Use Of Telemedicine Research Articles

Healthcare Disparities in Telemedicine Access and Use During the COVID‐19 Pandemic

ABSTRACTThis study investigates disparities in telemedicine access and use among racial groups in the United States during the COVID‐19 pandemic. Our analysis of a dataset from the National Center for Health Statistics (NCHS) reveals that telemedicine access and use varied significantly across racial groups, which the NCHS categorized as “Black,” “Hispanic,” “White,” or “Other.” Hispanic respondents were more likely to lack a regular place of care, which might explain their lower access to telemedicine, relative to other groups. White respondents reported relatively high telemedicine access. Black respondents also reported relatively high rates of telemedicine use, contrary to the literature suggesting lower healthcare access among African Americans. Findings underscore the need for public health agencies to disseminate information about telemedicine to all community members. We suggest future research exploring the socioeconomic barriers impacting individuals' ability to access and use telemedicine.

Uptake of and factors associated with telemedicine use for palliative care among patients diagnosed with advanced cancers during the onset of COVID-19.

53 Background: The COVID-19 pandemic propelled a rapid shift to telemedicine use, including patients with advanced cancers needing palliative care (PC). Yet, little is known about disparities in telemedicine use for PC. We leveraged population-based data to examine the trend and factors associated with telemedicine use for PC among Medicare beneficiaries diagnosed with advanced cancers during the onset of COVID-19 pandemic. Methods: We identified patients aged ≥65.5 years diagnosed with advanced-stage breast, colorectal, non-small cell lung (NSCL), small cell lung (SCL), pancreas, and prostate cancers in 2015-2019 from the SEER-Medicare data. We included those with continuous fee-for-service coverage and had any PC claims from diagnosis to death, hospice admission, or by 12/31/2020 (whichever came first). Telemedicine was identified using procedure codes, modifiers, and place of service codes on PC claims. We described the percent of PC recipients using telemedicine each quarter in 2019-2020. Multivariable logistic models assessed patient and provider characteristics associated with telemedicine use among PC recipients in 2020. Results: Telemedicine use for PC was 0.24% to 0.48% across 4 quarters in 2019, which increased to 16.3% in Q1 and stabilized at about 30% in Q2-Q4 in 2020. Among 2,945 PC recipients in 2020, 22.5% used telemedicine. Older patients (75-84 years and 85+ years) were 4.4 percentage points (ppts) and 8.6 ppts (p-values<0.05) less likely than patients ages 65-74 years to use telemedicine. Patients who were female (4.4 ppts), residing in higher socioeconomic status areas (Yost Quintile 5 vs 1: 7.7 ppts), treated by female providers (4.1 ppts), in hospital system (3.7 ppts vs. individual physician office) and organizations with hospice and palliative care specialists (8.9 ppts) were more likely to use telemedicine for PC (all p-values<0.05). (Table). Conclusions: Telemedicine use for PC surged during the onset of the COVID-19 pandemic, with considerable disparities by patient sociodemographic and provider characteristics. These disparities suggest potential barriers related to patients’ technology literacy and internet access, provider awareness, and healthcare organization resources. Future mixed-method studies need to elucidate these barriers to design interventions at patient, provider, and system levels to ensure effective PC delivery. Selected factors associated with telemedicine use for palliative care. Absolute Probability Difference (95%CI) Age group (ref: 65-74) 75-84 -4.4 (-7.6, -1.2) 85+ -8.6 (-13.4, -3.7) Female (ref: Male) 4.4 (0.9, 7.9) Yost quintile (ref : Q1-Q2) Q3-Q4 2.2 (-1.7, 6.1) Q5 7.7 (3.3, 12.1) Hospital system (ref: Individual physician office) 3.7 (0.6, 6.7) Provider: Female (ref: Male) 4.1 (0.7, 7.5) Organization with hospice and palliative care specialists 8.9 (5.4, 12.4)

Telemedicine in geriatric oncology is here to stay.

