Telehealth and Research in Orthopedics: New Means of Care Invites New Barriers to Evidence.
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ABSTRACT:
SUBMITTER: Kunze KN
PROVIDER: S-EPMC8077981 | biostudies-literature | 2021 Feb
REPOSITORIES: biostudies-literature
Publications
Telehealth and Research in Orthopedics: New Means of Care Invites New Barriers to Evidence.
Kunze Kyle N KN Nwachukwu Benedict U BU
HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20210221 1
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Project description:The role of telehealth in orthopedic surgery is rapidly expanding, a movement largely brought about by the coronavirus disease 2019 (COVID-19) pandemic. Virtual clinic encounters using a video chat platform or a simple telephone call offer the patient and surgeon numerous advantages that are now better appreciated by the orthopedic community at large. However, barriers to effective patient evaluation exist, and a successful patient assessment is highly dependent on technique. In particular, performing a shoulder physical examination during a virtual encounter poses many obstacles. We present a technique to complete a patient-led, comprehensive shoulder physical examination using an easy-to-understand pictorial guide called the Shoulder Telehealth Assessment Tool (STAT). A STAT form is provided to the patient and designed to be completed at home without the real-time instruction of a provider, before the virtual encounter. Parameters include assessments of all planes of shoulder range of motion, visual analog scale (VAS) and Single Assessment Numeric Evaluation (SANE) scores, and the components necessary to allow for conversion to an abbreviated Constant shoulder score if the provider so desires.
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Project description:BackgroundTelehealth is increasingly used in palliative care and its application is seen as one possible solution to improve access to palliative care services, thereby providing additional support for patients with advanced cancer. By completing a systematic review of the literature this research identifies the barriers and facilitators of telehealth adoption by patients with advanced cancer to determine the type of healthcare services needed to meet their needs.MethodsA systematic review of the literature was conducted on CINAHL, MEDLINE, EMBASE, PsycINFO, PsycArticles, the Cochrane Library, Scopus, Web of Science, ScienceDirect, IEEE Xplore as well as grey literature to identify the barriers and facilitators of adopting telehealth by patients with advanced cancer in palliative care. The search was registered on PROSPERO (CRD42023446460) and focused on articles published between March 2021 and August 2023, after the first wave of COVID-19.ResultsOverall, nine papers were identified and included in the review. Patients with advanced cancer were found to be willing to use telehealth reporting a high satisfaction. Patients with advanced cancer receiving palliative care experienced barriers such as software and hardware failures as well as technical issues. Complicating this even further was a language barrier, as well as aging and medical issues. Older patients found the use of telehealth difficult and reported needing additional support around its use, yet telehealth was broadly found to be accepted. Telehealth facilitated a sense of independence, control, comfort and security to patients. Operating in the background while remaining available it promoted a sense of empowerment for patients.ConclusionsIdentification of the barriers and facilitators of telehealth use by patients with advanced cancer in palliative care, contributes to condition specific benchmarks for telehealth use and further informs national treatment guidelines around patients with advanced cancer needs to ensure sustainability and relevance now and in the future.
| S-EPMC11863556 | biostudies-literature
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| S-EPMC10927463 | biostudies-literature
Project description:ObjectiveTo assess telehealth practice for headache visits in the United States.BackgroundThe rapid roll out of telehealth during the COVID-19 pandemic impacted headache specialists.MethodsAmerican Headache Society (AHS) members were emailed an anonymous survey (9/9/20-10/12/20) to complete if they had logged ≥2 months or 50+ headache visits via telehealth.ResultsOut of 1348 members, 225 (16.7%) responded. Most were female (59.8%; 113/189). Median age was 47 (interquartile range [IQR] 37-57) (N = 154). The majority were MD/DOs (83.7%; 159/190) or NP/PAs (14.7%; 28/190), and most (65.1%; 123/189) were in academia. Years in practice were 0-3: 28; 4-10: 58; 11-20: 42; 20+: 61. Median number of telehealth visits was 120 (IQR 77.5-250) in the prior 3 months. Respondents were "comfortable/very comfortable" treating via telehealth (a) new patient with a chief complaint of headache (median, IQR 4 [3-5]); (b) follow-up for migraine (median, IQR 5 [5-5]); (c) follow-up for secondary headache (median, IQR 4 [3-4]). About half (51.1%; 97/190) offer urgent telehealth. Beyond being unable to perform procedures, top barriers were conducting parts of the neurologic exam (157/189), absence of vital signs (117/189), and socioeconomic/technologic barriers (91/189). Top positive attributes were patient convenience (185/190), reducing patient travel stress (172/190), patient cost reduction (151/190), flexibility with personal matters (128/190), patient comfort at home (114/190), and patient medications nearby (103/190). Only 21.3% (33/155) of providers said telehealth visit length differed from in-person visits, and 55.3% (105/190) believe that the no-show rate improved. On a 1-5 Likert scale, providers were "interested"/"very interested" in digitally prescribing headache apps (median 4, IQR 3-5) and "interested"/"very interested" in remotely monitoring patient symptoms (median 4, IQR 3-5).ConclusionsRespondents were comfortable treating patients with migraine via telehealth. They note positive attributes for patients and how access may be improved. Technology innovations (remote vital signs, digitally prescribing headache apps) and remote symptom monitoring are areas of interest and warrant future research.
