Telemonitoring Service Research Articles

Beyond telehealth in heart failure, how a nurse-led mobile team unit improves management and reduces re-admission in elderly patients living in a rural area

Abstract Introduction Telehealth plays a crucial role in improving access to healthcare for elderly patients with heart failure (HF), particularly those who live in under-resourced geographic areas, have physical disabilities, or have difficulties with transportation. However, extending and improving telehealth faces significant obstacles, primarily due to its inadequacy to fully assess a patient's clinical status. While some components of HF can be measured remotely, others, such as cardiac and lung examinations, require in-person clinical evaluation. This leads to imprecise assessments of HF severity, excessive medical consultations, and inappropriate emergency transfers or hospitalization. We conducted an evaluation of a specialized mobile team unit (MTU) for HF care in a rural area. The team consisted of nurses trained in performing electrocardiograms (ECGs) and point-of-care ultrasound (POCUS) to extend telemonitoring services to elderly patients with HF in the comfort of their homes. This approach offers a direct and optimal evaluation of the patient's condition. Purpose This study aimed to evaluate the added value of an MTU in assessing and optimizing treatment for HF in elderly patients, ultimately leading to decreased hospitalization or medical request rates. Materials and methods This retrospective analysis examined data from elderly patients diagnosed with HF, who participated in a 6-month telemonitoring program, and received MTU visits. MTU was activated by the telemonitoring team, in patients presenting signs of decompensation, with an imprecise assessment of severity based on digital data only. Results During six months, 165 elderly patients were included in the telemonitoring platform after index HF hospitalization. The mobile team traveled over 3,040 kilometers in a rural area with limited cardiological care. They visited 84 patients (50.9%), offering personalized education and physical assessments to all of the patients, 45% received additional imaging (EKG, POCUS). This resulted in 30% therapeutic adjustments, 90% fewer General practitioner (GP) /Cardiologist consultations and 54% avoided readmissions: 20% of hospitalizations were avoided immediately and 34% likely avoided in the near future, demonstrating the intervention's 80% effectiveness. Conclusion Monitoring heart failure (HF) in elderly patients can be challenging, especially in rural areas with limited access to care, few caregivers, cognitive impairments, or difficulty using e-health platforms. This study emphasizes the benefits of a nurse-led mobile team unit in providing a reliable direct assessment of HF severity. This home intervention provides education, strengthens the decision-making capacity of the remote monitoring platform, assists with patient management, and significantly reduces the readmission rate.

Readiness and Service Model Exploration for Chronic Kidney Disease Telemonitoring at Public Hospital in Bengkulu, Indonesia

Public hospitals in Bengkulu lack health workers in hemodialysis units, making services not optimal, and the quality of life of chronic kidney disease patients is not controlled. Thus, telemonitoring should be an alternative to a remote health service. This study aimed to determine readiness and explore the telemonitoring service model needed in public hospitals in Bengkulu. This qualitative research used group discussion forums and in-depth interviews with 24 informants, consisting of management and health workers in the hemodialysis unit, recruited by purposive sampling. Audio recordings, verbatim transcripts, and thematic analyses were carried out. Public hospitals in Bengkulu are ready to carry out telemonitoring services regarding potential reasons, expectations from health workers, and benefits to implement as alternative solutions to improve service quality—inhibiting factors such as support tools, patients, health workers, organization, and low understanding of telemonitoring. Supporting factors are the adequacy of basic infrastructure facilities, the allocation of funds, and the required service models such as materials, supporting devices, and service settings. In conclusion, a public hospital in Bengkulu meets the readiness indicators of telemonitoring services for chronic kidney disease patients from a health worker’s perspective. Potential supporting factors need to be improved, inhibiting factors need to be anticipated, and the required service model needs to be described.