Advancing age is the most important risk factor for cancer. Collaborations with medical and surgical-oncology divisions, and supportive services are required to assist older adults with cancer through their assessment and treatment trajectories. This often requires numerous clinical encounters which can increase treatment burden on the patient and caregivers. One solution that may lighten this load is the use of telemedicine. At Memorial Sloan Kettering, the Cancer and Aging Interdisciplinary Team (CAIT) clinic risk stratifies and optimizes older adults planned for medical cancer treatment. We analyzed patients seen in the CAIT clinic between May 2021 and December 2023, focusing on their utilization of telemedicine, and on the differences in characteristics of the visits and the results of the Geriatric Assessment based on visit type. Of the 288 patients (age range 67-100) evaluated, the majority (77%) chose telemedicine visits. Older age, lower educational status, living in New York City, abnormal cognitive screen, impaired performance measures, IADL dependency and having poor social support were all associated with choosing an in-person visit as opposed to telemedicine. Older patients with cancer frequently choose and can complete telemedicine visits. Efforts should be directed to develop an infrastructure for remote engagement, improving reach into rural and underserved areas, decreasing the burden generated by multiple appointments.

Use of Telemedicine in a Sports Medicine Clinic: An Investigation of Patient Satisfaction

Objective: Compare patient satisfaction between telemedicine and in-office visits and between providers post-operatively in an orthopedics setting with athletic trainers and physicians. Design: Cross-sectional study Methods: Patients from a Sports Medicine Clinic that received an orthopedic surgical intervention from March 2020-September 2021, and engaged in telemedicine, or an in-office visit post-operatively. Provider type included full-time athletic trainers, resident athletic trainers, physician (MD) resident/fellows, and float athletic trainers. Press-Ganey Patient Experience Surveys were collected at the time of follow up visit, with focus on items, “likelihood to recommend” and “how well staff worked together.” Results: There was a total of 255 patients (age=50±17 years). Providers included the attending physician with full-time athletic trainers (n=134, 52.3%), resident athletic trainers (n=77, 30.1%), MD residents/fellows (n=38, 14.8%), or float athletic trainers (n=6, 2.3%). No significant difference was found with patient satisfaction between in-office (n=175, 68.4%), or telemedicine visits (n=80, 31.3%), (p>.44). Patients were more satisfied with care provided by the full-time athletic trainers compared to MD residents/fellows (p.18). Conclusions: This study demonstrates no significant differences with patient satisfaction between in-office or telemedicine visits. Patients seeing full-time athletic trainers had the highest patient satisfaction, demonstrating the capability of athletic trainers to effectively use telemedicine in a physician practice.

Can tele-physiotherapy help in filling treatment gaps during pandemics in multiple sclerosis?

ABSTRACT Background: Published data demonstrate promising results for rehabilitation in patients with multiple sclerosis (MS), including telerehabilitation technologies. Given the travel limitations during the coronavirus disease 2019 (COVID-19), telerehabilitation may provide a viable alternative to in-person physiotherapy. Objective: To determine the efficacy of telerehabilitation in MS patients during COVID-19. Design/Methods: A total of 42 patients participated in the study of which 24 were followed up till the end of 6 weeks. The investigated group consisted of 15 females and 09 males; the mean age was 42 ± 10 years. The telerehabilitation was provided for a duration of 6 weeks at a frequency of three classes per week. The patients used either laptops or mobile phones for attending these sessions. The inclusion criteria were a 6-minute walk test (with or without assistance). Motor function was evaluated using the Timed Up and Go (TUG) test and the 30-Second Sit-to-Stand (30STS) test. Patients were required to fill out two questionnaires also: 12-item MS Walking Scale (MSWS) and Modified Fatigue Impact Scale (MFIS). All the patient assessments were made by an independent physiotherapist before and after the intervention. Results: There was a statistically significant improvement in motor performance and MFIS and 12-item MSWS. The following results were observed: statistically improved parameters of TUG, 30STS, 12-item MSWS and MFIS. Conclusions: Based on the findings, it is reasonable to infer that the use of telemedicine in the rehabilitation of MS patients is very promising.