| S-EPMC8721517 | biostudies-literature
Project description:ImportanceUnderstanding geographic and financial barriers to health care is an important step toward creating more accessible health care systems. Yet, the barriers to dermatological care access for American Indian populations in rural areas have not been studied extensively.ObjectiveTo evaluate the driving distances and insurance coverage for dermatological care and the current availability of teledermatological programs within the Indian Health Service (IHS) or tribal hospitals system.Design, setting, and participantsThis mixed-methods study was conducted from May 7, 2018, to September 1, 2018, and did not take place in any IHS or tribal health care facility in the continental United States. The study design involved a geographic analysis and a cross-sectional telephone survey with brick-and-mortar dermatology clinics (n = 27) and teledermatological programs (n = 49). Brick-and-mortar clinics were selected for their proximity to a rural IHS or tribal hospital.Main outcomes and measuresMean driving distance from rural IHS or tribal hospital to nearest dermatology clinic, number of dermatology clinics within a 35-mile or 90-mile radius of IHS or tribal hospitals, insurance and referral types accepted by dermatology clinics, and number of teledermatological programs collaborating with IHS or tribal hospitals or health centers.ResultsIn total, 27 brick-and-mortar dermatology clinics and 49 teledermatological programs were identified and contacted for the survey. The median (interquartile range [IQR]) driving distance between rural IHS or tribal hospitals and the nearest dermatology clinic was 68 (30-104) miles. Of the 27 dermatology clinics in closest proximity to rural IHS or tribal hospitals (median [IQR] driving distance, 82.4 [31-114] miles), 25 (93%) responded to the survey, 6 (22%) did not accept patients with Medicaid, and 6 (22%) did not accept IHS referrals for patients without insurance. Of the 49 teledermatological programs, 45 (92%) responded and 14 (29%) were no longer active. Ten (20%) teledermatology programs were currently partnering (n = 6), previously partnered (n = 2), or were setting up services (n = 2) with an IHS or tribal site. Only 9% (n = 27) of the 303 rural IHS or facility in the continental United States reported receiving teledermatological services.Conclusions and relevanceSubstantial geographic and insurance coverage barriers to dermatological care exist for American Indian individuals in rural communities; teledermatological innovations could represent an important step toward minimizing the disparities in dermatological care access and outcomes.
| S-EPMC6584892 | biostudies-literature
Project description:BackgroundThe postpartum period is a critical time for women to optimise their physical and mental health. Primary care physicians (PCP) often manage postpartum women in the community setting after uneventful births. However, women encounter difficulties accessing care before and after their conventional 6-week physical review. Telehealth-based interventional studies have demonstrated their successful applications in several areas of postpartum care but is not widely adopted. The study aimed to explore the PCPs' views on their acceptability and perceived barriers of telehealth in delivering postpartum care to women in primary care.MethodsTwenty-nine PCPs participated in eleven in-depth interviews and four focus group discussions for this qualitative study conducted in Singapore. The purposively sampled PCPs had varied demographic background and medical training. Two investigators independently coded the audited transcripts. Thematic content analysis was performed using the codes to identify issues in the pertaining to the perceived usefulness, ease of use and attitudes towards telehealth in postpartum care as described in the "Telehealth Acceptance Model" framework.ResultsMost PCPs perceived usefulness and ease of use of video consultation in delivering postpartum care. They recognised telehealth service to complement and support the current face-to-face postpartum care amidst the pandemic. However, training, leadership support, organizational infrastructure, healthcare financial policy and personal demographic profile influence their acceptance of a new care model for postnatal mothers.ConclusionAddressing the barriers and strengthening the facilitators will enhance PCPs' acceptance and utilisation of the proposed hybrid (telehealth and in-person) postnatal care model for mothers.