Medical students experience in working in a public COVID-19 telehealth program: a descriptive study

BackgroundGiven the health and social needs generated by the COVID-19 pandemic, the Telehealth Network of Minas Gerais, Brazil, implemented a teleconsultation and telemonitoring program to assist patients with suspected or confirmed COVID-19, the TeleCOVID-MG program. The telemonitoring service was conducted by medical students, under the supervision of a physician. The main goal of this study was to analyze the experience of the students while collaborating on the aforementioned telemonitoring program.MethodsA questionnaire with 27 questions was developed to address the participation of the students in the telehealth program. The questionnaire included questions about the student’s profile, the system usability, and the satisfaction in participating in such a telehealth program. The questionnaire was generated on Google Forms® platform and sent via email to each student who was part of the telemonitoring team.ResultsSixty students were included in the analysis (median age 25 years-old [interquartile range 24–26], 70% women). Of those, 61.6% collaborated on the telehealth program for more than 6 months, 65.1% performed more than 100 telemonitoring calls, 95.2% reported difficulties in contacting the patient through phone calls; 60.3% believe some patients might have felt insecure about being approached by medical students and not by graduate professionals; and 39.6% reported eventual system instabilities. The main strengths reported by the students were related to the system usability and to the self-perception of the quality of healthcare delivered to the patients. Even though 68.3% of the students mentioned technical difficulties, 96.6% reported that they were promptly solved. Finally, 98.3% believed that the program was useful and would recommend it to an acquaintance.ConclusionThis study reports a successful experience of undergraduate medical students in a COVID-19 telemonitoring program. Overall, the medical students were satisfied with their participation, especially considering the continuity of clinical practice remotely during a period of classes suspension during the COVID-19 pandemic and their important role in the assistance of patients from low-income regions, which has minimized the health system burden in an emergency context.

ENGAGEMENT AND ATTRITION IN A TELEHEALTH SERVICE FOR HYPERTENSIVE PATIENTS. A SINGLE CENTER EXPERIENCE

Objective: To investigate engagement with blood pressure telemonitoring and counselling (BPTM) in patients with hypertension (HTN) and its predictors. Design and method: Patients with uncontrolled HTN (office systolic (S) BP >140 mm Hg) were recruited consecutively in a large reference center. Only patients who were motivated and willing to participate were included. The telehealth system consisted of a home BP telemonitoring service and an on-demand text chat with the patient's attending physician. The BPTM continued for 3 months with mandatory baseline and follow-up visits, as well as completion of the HYPE (HYpertension imPact quEstionnaire) to assess quality of life. Patients who did not report BP readings for 2 weeks + after 2 alerts were termed ’quit’. Others comprised the ’continued’ group. Results: A total of 92 patients were included in the final analysis (median age 43 years, 69 men, 49 at low-intermediate CVD risk). At baseline, median office SBP was 155 mm Hg (150;162) and office diastolic (DBP) was 95 mm Hg (90;102). Over the 3 months, SBP and DBP decreased significantly (-16 and -11 mm Hg, respectively; p <0.001 for both). There was a greater reduction in SBP at home (-8 mm Hg from 1 week to 3 months, p <0.001). A total of 43 patients continued BPTM and 48 patients discontinued BP telemonitoring (85% of them after 1 month). The groups were well matched for age, sex, and baseline BP. The δSBP did not differ between the two groups, nor did the median number of questions (3 consultations/patient). Higher baseline office SBP (β = 0.03, p = 0.043) and male sex (β = 1.15, p = 0.041) were predictors of high engagement with the telehealth service after adjustment for other covariates. Quality of life at 3 months was higher in the ’continuing’ patients. (δ+8 points HYPE). Conclusions: Telemonitoring and remote counseling are effective in patients with HTN. Even when patients are motivated to use telehealth, more than half of them discontinue during the first months, predominantly female patients with mild uncontrolled HTN. Patients who continue BPTM experience a higher quality of life.

Experience of Patients Utilizing the COVID-19 Services of the Employees' Clinic of a Tertiary Hospital during the COVID-19 Pandemic: A Cross-sectional Study.