8748 Use of Telemedicine In Diabetes Self-Management Education (DSME) Of Patients With Type 2 Diabetes Mellitus At The University of Santo Tomas Hospital: A Randomized Controlled Trial

8748 Use of Telemedicine In Diabetes Self-Management Education (DSME) Of Patients With Type 2 Diabetes Mellitus At The University of Santo Tomas Hospital: A Randomized Controlled Trial

Downstream Emergency Department and Hospital Utilization Comparably Low Following In-Person Versus Telemedicine Primary Care for High-Risk Conditions.

Telemedicine use expanded greatly during the COVID-19 pandemic. More data is needed to understand how this shift may impact other venues of acute care delivery. We evaluate the association of visit modality (telephone, video, or office) and downstream emergency department (ED) and hospital visits among primary care visits for acute, time-sensitive conditions. Observational study of patient-scheduled primary care telemedicine and office visits for acute conditions (cardiac, gastrointestinal, neurologic, musculoskeletal, and head and neck) in a large, integrated healthcare delivery system. Adults with a new self-booked primary care appointment for an eligible acute condition from January 1, 2022, to December 31, 2022 (with no primary care, ED, or hospital visits in prior 30 days). Visit modality, including office, video, or telephone. Seven-day ED and hospital utilization, adjusted for patient and visit characteristics. Among 258,958 primary care visits by 239,240 adult patients, 57.7% were telemedicine visits; of these, 72.4% were telephone and 27.6% were video. Telephone visits were the timeliest, with over 70% of visits scheduled within 1 day of booking. Rates of 7-day ED utilization were low, and varied by condition group, with cardiac visits having the highest rates (4.8%) and musculoskeletal visits having the lowest (0.8%). There was less than a 1% absolute difference in ED use by visit modality for all condition types; however, telephone visits were associated with slightly higher rates than video visits. The 7-day hospitalization rate was less than 1% and observed between visit type differences varied by clinical condition. Among office, telephone, and video visits in primary care for potentially high-risk, time-sensitive conditions, downstream ED and hospital use were uncommon. ED utilization was lower for video visits than telephone visits, although telephone visits were timelier and may offer a safe and accessible option for acute care.

Nursing care aspects and indicators impacted by information and communication technology: Systematic review

Background: Information technology is used in healthcare to solve the problems of an aging population, an increase in chronic illnesses, and the growing need for autonomy, independence, and quality of life. The adoption rate of IT applications among professionals such as nurses is relatively low, and it appears that not using them is the norm. Finding nursing care aspects and indications that have been altered by IT was our goal in doing this research. Method: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement (9) was adhered to in this systematic review. Our search objective was to locate papers that addressed nursing care aspects and indicators that were changed by IT. The search method was used in the Google Scholar, CINAHL, and PubMed databases between 2015 and 2023. Result: Five publications were included in this systematic review. Four studies found elements related to teams that affect the adoption of telemedicine. The organizational and team culture is one of the main determinants of technology adoption. One study found that creative companies support employees in adjusting to new circumstances and that telemedicine implementation requires cultural transformation in enterprises. Implementing telemedicine in a company can be hindered by working in a changing environment and resisting change. Employees felt overwhelmed by all of the changes they experienced at work. Workloads increased as other advances were sometimes considered more significant than the use of telemedicine. Conclusion: When technology is used improperly, nurses can get disillusioned with its use for tasks that are traditionally completed by humans. Therefore, if healthcare professionals want to include telemedicine into their regular workflow, they must remove hurdles.

Teleneonatal or routine resuscitation in extremely preterm infants: a randomized simulation trial.

