients to return to work after ORIF of isolated capitellar shear fractures and assess long-term functional outcomes. We retrospectively reviewed the cases of 18 patients with isolated capitellar shear fractures with or without lateral trochlear extension and investigated demographic data, occupation, worker's compensation status, injury characteristics, surgical details, motion, radiographic appearance at final in-person follow-up, complications, and return to work status via in-person and long-term telemedicine follow-ups. Final follow-up was at an average of 76.6 (7-222.6) months or 6.4 (0.58-18.6) years. Of the 14 patients working at the time of injury, 13 patients had returned to work at final clinical follow-up. The work status of the remaining patient was not documented. Mean elbow motion at final follow-up was 4° (range, 0-30) to 138° (range, 130-145) of flexion, 83° of supination, 83° of pronation. Two patients had complications that required reoperation but had no further complications. For the 13 of 18 patients with long-term telemedicine follow-up, the average Quick Disabilities of the Arm, Shoulder, and Hand score was 6.8 (0-25). In our series, rates of return to work were high after ORIF of coronal shear fractures of the capitellum with or without lateral trochlear extension. This was true across all occupational classes including manual labor, clerical, and professional. With anatomic restoration of articular congruity, stable internal fixation, and postoperative rehabilitation, these patients had excellent ROM and functional scores at an average of 7.9 years of follow-up. After ORIF of isolated capitellar shear fractures with or without lateral trochlear extension, patients can expect a high rate of return to work with excellent ROM and functionality and low long-term disability.

Assessment of functionalities and attitude toward telemedicine for patients with cardiovascular disease.

Many patients with cardiovascular diseases are only seen by a physician once or twice a year unless urgent symptoms. Recent years have shown an increase in digital technologies to follow patients remotely, that is, telemedicine. Telemedicine can be supportive for follow-up of patients at continuous risk. This study investigated patients' attitude toward telemedicine, the defined features they consider important and future willingness to pay. Cardiology patients with various types of prior telemedicine follow-up or who never had a telemonitoring follow-up were included. A new self-developed survey was implemented electronically and took 5-10 min to complete. In total, 231 patients (191 telemedicine [T] and 40 controls [C]), were included. Most participants owned a smartphone (84.8%) and only 2.2% of the total participants did not own any digital device. The most important feature of telemedicine cited in both groups was personalization (i.e., personalized health tips based on medical history, 89.6%; personalized feedback on entered health parameters 86.1%). The most important motivating factor for the use of telemedicine is recommendation by a physician (84.8%), while the reduction of in-person visits is a minor reason (24.7%). Only half of the participants (67.1%) would be willing to pay for telemedicine tools in the future. Patients with cardiovascular disease have a positive attitude to telemedicine, especially when it allows for more personalized care, and when it is advocated by the physician. Participants expect that telemedicine becomes part of reimbursed care. This calls for interactive tools with proven efficacy and safety, while guarding unequal access to care.

1067 TELEMEDICINE FOR LIPID LEVELS FOLLOW UP AFTER ACUTE CORONARY SYNDROME

Abstract Background The implementation of guidelines on LDL cholesterol levels after acute coronary syndrome (ACS) is very poor according to registries and surveys. Telemedicine could improve adherence to guidelines and facilitate clinical follow-up of patients with ACS, even with the limitations of Covid-19 pandemic. Aim of the study To evaluate the efficacy of telemedicine follow-up in improving adherence to LDL guidelines and improving rates of prescription of PCSK9-inhibitors. Design and Methods 650 consecutive patients discharged with diagnosis of ACS or Chronic CS were enrolled in the study and followed after 2 and 4 months. LDL levels and lipid lowering drug prescription were recorded. Data from 300 patients with ACS patients and &amp;lt;80 years were analyzed and LDL values of telemedicine followed-up patients (telephone/smartphone app/pc teleconsultation) were compared with controls. Results Baseline mean LDL levels were 120 mg/dl, 55% of patients were naive of lipid lowering therapy. At second follow-up mean LDL levels were 55 mg/dl (p&amp;lt;0.05 vs baseline) and rates of prescription of statins, ezetimibe and PCSK9-inhibitors were 98%, 79%, and 18% respectively. Rates of subjects with LDL levels below recommended threshold were 4% at baseline, 39% at first follow-up, 53% at second follow-up (p&amp;lt;0.05). Patients followed up with telemedicine showed lower LDL levels at second follow-up (55vs72 mg/dl, p=0.08) and higher rates of subjects below recommended LDL levels (63%vs30%, p=0.05). Conclusions Telemedicine follow-up may improve the implementation of guideline recommended LDL levels after ACS.

Pediatric asthma control in tertiary care setting using telemedicine during COVID-19 era.