Patient experience is the interaction with the healthcare system and is one of the three pillars of quality in healthcare. Its assessment provides an opportunity to assure quality of care, meet patients' expectations, direct strategic decision making, and document benchmarks for healthcare organizations.The onset of the pandemic pushed the employees' clinic to institute new processes and focus on COVID-19 screening and monitoring of affected employees. The clinic used patient feedback to improve its services.A survey tool was developed and released by the clinic in June 2020 to elicit feedback and improve its services. Most items were yes/no questions and patients were asked to rate based on a Likert scale of 0-5 for the other items. They were also given space for their additional comments/feedback. The study described the experience of patients utilizing the COVID-19 services of the employees' clinic of a tertiary hospital. This was a cross-sectional study that involved a retrospective review of all data retrieved from the feedback forms from those who availed the COVID-19 services of the employees' clinic, namely consultation, swabbing, and/or telemonitoring, from June 2020 to December 2021. A total of 4,136 feedback forms were retrieved from the employees' clinic. There were 1,598 forms from consultation, 1,268 forms from swabbing and 1,270 forms from telemonitoring. A total of 456 comments were positive and 275 were negative. Most forms listed receiving an introduction from their physician/nurse (92.74%) and received instructions for swabbing (90.43%) during consultation. For swabbing, most received information regarding their schedule (95.43%). Almost all forms listed receiving SMS or calls (98.74%) and information regarding return-to-work or admission (96.14%) from the telemonitoring service. Only about half were able to discuss fears and anxieties (48.76%) during consultation and about two-thirds (68.93%) received information regarding their RT-PCR results. Feedback stated that the clinic staff were respectful and courteous, and the service hours were convenient. However, concerns with data privacy were apparent. Overall patient experience was generally positive despite the rapidly changing processes of the clinic.

Exploring the patient experience of remote hypertension management in Scotland during COVID-19: a qualitative study

ObjectivesThe aim of this study was to understand how patients experienced hypertension management, with or without blood pressure (BP) telemonitoring, during the COVID-19 pandemic.Design, methods, participants and settingThis qualitative study...

Patient Engagement With and Perceptions of the COVIDA Project, a Volunteer-Led Telemonitoring and Teleorientation Service for COVID-19 Community Management: Mixed Methods Study.

During the pandemic in Peru, the COVIDA (Collaboration Network of Volunteer Brigade Members for the Investigation, Detection, and Primary Management of Community Cases Affected by COVID-19) project proposed an innovative way to provide telemonitoring and teleorientation to COVID-19 patients, led by health care student volunteers. However, it has not been described how this interaction is perceived from the patient's perspective and which factors increase their engagement with this service. The aim of this study is to describe the perceptions of patients about COVIDA and identify factors associated with their engagement with this service. A mixed methods study was conducted to evaluate perceptions of patients that participated in the COVIDA project. This telehealth intervention organized by the National University of San Marcos was implemented in Peru from August to December 2020. The service involved daily phone calls by volunteer students to monitor registered COVID-19 patients until the completion of the 14th day of the illness or if a warning sign was identified. The volunteers also provided teleorientation to address the patients' needs and concerns. Quantitative analysis was performed to describe the characteristics of the patients and to assess the factors related to their engagement with the service, which was defined by the percentage of participants who completed the follow-up according to their individual schedule. Qualitative analysis through semistructured interviews evaluated the patients' perceptions of the service regarding the aspects of communication, interaction, and technology. Of the 770 patients enrolled in COVIDA, 422 (55.7%) were female; the median age was 39 (IQR 28-52) years. During the monitoring, 380 patients (49.4%) developed symptoms, and 471 (61.2%) showed warning signs of COVID-19. The overall median for engagement was 93% (IQR 35.7%-100%). Among those patients who did not develop warning signs, engagement was associated with the presence of symptoms (OR 3.04, 95% CI 2.22-4.17), a positive COVID-19 test at the start of follow-up (OR 1.97, 95% CI 1.48-2.61), and the presence of comorbidities (OR 1.83, 95% CI 1.29-2.59). Patients reported that the volunteers provided clear and valuable information and emotional support. Communication via phone calls took place smoothly and without interruptions. COVIDA represents a well-accepted and well-perceived alternative model for student volunteers to provide telemonitoring, teleorientation, and emotional support to patients with COVID-19 in the context of overwhelmed demand for health care services. The deployment of this kind of intervention should be prioritized among patients with symptoms and comorbidities, as they show more engagement with these services.