Teleneonatology, the use of telemedicine for newborn resuscitation and care, can connect experienced care providers with high-risk deliveries. In a simulated resuscitation, we hypothesized that teleneonatal resuscitation, compared to usual resuscitation, would reduce the no-flow fraction. This was a single-center, randomized simulation trial in which pediatric residents were randomized to teleneonatal or routine resuscitation. The primary outcome was no-flow fraction defined as time without chest compressions divided by the time during which the heart rate was <60. Secondary outcomes included corrective modifications of bag-mask ventilation and times to intubation and epinephrine administration. Fifty-one residents completed the scenario. The no-flow fraction (median [IQR]) was significantly better in the teleneonatal group (0.06[0.05]) compared to the routine resuscitation group (0.07[0.82]); effect (95% CI): -16 (-43 to 0). Participants in the teleneonatal resuscitation group more frequently performed corrective modifications to bag-mask ventilation (60% vs 15%; p < 0.001). Time to intubation (214 s vs 230 s; p = 0.58) and epinephrine (395 s vs 444 s; p = 0.21) were comparable between groups. In this randomized simulation trial of neonatal resuscitation, teleneonatal resuscitation reduced adverse delivery outcomes compared to routine care. Further in hospital evaluation of teleneonatology may substantiate this technology's impact on delivery outcomes. NCT04258722 IMPACT: Whereas telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings, unique challenges include the need for real-time, high-fidelity audio-video communication with a low failure rate. The no-flow fraction, which evaluates the quality of chest compressions when indicated, has been associated with survival in other clinical contexts. We report a reduction in no-flow fraction in neonatal resuscitations supported with telemedicine, in addition to improvements in the quality of neonatal resuscitation. Telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings without direct access to neonatologists.

Analysis of Medical Personnel Communication Competence Prof. Dr. Chairuddin Panusunan Lubis University of Sumatera Utara Hospital with Coronavirus Disease Patients Through the Use of Telemedicine in Medan

This study analyzes the communication competence of medical staff at Prof. Dr. Hairuddin Panusunan Lubis Hospital, Universitas Sumatera Utara, in interacting with COVID-19 patients through the utilization of telemedicine. The purpose of this research is to evaluate how effectively medical staff communicate with patients in a virtual environment, focusing on clarity, empathy, and professionalism. The research was conducted using a mixed-method approach, including surveys and interviews with both medical staff and patients. The results indicate that while telemedicine has facilitated continued care, there are significant challenges in maintaining effective communication. Recommendations for improving communication skills in telemedicine are discussed.

Chinese physicians’ perceptions and willingness to use telemedicine during the COVID-19 pandemic

The outbreak of the COVID-19 pandemic catalysed the rapid uptake of telemedicine as a vital tool for physicians to provide healthcare services to patients. However, despite the potential advantages of telemedicine, there remains a paucity of research examining physicians’ attitudes and utilisation patterns towards this mode of healthcare delivery. Therefore, this study investigated the factors impacting physicians’ telemedicine utilisation during the COVID-19 pandemic. Based on the unified theory of acceptance and use of technology and protection motivation theory, a cross-sectional survey was conducted between June 3rd and October 26th, 2022. A structural equation model was subsequently developed to validate the response-based research model. Of the 296 physicians surveyed, 134 reported an increase in the frequency of telemedicine use following the COVID-19 pandemic, and 88.9% of respondents supported the implementation of telemedicine services at their hospitals. The analysis revealed that perceived vulnerability, perceived severity, performance expectations, effort expectations, and facilitating conditions were significant factors influencing physicians’ willingness to adopt telemedicine. Importantly, the results suggest that strategies to enhance the usefulness and convenience of telemedicine systems are imperative for fostering adoption. Such efforts will be instrumental in expediting the promotion and implementation of internet-based healthcare services to enhance the accessibility of healthcare services in China.

Current trends and future directions in surgery: A brief scoping review

Surgery is undergoing rapid transformation due to advancements in technology, innovative techniques, and a shift toward patient-centered care. This review explores current trends and future directions in the field of surgery, focusing on five major areas: minimally invasive surgery (MIS), robotic-assisted surgery, personalized medicine, enhanced recovery after surgery (ERAS) protocols, and the use of telemedicine. MIS techniques, including laparoscopy and NOTES, continue to evolve, offering benefits such as reduced recovery times and fewer complications. Robotic-assisted surgery has advanced with systems such as the da Vinci Surgical System, which enhances surgical precision and has expanded into new specialties. Personalized medicine, driven by genomics and bioinformatics, aims to tailor surgical interventions to individual patient profiles, improving treatment outcomes. ERAS protocols represent a significant shift toward optimizing perioperative care, with a focus on multimodal pain management and early mobilization to improve recovery. Additionally, the rise of telemedicine and remote monitoring has facilitated preoperative and postoperative care, mostly in the context of the COVID-19 pandemic. The future of surgery promises continued technological advancements, with potential developments including enhanced robotic systems, AI integration, and expanded applications of ERAS principles. However, challenges such as high costs, the need for ongoing training, and the integration of new technologies into healthcare systems must be addressed to fully realize these advancements. This review provides an overview of these trends and highlights areas for future research and development in the surgical field.