During the coronavirus disease 2019 (COVID-19) pandemic, national measures have affected health care services. Children with asthma were a vulnerable population who were advised to avoid needless hospital visits. Telemedicine was utilized in this circumstance. However, data in Thailand is limited. This study aimed to evaluate asthma control in patients who were followed up by telemedicine compared with in-person visits at an outpatient clinic in Thailand's tertiary academic medical center. This was a retrospective study among pediatric patients with asthma who were followed up in the pediatric pulmonary and allergy clinic of Srinagarind Hospital from 1 January to 31 May 2021. We offered telemedicine (telephone visit) and in-person visits at the hospital by their willingness during this period. All patients were asked about asthma clinical control symptoms, medication compliance, exacerbation events, and hospital admissions by pediatric pulmonologists and allergists. Then, we decided to prescribe in controller medications. In the telemedicine groups, we used the postal service to deliver controller medicine to patients. Among 195 asthmatic children, 83 (42.56%) were followed up by telemedicine. Children who were followed up by telemedicine had more controlled symptoms than the in-person visit group [adjusted relative risk (aRR): 1.219; 95% confidence interval (CI): 1.062-1.400; P value =0.005]. In the in-person visit group, children had more asthma exacerbation events than telemedicine (5 vs. 0, respectively, P value =0.073). During the COVID-19 pandemic, telemedicine follow-up in asthmatic children resulted in well-controlled symptoms and few asthma exacerbation events.

Racial and Socioeconomic Differences in Heart Failure Hospitalizations and Telemedicine Follow-up During the COVID-19 Pandemic: Retrospective Cohort Study.

Low rates of heart failure (HF) hospitalizations were observed during the 2020 peak of the COVID-19 pandemic. Additionally, posthospitalization follow-up transitioned to a predominantly telemedicine model. It is unknown whether the shift to telemedicine impacted disparities in posthospitalization follow-up or HF readmissions. The aim of this paper is to determine whether the shift to telemedicine impacted racial and ethnic as well as socioeconomic disparities in acute decompensated heart failure (ADHF) follow-up and HF readmissions. We additionally sought to investigate the impact of the COVID-19 pandemic on the severity of ADHF hospitalizations. This was a retrospective cohort study of HF admissions across 8 participating hospitals during the initial peak of the COVID-19 pandemic (March 15 to June 1, 2020), compared to the same time frame in 2019. Patients were stratified by race, ethnicity, and median neighborhood income. Hospital and intensive care unit (ICU) admission rates, inpatient mortality, 7-day follow-up, and 30-day readmissions were assessed. From March 15, 2019, to June 1, 2020, there were 1162 hospitalizations for ADHF included in the study. There were significantly fewer admissions for ADHF in 2020, compared with 2019 (442 vs 720; P<.001). Patients in 2020 had higher rates of ICU admission, compared with 2019 (15.8% vs 11.1%; P=.02). This trend was seen across all subgroups and was significant for patients from the highest income quartile (17.89% vs 10.99%; P=.02). While there was a trend toward higher inpatient mortality in 2020 versus 2019 (4.3% vs 2.8%; P=.17), no difference was seen among different racial and socioeconomic groups. Telemedicine comprised 81.6% of 7-day follow-up in 2020, with improvement in 7-day follow-up rates (40.5% vs 29.6%; P<.001). Inequities in 7-day follow-up for patients from non-Hispanic Black racial backgrounds compared to those from non-Hispanic White backgrounds decreased during the pandemic. Additionally, those with telemedicine follow-up were less likely to be readmitted in 30 days when compared to no follow-up (13.8% vs 22.4%; P=.03). There were no major differences in HF ICU admissions or inpatient mortality for different racial and socioeconomic groups during the COVID-19 pandemic. Inequalities in 7-day follow-up were reduced with the advent of telemedicine and decreased 30-day readmission rates for those who had telemedicine follow-up.

QLTI-21. SAFETY OF THE UTILIZATION OF TELEMEDICINE FOR BRAIN TUMOR NEUROSURGERY FOLLOW-UP

Abstract BACKGROUND There is a need to evaluate the outcomes of patients who underwent brain tumor surgery and were followed by telemedicine or in-person consults during the COVID-19 pandemic. METHODS We retrospectively included all patients who underwent surgery for brain tumor resection by a single neurosurgeon at our Institution from the beginning of the COVID-19 pandemic restrictions (March 2020) to August 2021. Outcomes were assessed by stratifying the patients using their preference for follow-up method (telemedicine or in-person). RESULTS Three-hundred and eighteen (318) brain tumor patients who were included. The follow-up method of choice was telemedicine in 185 patients (58.17%), and in-person consults in 133 patients. We found that patients followed by telemedicine lived significantly farther, with a median of 22.23 miles, compared to a median of 36.34 miles in the TM cohort (p = 0.0025). When comparing visits to the emergency department (ED) within 30 days after surgery, and we found no statistical difference between the TM and the IP group (7.3% vs 6.01%, p=0.72). Readmission rates, wound infections and 30-day mortality were similar in both cohorts. These findings were also consistent after matching cohorts using a propensity score. The percentage of telemedicine follow-up consults was higher in the first semester (73.17%) of the COVID-19 pandemic, compared to the second (46.21%) and third semesters (47.86%). CONCLUSIONS Telehealth follow-up alternatives may be safely offered to patients after brain tumor surgery, thereby reducing patient burden in those with longer distances to the hospital or special situations as the COVID-19 pandemic.