PTFS01-07-23 Perspectives and Perceived Usability of Telemonitoring Services Among Pregnant Women With Gestational Diabetes in Dhulikhel, Nepal

PTFS01-07-23 Perspectives and Perceived Usability of Telemonitoring Services Among Pregnant Women With Gestational Diabetes in Dhulikhel, Nepal

Patient safety and sense of security when telemonitoring chronic conditions at home: the views of patients and healthcare professionals - a qualitative study

BackgroundChronic diseases are increasing worldwide, and the complexity of disease management is putting new demands on safe healthcare. Telemonitoring technology has the potential to improve self-care management with the support of healthcare professionals for people with chronic diseases living at home. Patient safety threats related to telemonitoring and how they may affect patients’ and healthcare professionals’ sense of security need attention. This study aimed to explore patients’ and healthcare professionals’ experiences of safety and sense of security when using telemonitoring of chronic conditions at home.MethodsSemi-structured interviews were conducted with twenty patients and nine healthcare professionals (nurses and physicians), recruited from four primary healthcare centers and one medical department in a region in southern Sweden using telemonitoring service for chronic conditions in home healthcare.ResultsThe main theme was that experiences of safety and a sense of security were intertwined and relied on patients´ and healthcare professionals´ mutual engagement in telemonitoring and managing symptoms together. Telemonitoring was perceived to increase symptom awareness and promote early detection of deterioration promoting patient safety. A sense of security emerged through having someone keeping track of symptoms and comprised aspects of availability, shared responsibility, technical confidence, and empowering patients in self-management. The meeting with technology changed healthcare professionals’ work processes, and patients’ daily routines, creating patient safety risks if combined with low health- and digital literacy and a naïve reliance on technology. Empowering patients’ self-management ability and improving shared understanding of the patient’s health status and symptom management were prerequisites for safe care and the patient´s sense of security.ConclusionsTelemonitoring chronic conditions in the homecare context can promote a sense of security when care is co-created in a mutual understanding and responsibility. Attentiveness to the patient’s health literacy, symptom management, and health-related safety behavior when using eHealth technology may enlighten and mitigate latent patient safety risks. A systems approach indicates that patient safety risks related to telemonitoring are not only associated with the patient’s and healthcare professionals functioning and behavior or the human-technology interaction. Mitigating patient safety risks are likely also dependent on the complex management of home health and social care service.

Organização da atenção e vigilância em saúde na atenção primária frente à COVID-19 em municípios do Nordeste brasileiro

Abstract The aim of this study was to analyze the organization and development of primary health care and surveillance, including normative frameworks and the implementation of local health actions. Qualitative descriptive multiple-case study involving three municipalities in the state of Bahia. We conducted 75 interviews and a document analysis. The results were categorized into the following two dimensions: approach to the organization of the pandemic response; and development of care and surveillance actions at local level. Municipality 1 was found to have a well-defined concept of the integration of health and surveillance with a view to organizing team work processes. However, the municipality did not strengthen the technical capacity of health districts to support surveillance actions. In M2 and M3, delays in defining PHC as the entry point for the health system and the prioritization of a central telemonitoring service run by the municipal health surveillance department compounded the fragmentation of actions and meant that PHC services played only a limited role in the pandemic response. Clear policy and technical guidelines and adequate structural conditions are vital to ensure the effective reorganization of work processes and foster the development of permanent arrangements that strengthen intersectoral collaboration.

Facilitators and barriers to blood pressure telemonitoring: A mixed-methods study.

Telemonitoring of blood pressure (BP) may improve BP control. However, many patients are not using BP telemonitoring due to personal, technological, and health system barriers. Individuals are required to have electronic health literacy (e-HL), defined as knowledge and skills to use technology services effectively, such as BP telemonitoring. The objective was to determine the facilitators and barriers experienced by patients with hypertension in telemonitoring of BP using the e-HL framework (e-HLF). This study was a prospective mixed-methods study using a convergent design. We recruited a convenience sample of 21 patients with hypertension. The qualitative section was online or phone individual in-depth interviews based on the e-HLF, which has seven domains. The quantitative section was an online survey consisting of demographics, an e-HL questionnaire, and patient-provider communication preferences. A joint display was used in the mixed-methods analysis. Five themes including knowledge, motivation, skills, systems, and behaviors along with 28 subthemes comprising facilitators or barriers of BP telemonitoring were identified. The mixed-methods results showed concordance between the participants' e-HL status and their experiences in the ability to actively engage with BP monitoring and managing digital services (domain 3) of the e-HLF. Other e-HL domains showed discordance. Patients may engage with BP telemonitoring when they feel the usefulness of concurrent access to telemonitoring services that suit their needs.

Telemonitoring as a Telehealth strategy to contain the COVID-19 pandemic in a Brazilian capital.