Innovation of Remote Vital Signs Monitoring and Telemedicine Systems Using Internet of Things for Rural Health Care

Abstract: The emergence of the COVID 19 pandemic called the attention of the public to the challenges that the healthcare system in the Philippines needs to overcome. Rural and remote areas that have geographical disadvantages were also affected due to limited access to healthcare services during the implementation of lockdown in the country. This paper focuses on the developed remote vital sign monitoring and telemedicine system called PaglauM. It is a device that measures a person’s heart and pulse rate, blood oxygen saturation, body temperature, heart rhythm, and heart’s electrical activity and comes with an application that can be used to monitor the user’s vitals and access telemedicine services. This study involved 30 participants for the testing and evaluation of PaglauM compared to available medical devices. The results of the conducted test showed promising output in delivering pre- diagnosis of health. With the use of PaglauM, rural areas that struggle in providing health care because of limited health care facilities and geographical disadvantages can be helped by this cost-effective vital monitoring device that implements the use of telemedicine, providing a way for rural areas to connect to tertiary hospitals regardless of their distance.

Investigating the Use of Telemedicine by Health Care Providers to Diagnose and Manage Patients With Musculoskeletal Disorders: Systematic Review and Meta-Analysis.

Access to care is a major challenge for patients with musculoskeletal disorders (MSKDs). Telemedicine is one of the solutions to improve access to care. However, initial remote diagnosis of MSKDs involves some challenges, such as the impossibility of touching the patient during the physical examination, which makes it more complex to obtain a valid diagnosis. No meta-analysis has been performed to date to synthesize evidence regarding the initial assessment including a physical evaluation using telemedicine to diagnose patients with MSKDs. This study aims to appraise the evidence on diagnostic and treatment plan concordance between remote assessment using synchronous or asynchronous forms of telemedicine and usual in-person assessment for the initial evaluation of various MSKDs. An electronic search was conducted up to August 2023 using terms related to telemedicine and assessment of MSKDs. Methodological quality of studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Random-effect model meta-analyses were performed. The Grading of Recommendations, Assessment, Development, and Evaluations framework was used to synthesize the quality and certainty of the evidence. A total of 23 concordance studies were eligible and included adult participants (N=1493) with various MSKDs. On the basis of high certainty, pooled κ and prevalence-adjusted and bias-adjusted κ for the diagnostic concordance between remote and in-person assessments of MSKDs were 0.80 (95% CI 0.72-0.89; 7 studies, 353 patients) and 0.83 (95% CI 0.76-0.89; 6 studies, 306 patients). On the basis of moderate certainty, pooled Gwet AC1 for treatment plan concordance between remote and in-person assessments of MSKDs was 0.90 (95% CI 0.80-0.99; 2 studies, 142 patients). The diagnostic concordance for MSKDs is good to very good. Treatment plan concordance is probably good to excellent. Studies evaluating the accuracy to detect red and yellow flags as well as the potential increase in associated health care resources use, such as imaging tests, are needed.

Postoperative outcomes among patients evaluated via telemedicine-based preoperative consultations for inguinal hernia care.

In an era where telehealth is gaining traction within healthcare systems, its integration into preoperative assessment protocols presents both challenges and opportunities. Preoperative assessments have an important role in determining the best plan of action for each patient. Recent studies have reported adequate operative outcomes after telemedicine preoperative consultations. This study examines telehealth's efficacy relative to traditional in-person evaluations in the context of preoperative consultations for inguinal hernia repairs and provides a deeper insight into how telemedicine might be utilized for pre-surgical assessments. We analyzed a prospectively maintained single-center database at a tertiary referral hospital with a dedicated hernia and abdominal wall reconstruction center for pre, intra and postoperative variables comparing patients that received telemedicine (phone or video) preoperative consultations versus in-person clinic visits only. Secondary analysis with propensity score matching was employed to adjust for possible confounders. 265 patients that underwent inguinal hernia repair were included, with 60 encounters being telemedicine only and the rest in-person. This analysis found no difference in rates of postoperative complications between the telemedicine and in-person groups. The telemedicine group required less preoperative encounters with their surgeon (P < 0.001). In the preoperative in-person group, 41% switched to virtual follow-ups, while in the virtual group, only 18% chose in-person follow-ups (P = 0.003). Based on our analysis, the use of telemedicine for preoperative assessments in inguinal hernia repairs as a feasible and safe choice for patients opting for this approach, potentially reshaping the preoperative paradigm in surgical practices.