| S-EPMC9375064 | biostudies-literature
Project description:Background/objectivesTo identify major barriers to video-based telehealth use among homebound older adults.DesignCross-sectional survey.SettingA large home-based primary care (HBPC) program in New York City (NYC) serving 873 homebound patients living in the community.ParticipantsSixteen primary care physicians.MeasurementsAn 11-item assessment of provider perceptions of patients' experience with and barriers to telehealth.ResultsAccording to physicians in the HBPC program, more than one-third (35%) of homebound patients (mean age of 82.7; 46.6% with dementia; mean of 4 comorbidities/patient) engaged in first-time video-based telehealth encounters between April and June 2020 during the first COVID-19 surge in NYC. The majority (82%) required assistance from a family member and/or paid caregiver to complete the visit. Among patients who had not used telehealth, providers deemed 27% (n = 153) "unable to interact over video" for reasons including cognitive or sensory impairment and 14% lacked access to a caregiver to assist them with technology. Physicians were not knowledgeable of their patients' internet connectivity, ability to pay for cellular plans, or video-capable device access.ConclusionThe COVID-19 pandemic resulted in a large and dramatic shift to video-based telehealth use in home-based primary care. However, 4 months into the pandemic a majority of patients had not participated in a video-based telehealth encounter due to a number of barriers. Patients lacking caregiver support to assist with technology may benefit from novel approaches such as the deployment of community health workers to assist with device setup. Physicians may not be able to identify potentially modifiable barriers to telehealth use among their patients, highlighting the need for better systematic data collection before targeted interventions to increase video-based telehealth use.
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Project description:The COVID-19 national emergency has led to surging care demand and the need for unprecedented telehealth expansion. Rapid telehealth expansion can be especially complex for pediatric patients. From the experience of a large academic medical center, this report describes a pathway for efficiently increasing capacity of remote pediatric enrollment for telehealth while fulfilling privacy, security, and convenience concerns. The design and implementation of the process took 2 days. Five process requirements were identified: efficient enrollment, remote ability to establish parentage, minimal additional work for application processing, compliance with guidelines for adolescent autonomy, and compliance with institutional privacy and security policies. Weekly enrollment subsequently increased 10-fold for children (age 0-12 years) and 1.2-fold for adolescents (age 13-17 years). Weekly telehealth visits increased 200-fold for children and 90-fold for adolescents. The obstacles and solutions presented in this report can provide guidance to health systems for similar challenges during the COVID-19 response and future disasters.
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Project description:BACKGROUND:The implementation of early palliative care within a primary care setting is a recent academic topic. Recruiting General Practitioners (GPs) to participate in a palliative care study can be challenging. The pro-Spinoza project implemented a Care Pathway for Primary Palliative Care in 5 areas in Belgium. During this project, the feasibility of the recruitment of GPs and palliative care patients was evaluated. METHODS:The recruitment process was recorded in detail via an electronic logbook combining quantitative and qualitative data. Quantitative recordings included the contact types and the number of contacts with eligible GPs and were analysed descriptively. Qualitative recordings included field notes with feedback from the GPs and other stakeholders and were thematically analysed starting from the Grol and Wensing framework for professional behaviour change. RESULTS:Of 4065 eligible GPs working in 5 areas under research, 787 GPs (19%) were contacted individually, 398 GPs (9,8%) were contacted face-to-face and most of these 398 GPs showed high interest in the topic. 112 GPs (2,8%) signed the collaboration agreement, but finally only 65 GPs (1,6%) delivered at least a completed baseline-questionnaire. Despite the initial interest in participating, the unpredictable and busy daily workloads of the GPs, as well as inexperience with research protocols, impeded the ability of the GPs to fully engage in the study. This resulted in the high dropout rate. Participating GPs reported that they had underestimated the effort required to effectively participate in the project. CONCLUSIONS:Recruitment of GPs to palliative care research is challenging. Primary care is a vital service to engage in palliative care research however the practical limitations reduce the ability of the service to effectively engage in the research. More research is needed to determine how GPs might be better supported in research. TRIAL REGISTRATION:ClinicalTrials.gov, NCT02266069 , Registered 16th October 2014, retrospectively registered.
| S-EPMC6399951 | biostudies-literature
Project description:IntroductionTraditionally, medical care and research in Parkinson's disease (PD) have been conducted with in-person encounters. The recent COVID-19 pandemic has profoundly impacted the delivery of in-person clinical care and clinical research. We conducted an online survey of active clinician members of the Parkinson Study Group (PSG) to evaluate the adoption of various non-face-to-face methods in clinical practice and research in PD during the COVID-19 pandemic.MethodsWe conducted a survey using the open-access online SurveyMonkey tool (http://www.surveymonkey.com). The survey had 27 items and was designed to elucidate clinical/research care before and during the COVID-19 pandemic. The survey was sent to 414 active PSG members with weekly reminders and it remained accessible for 30 days from May 2020.ResultsWe received 142 responses, of which 133 (93.7%) provided demographic data. The clinical use of virtual visits via synchronous video conferencing increased from 39.5% pre-COVID-19 to 94.6% during the COVID-19 pandemic. Lack of access for patients (68.2%) and patient resistance (51.4%) were the top barriers for its use. Approximately 70% respondents stated that 75-100% of their research activities were suspended during the COVID-19 pandemic. Many sites had to fill out protocol deviations (38.2%), protocol exceptions (25.5%) or change their research profile due to layoffs (16.8%). The overall use of video conferencing increased from 30.3% to 64.1%.ConclusionThe current results suggest a need for flexibility in conducting office visits and clinical trials in PD patients. Technology has the potential to enhance patient care and convenience, when in-person visits can be challenging.
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