This study aimed to describe and analyze the process of creating and implementing telemonitoring services for COVID-19 cases, focusing on strengths and weaknesses. A single case study incorporating qualitative and quantitative data using descriptive and exploratory approach was performed from 24 March 2020 to 24 March 2021 in a Brazilian capital city. Data collection took place through interviews, document analysis, and direct observation. Thematic content analysis was performed, and the results were presented in categories. The project included 512 health professionals, and 102,000 patients were monitored. The service was designed to break the chain of transmission, reinforce biosecurity measures, and provide comprehensive care to patients. Initially, two levels of monitoring were created. The first was a multidisciplinary health team that made calls to patients in the database. If the patients showed warning signs or aggravation, they were referred to the physician's monitoring referral service. Subsequently, a third level was created and staffed by psychologists. The main challenges were the number of patients notified, needing to update the contact forms as COVID-19 knowledge increased, and inconsistent telephone numbers recorded in the notifications. Telemonitoring allowed signs of worsening COVID-19 to be identified, monitored thousands of people, and stopped infected patients from circulating. Adapting the existing telehealth structure was a viable, agile, and powerful strategy to reach a large number of people.

Remote monitoring of gestational diabetes with my Sugr App integrated to diabetology EMR during Covid-19 emergency

The aim of our study was demonstrate how the implementation of a shared management process using innovative tools, such as telemonitoring with a mobile app, has a benefits in term of facilitating the management of women with GD and reducing access to hospitals. Due to COVID-19 emergency in 2020, the integration between the Diabetologist EMR (SDC) and mySugr app for people with diabetes was activated for 4 months; the patient can enter blood sugar and other clinical data in the app for recording and tracking data directly in the EMR. The telemonitoring service was proposed to pregnant patients to avoid further direct access for the visits. The analysis of glycemic control and maternal-fetal outcome was performed on a total of 46 pregnant women (38 Italian and 8 foreign, age 35.4 ± 4.9 years, graduates 73%, pre-pregnancy BMI 24.9 ± 5.4 Kg / m2) enrolled on average at 30 ± 5 weeks. The total blood glucose levels recorded were 8818 (176 ± 98 blood sugar levels per patient), the mean pre- and post-meal blood glucose levels were respectively 96 ± 9.8 mg / dl and 127.8 ± 34.6 mg / dl. Delivery took place at 39 ± 2 weeks, in 65.2% spontaneously (34.8% Caesarean section) in the absence of preterm births or birth trauma. All the women examined showed a high degree of satisfaction. Despite numerical limitation, this experience shows how the use of my- Sugr app integrated with SDC can offer to Diabetologists a secure data flow in electronic format, permitting an immediate consultation and a subsequent benefits on the metabolic control in women with GD. The solutions used are appreciated by all pregnant women and allowed the reduction of access to diabetes Centers. The implementation of this experience of telemedicine management is also desirable outside the period of COVID-19 emergency. KEY WORDS diabetes; telemedicine; pregnancy.

A telemonitoring programme in patients with heart failure in France: a cost-utility analysis

BackgroundCertain telemedicine programmes for heart failure (HF) have been shown to reduce all-cause mortality and heart failure-related hospitalisations, but their cost-effectiveness remains controversial. The SCAD programme is a home-based interactive telemonitoring service for HF, which is one of the largest and longest-running telemonitoring programmes for HF in France. The objective of this cost-utility analysis was to evaluate the cost-effectiveness of the SCAD programme with respect to standard hospital-based care in patients with HF.MethodsA Markov model simulating hospitalisations and mortality in patients with HF was constructed to estimate outcomes and costs. The model included six distinct health states (three ‘not hospitalised’ states, two ‘hospitalisation for heart failure’ states, both depending on the number of previous hospitalisations, and one death state). The model lifetime in the base case was 10 years. Model inputs were based on published literature. Outputs (costs and QALYs) were compared between SCAD participants and standard care. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty in the input parameters of the model.ResultsThe number of quality-adjusted life years (QALYs) was 3.75 in the standard care setting and 4.41 in the SCAD setting. This corresponds to a gain in QALYs provided by the SCAD programme of 0.65 over the 10 years lifetime of the model. The estimated total cost was €30,932 in the standard care setting and €35,177 in the SCAD setting, with an incremental cost of €4245. The incremental cost-effectiveness ratio (ICER) for the SCAD programme over standard care was estimated at €4579/QALY. In the deterministic sensitivity analysis, the variables that had the most impact on the ICER were HF management costs. The likelihood of the SCAD programme being considered cost-effective was 90% at a willingness-to-pay threshold of €11,800.ConclusionsEnrolment of patients into the SCAD programme is highly cost-effective. Extension of the programme to other hospitals and more patients would have a limited budget impact but provide important clinical benefits. This finding should also be taken into account in new public health policies aimed at encouraging a shift from inpatient to ambulatory care.