Retrospective Observational Study on Telemedicine in Sublingual Immunotherapy for Patients with Japanese Cedar Pollinosis and House Dust Mite Allergic Rhinitis.

Introduction: In Japan, telemedicine has gradually expanded due to deregulation in response to the COVID-19 pandemic. However, its current status remains unclear, as it is primarily provided by general practitioners. This study aims to examine the use of telemedicine in sublingual immunotherapy (SLIT) for patients with Japanese cedar pollen allergy and/or house dust mite allergic rhinitis. Methods: We conducted a retrospective analysis of medical record data from seven otorhinolaryngology clinics and performed an exploratory evaluation between a group that combined telemedicine and in-person visits during the initial 6 months of SLIT and another group with only in-person visits. Results: Following propensity score matching, 51 and 82 patients were eligible for the telemedicine and in-person groups, respectively, with 33 cases in both groups. Both groups had similar characteristics after matching. No significant difference was found in the withdrawal rate at 6 months from the start of SLIT (6.1% and 9.1% in each group; p = 1.00), side effects, or treatment efficacy between the two groups. The average copayment for patients tended to be significantly higher in the telemedicine group after one, three, and 6 months following SLIT initiation. Discussion: The situation of patients who receive an appropriate combination of telemedicine and in-person visits is not significantly different from patients who receive in-person visits alone. This study may help indicate the actual status of telemedicine in Japan. Further investigation at more facilities is necessary in the future to dispel concerns in the practice setting.

Integrating tele-urgent care in undergraduate medical education: a partnership between the US Department of Veterans Affairs and academia

Background: The COVID-19 pandemic made clinical rotations for medical students difficult to maintain in person. Several medical schools adapted to the pandemic by providing some training in telemedicine. The use of telemedicine has grown exponentially in the United States in recent years and COVID-19 acted as an accelerant for its growth. What remains largely unknown is the longterm value and sustainability of telemedicine in medical education. This study aims to address this gap in the literature by examining the value of integrating a clinical virtual urgent care rotation in the training of medical students. Methods: The authors examined retrospective descriptive data from Veterans who utilized telemedicine services from a virtual urgent care clinic. The analysis included 2,512 patient episodes with 23 medical students between July 1, 2020 to April 30, 2023. The study examined trends in monthly average first contact resolution (FCR) and tested whether the first contact resolution from the medical student rotation was statistically different from the Clinical Contact Center (CCC) overall. Results: The retrospective descriptive analysis found that the monthly first contact resolution for patients seen by medical students was approximately 80%. This average was not statistically different than the 18,000 patient episodes that occurred within the CCC during the same period. Informal feedback from the students was positive, and they all presented on wellreceived capstone topics such as tele-critical care, tele-cardiology, tele-orthopedics, and a history and critical analysis of telemedicine. Conclusions: This study confirmed the value of telemedicine in medical education and the call to medical schools to consider incorporating formal education on telemedicine in the medical student curricula. As medicine moves toward incorporating telemedicine in specialty practices, having it as part of medical education will be a valuable inclusion for future physicians.