Willingness to engage in post-discharge follow-up service conducted via video telemedicine: Cross-sectional study

BackgroundLeading influencing factors for telemedicine implementation remain unclear, affecting the focus of intervention strategies. Despite recent effectiveness evidence of video telemedicine visits, limited evidence exists regarding patients’ willingness to use video follow-up. Moreover, patients’ acceptance is crucial for implementing such services. ObjectiveWe conducted a large-sample survey to analyze patient willingness and perceptions of post-discharge video follow-up and assessed the factors influencing their willingness during the COVID-19 outbreak. MethodIn February and March 2022, we conducted a face-to-face questionnaire survey involving inpatients in a tertiary care hospital in Longhua District, Shenzhen, China. We assessed demographics, health-related determinants, access to technology and literacy, preferences, willingness, and opinions toward video telemedicine follow-up. We implemented random forest and logistic regression analyses to obtain reliable results. ResultsIn total, 1,017 inpatients completed the survey. Overall, as an initial choice, 44.9 % preferred telephone consultation for post-discharge follow-up, which was followed by video telemedicine (17.1 %), WeChat voice calls (11.6 %), SMS text messages (10.7 %), WeChat graphic messages (10.5 %), and in-person visits (4.5 %). Moreover, 54.9 % were willing to experience video visits. The results highlight the perceived benefits outweighing the risks (OR 2.64, 95 % CI 1.76, 3.95), patients’ trust in the physician (OR 2.41, 95 % CI 1.45, 3.99), access to a private space (OR 2.18, 95 % CI 1.01, 2.96), medium geographical distance (compared to long distance, OR 0.72, 95 % CI 0.54, 0.98), moderate disease (compared to mild disease, OR 0.75, 95 % CI 0.57, 0.99), followed by the comfort with video technology (OR 1.73, 95 % CI 1.76, 3.95), broadband internet accessibility (OR 1.56, 95 % CI 1.07, 2.27), privacy concerns (OR 0.62, 95 % CI 0.43, 0.89), and prior telemedicine video experience (OR 1.77, 95 % CI 1.15, 2.72), as factors influencing the willingness to use video follow-up. ConclusionsA low percentage of patients chose video visits as their initial decisions; nevertheless, most had a positive attitude toward video follow-up visits. The willingness to choose video telemedicine post-discharge follow-up was influenced by geographical distance, disease severity, basic telemedicine requirements, physician–patient relationship, and perceptions of video communication.

Long-term efficacy of sensor-augmented pump therapy (Minimed 640G system) combined with a telemedicine follow-up in patients with type 1 diabetes: A real life study

ObjectiveEvaluate the efficacy of a new modality of insulin therapy associating both the sensor-augmented pump therapy with predictive low-glucose management (SAP-PLGM) and a telemedicine follow-up in patients with Type 1 diabetes (T1D) in a real-life setting. MethodsT1D adults under Minimed 640G system with a telemedicine follow-up for glucose management were included in a retrospective study. The primary endpoint was HbA1c while continuous glucose monitoring parameters (CGM) and treatment compliance were the secondary endpoints. These parameters were analyzed according to the therapeutic indication, HbA1c ≥ 8 % (GroupA) or severe hypoglycemic events (GroupB) and in patients switched to SAP-PLGM therapy. Results62patients were analyzed with a 28 ± 12 months of follow-up. In GroupA, HbA1c decreased from 8.3 ± 0.4 % to 7.7 ± 0.7 % (p < 0.05) and to 7.9 ± 0.3 % (p < 0.05) after 2 and 3 years, respectively. In patients switched to SAP-PLGM therapy, HbA1c decreased from 7.7 ± 0.7 % to 7.2 ± 0.8 % (p < 0.05) at 2 years. After 6 months, the time-below-range (<70 mg/dL) decreased from 2.1 % [0.6–4] to 1.1 % [0.3–2.6] (p < 0.05). Severe hypoglycemic events decreased from 1.62 to 0.5events/patient/year in GroupB (p < 0.05). At 3 years, treatment compliance was 92 % [70–97] in the total population. ConclusionsLong-term real-life treatment with the SAP-PLGM therapy combined with telemedicine was associated with improved glycemic control in T1D, along with high treatment compliance.