Feasibility, Usability, and Customer Satisfaction of the Tele-COVID19 Project, Sicilian Model.

Background and Objectives: In March 2020, COVID-19 pandemic affected the world. All countries, to limit viral transmission, imposed quarantine. This emergency exerted personal, social, economic, and psychological impact on people. For health systems, was needed to create alternative care pathways. Telemedicine can be helpful to reduce isolation, provide health care services, and monitor virus infections. Italian regions, including Sicily, have activated telemedicine services for management of patients with COVID-19. Objective: The purpose of study is to describe a Sicilian telemedicine model for management of COVID-19 patients, showing results on feasibility, usability and quality of service and patient satisfaction. Materials and Methods: This is a descriptive exploratory study on a telemedicine service for residents in Messina infected by COVID-19. It included monitoring of vital signs and specialist consultations (i.e., doctor, psychologists, social workers, and nutritionist biologists). Results: More than twenty percent (23.8%) of participants used tele-monitoring and tele-counselling services; 14.3% were only telemonitored. Participants judged positively telemedicine service (30% were quiet and 50% were very satisfied), as well as tool (70% were quiet and 10% were very satisfied). Telemonitoring had a low agreement (10% were slightly satisfied and 50% were neutral); tele-counselling had a high rate of satisfaction (40% quiet and 60% were very satisfied). Conclusions: This study showed that telemedicine model for Sicilian population affected by COVID-19 was feasible, easy to use and appreciated by patients. Our promising results allow us to assume that if in Sicily there was a return of the emergency, we would be ready to manage it This system can be the solution to remote management of these patients, to reduce isolation, provide health services, and monitor virus infections. The use of this technology should encourage future research to change the health care system and provides opportunities to ensure health and care for oneself and others.

Technology in the Era of COVID-19: A Systematic Review of Current Evidence.

During the COVID-19 pandemic, the use of technology-based services has been incremental by the care providers for patients scheduling, regulatory considerations, resource allocation, thus enabling virus exposure prevention while maintaining effective patient care. This study aims to review the currently available evidence to identify available technology solutions in the era of COVID-19. A systematic review in July 2020 using the PubMed, Scopus, Embase, Science Direct, and Web of Science databases has been carried out. After evaluating the title and abstract to select the most relevant studies based on inclusion and exclusion criteria, the selected articles underwent quality assessment. The full text of selected articles was then thoroughly evaluated to extract the essential findings. In this study, 20 technology-based approaches have been identified for provision of healthcare services to patients with COVID-19. These methods included telemedicine, virtual visits, e-consult, tele-consulting, video conference, virtual healthcare, mobile-based self-care, social media, tele ICU, 3D printing technology, telemonitoring, teleradiology, telesurgical, and cloud-based service. Due to the rapid spread of the coronavirus, the use of technology-based methods for the provision of remote healthcare services can help control the disease. The effectiveness of each of these approaches can be investigated in future research.

Key drivers involved in the telemonitoring of covid-19 for self-health management: an exploratory factor analysis