Assessment of the economic value of physiotherapy treatment for economically effective results

The purpose of the study was to compare the pricing of physiotherapy treatment in various countries of the world. A comparative analysis of the cost of physiotherapy was conducted in the United Kingdom, Germany, Slovenia, Spain, Switzerland, Ireland, Canada, Indonesia, New Zealand, and Australia. The cost of physiotherapy was calculated considering 10 sessions per course of treatment in each clinic. The study determined that the cost of physiotherapy and massage varied substantially depending on the region and the medical institution. In the London clinic, the cost of 10 sessions of physiotherapy ranges from USD 721.62 to USD 1,818.49, depending on the duration of the procedures, and 10 massage sessions – from USD 787.23 to USD 1,115.24. In Switzerland, the same 45-minute course of physiotherapy costs USD 1,150, and an hour-long massage – USD 1,100. Financial costs for these procedures are substantially lower in Slovenia and Indonesia. In a Slovenian clinic, a course of 10 sessions of physiotherapy costs from USD 331.1 to USD 551.83, and massage – from USD 364.21 to USD 540.79. In Indonesia, the same course of physiotherapy is offered for USD 590.21-780.95, and massage – for USD 394.75-592.12. The cost of physiotherapy and massage procedures was directly related to the level of life and economic conditions in the country. In the United Kingdom and Switzerland, high health costs are explained by a high level of life and a developed medical infrastructure, while in Slovenia and Indonesia, services are more accessible to the public. Based on this, the most economically profitable solution for physiotherapy and massage is the introduction of batch sessions, which reduces the cost per session overall. In addition, financial costs are reduced due to reduced time for the procedure and the use of telemedicine during the rehabilitation session. This study helps to assess the pricing of physiotherapy procedures and further optimise national schemes with the formation of the most financially effective programmes

Associations Between Telemedicine Use Barriers, Organizational Factors, and Physician Perceptions of Care Quality.

Introduction: Evaluating physician perceptions of telemedicine use and its impact on care quality among physician providers is critical to sustaining telemedicine programs, given the uncertainty of reimbursement policy, preferences, inadequate training, and technical difficulties. Physicians reported technical barriers to effectively practicing integrated medicine using telemedicine as patient volumes increased during the pandemic. The objective of this work was to examine whether perceived practice barriers and facilitators were associated with physician respondents' perceptions of telemedicine care quality compared with in-person care. Methods: This cross-sectional study analyzed the 2021 National Electronic Health Record Survey. The sample comprised 1,857 nonfederally employed physicians (weighted n = 403,013) delivering integrated patient care. Of those physicians, 1,630 (weighted n = 346,646) reported providing care through telemedicine. We reported frequencies and percentages of reported practice characteristics. Generalized ordinal logistic regressions examined relationships between practice factors and care quality for telemedicine care. Results: Most of the sample (n = 1,630) were male (66.1%), >50 years of age (66.1%), and worked in a single location (73.5%). A total of 70% of respondents reported that patients had difficulty using telemedicine platforms, and 64% reported limitations in patients' access to technology. Most respondents indicated having provided quality care to some extent (45%) and to a great extent (26%) during telemedicine visits compared to in-person visits. Associations between barriers, facilitators, and care quality perceptions were positive, underscoring resiliency in telemedicine programs among practices. Conclusion: Care modalities and the organizational, environmental, and personal facilitators drive quality perceptions among physicians. Perceived fit and usability determine perceptions of care quality for providers integrating telemedicine into their practice.

Antibiotics Consumption and Antibiotic Resistance during and Post Covid-19: Impact on Global Health

In the modern healthcare environment, the growth in multidrug-resistant pathogen prevalence has been associated with the increasing use of broad-spectrum antibiotics globally. We carried out a study to look at the trends and procedures related to antibiotic prescriptions in order to assess antibiotic use in its entirety. The overuse of antibiotics in the treatment of COVID-19 is a specific cause for focus as it raises concerns about the possible emergence of antimicrobial resistance. The study verifies a significant pattern in which COVID-19 patients received antibiotic prescriptions regardless of their reported severity, indicating a severe deficiency in clinical examination, the prescribing of antibiotics without a prescription is analyzed in perspective with changing healthcare practices including the increasing use of telemedicine. The concerns about the emergence of antimicrobial resistance while addressing the growing problem of unnecessary antibiotic use in the treatment of COVID-19. The concerns related to COVID-19 and the lack of treatment strategy led to the overuse of antibiotics without proper clinical treatment can be identified as main reason for increase in Antibiotics Consumption and Antibiotic Resistance.