BackgroundThe recent COVID-19 pandemic and the shortage of general practitioners has determined a strong pressure on the Italian health system. This critical issue highlighted the fundamental support of e-health services not only to lighten the workload of doctors, but also to offer patients a health service tailored to real needs. Therefore, the digital engagement platforms represent a valid aid, as they reconcile the efficiency needs of the healthcare system with the benefits for the patients involved. In this perspective, little is known about the main factors associated with use of telemonitoring platforms and their effectiveness. This paper investigates the critical success factors of telemonitoring platforms during COVID-19 in order to understand the mechanisms underlying patient participation with the health engagement platforms.MethodsAn exploratory factor analysis was used to explain the main dimensions of patient participation in the COVID-19 telemonitoring. A sample of 119 patients with a suspected or confirmed infection was used in the investigation. Moreover, an analysis of variance was calculated to identify the differences between three types of patients (infected, uninfected, with suspected infection) and verify the effectiveness of the platform.Main FindingsThere are six main factors underlying the use of the COVID-19 telemonitoring platform. “Self-Health Engagement” emerges as a novel factor. Moreover, compared to other platforms, cognitive engagement is a crucial trigger for effective telemonitoring.DiscussionBy identifying the main triggers involved in the use of health engagement platforms, we can improve the satisfaction of telemonitoring services for appropriate health-crisis management. Furthermore, the COVID-19 telemonitoring platform appears to improve health management for both patients and health care providers as it provides the patient with the necessary tools for Self-Health Management (SHM), as well as helping to enrich the literature on health care.ConclusionA new construct emerges in the study of digital telemonitoring platforms: “health self-engagement”, that is, an engagement based on self-care that demonstrates the decisive role assumed by both digital technology and patient participation in self-management.

The Healthcare Organization in COVID-19 Age: An Evaluation Framework for the Performance of a Telemonitoring Model

Telemedicine services (TS) are not only supportive for healthcare professionals, but managers also see them as essential for the provision of an efficient, effective, and sustainable healthcare service. Several systems make TS available in different ways and contexts. However, no commonly accepted framework meets the need to draw conclusions about which TS can efficiently be measured. For this purpose, a framework is proposed in order to define a dynamic method of performance evaluation that can be used to improve the sustainable management of a telemonitoring model for COVID-19 patients. A case study analysis based on the experience of three telemedicine networks in different locations providing telemonitoring services (northern, central, and southern Italy) was performed. A total of four phases (1. Identification of the target population; 2. Identification of health needs; 3. Definition of the operational plan; and 4. Monitoring of the service by indicators), and seven indicators have been identified. Despite the differences raised in the Italian contexts, applying a performance evaluation framework could help the managerial sector to understand if the service is working as intended and what effects the service is producing on the healthcare organization. Considering the long-term field experience, this framework is an easy-to-use tool that will allow healthcare organizations to evaluate the performance of their telemonitoring model, and improve it according to new needs. Providing a healthcare service in an efficient context is fundamental for the sustainability of the health system as a whole.

SIMpLE: A Mobile Cloud-Based System for Health Monitoring of People with ALS.

Adopting telemonitoring services during the pandemic for people affected by chronic disease is fundamental to ensure access to health care services avoiding the risk of COVID-19 infection. Among chronic diseases, Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is a progressive neurodegenerative disease of adulthood, caused by the loss of spinal, bulbar and cortical motor neurons, which leads to paralysis of the voluntary muscles and, also, involves respiratory ones. Therefore, remote monitoring and teleconsulting are essential services for ALS patients with limited mobility, as the disease progresses, and for those living far from ALS centres and hospitals. In addition, the COVID 19 pandemic has increased the need to remotely provide the best care to patients, avoiding infection during ALS centre visits. The paper illustrates an innovative, secure medical monitoring and teleconsultation mobile cloud-based system for disabled people, such as those with ALS (Amyotrophic Lateral Sclerosis). The design aims to remotely monitor biosignals, such as ECG (electrocardiographic) and EMG (electromyographic) signals of ALS patients in order to prevent complications related to the pathology.

Increased Self-medication with Steroids in Inflammatory Bowel Disease Patients during COVID-19 Pandemic: Time to Optimize Specialized Telemonitoring Services.

Inflammatory bowel disease (IBD) is a serious condition characterized by a complex interaction of genetic, environmental, and inflammatory variables that affect the gut and other extragastrointestinal systems. Self-medication with steroids has become a major issue in light of the current pandemic situation in IBD patients. We observed a higher frequency of steroid self-medication (17.9%) and steroid overprescription (28.2%) by non-gastroenterologists during the pandemic. The use of telemonitoring tools can improve patient-IBD care provider communications in terms of drug compliance and better disease outcomes.How to cite this article: Vinay G. Increased Self-medication with Steroids in Inflammatory Bowel Disease Patients during COVID-19 Pandemic: Time to Optimize Specialized Telemonitoring Services. Euroasian J Hepato-Gastroenterol 2021;11(2):103–104.